Mini-review
Are interventions to enhance communication performance in allied health professionals effective, and how should they be delivered? Direct and indirect evidence

https://doi.org/10.1016/j.pec.2008.05.029Get rights and content

Abstract

Objective

  • (1)

    To systematically review direct evidence about effects of interventions to improve communication performance amongst allied health professionals (AHPs).

  • (2)

    To summarise indirect evidence pertinent to design, delivery, effects, and evaluation of such interventions.

Methods

  • (1)

    Systematic search and narrative review of evaluations of interventions for AHPs.

  • (2)

    Systematic search and narrative summary of reviews of corresponding interventions in medicine and nursing.

Results

Five reports of interventions for AHPs were included. All reported positive effects of training. Strongest evidence was from two small-n within-subjects controlled studies that evaluated highly specific training for qualified therapists in brain injury rehabilitation environments.

Indirect evidence from nine systematic reviews in medicine and nursing indicated positive effects of communication training. Robust designs yielded smallest effect sizes. Interventions based on strong conceptual and empirical foundations and targeting specific areas of practice appeared more effective. Strongest evidence is for performance-based training for clinicians already working with patients.

Conclusion

More empirical and conceptual understandings about AHPs’ communication practices are required so as to improve the design, delivery and subsequent evaluation of communication training amongst these important healthcare workers.

Practice implications

Preliminary and indirect evidence suggest it is possible to positively influence AHP clinicians’ performance and patients’ outcomes if training interventions are specific, founded on evidence about effective practice and delivered using practical modalities.

Introduction

It is well recognised that medical practitioners’ communication skills and the communication patterns arising within their consultations have important effects on quality of healthcare, patient perceptions, and clinical outcomes [1], [2], [3], [4]. Research has documented communication practices entailed in doctor patient consultations, especially within medical interviewing and primary care [1], [5], [6]. This work has identified, described and classified specific practices [1], [5], [6] and established evidence of their beneficial effects [2], [3], [4]. In this context, communication training has become a well-established component of qualifying degrees in medicine [5], [7], and it is also increasingly recognised in nursing [8], [9]. Communication training interventions in medicine and nursing have been evaluated in numerous studies [9], [10], [11], [12], [13].

This study aimed to review evidence on communication training interventions delivered to allied health professionals (AHPs) and to provide reasoned guidance for AHPs and their trainers about effects of training, and best practice in its design and evaluation. A systematic review was conducted of studies that have evaluated interventions aimed at influencing communication performance amongst AHPs, specifically amongst the largest groupings of these: physiotherapists (sometimes known as physical therapists), occupational therapists and speech and language therapists. Primary research evidence in this field is in an early stage of development, so a turn to indirect evidence was also needed: a further literature review identified and collated indirect relevant evidence from systematic reviews in medicine and nursing.

AHPs work with patients in a wide variety of clinical settings. Communication is widely recognised as a central component of their work [14], [15], [16], [17], [18]. There is evidence that AHPs’ communication can affect patients’ experience of their condition [19], [20], and that patients view AHPs’ communication performance as very important [21], [22], [23]. However, in comparison to medicine, there has been little work identifying and describing AHP communication practices, and even less work on associations between communication practice and outcomes.

In judging evidence about interventions designed to influence clinical communication performance, one particularly important consideration is how effects were measured; including whether measurement adequately reflected content of the training programme [11], [24]. Measurements can be made at three broad levels [11], [25]. The first entails collecting trainees’ self-reports of their knowledge, skills, and/or attitudes. However, there is no clear relationship between these self-reports and what practitioners/trainees actually do in practice [25], [26], [27]. The second level entails independent observations of practitioners’ behaviour, either with simulated situations and patients, or with actual patients during trainees’ everyday practice. The third level examines patient outcomes, including satisfaction and health-related behaviours (e.g. attendance and adherence rates).

Section snippets

Methods for first review: direct evidence

A protocol for a systematic scoping review was designed, drawing on contemporary guidance [26]. The following electronic databases were searched:

  • AMED (1985 to July 2006);

  • CINAHL (1982 to July 2006);

  • EMBASE (1980 to July 2006);

  • Medline (1966 to July 2006);

  • Psycinfo (1906 to July 2006);

  • ERIC-dialogue (1966 to July 2006);

  • ASSIA (1987 to July 2006);

  • National Health Service Health Technology Assessment Database (complete database);

  • Education-line (1997 to July 2006);

  • ISI Proceedings (1999 to July 2006);

  • Index

Methods for second review: indirect evidence

Since the literature describing and evaluating communication training interventions in medicine and nursing is voluminous, best available current evidence was gathered by searching for and analysing systematic and Cochrane reviews published in the last decade (i.e. since 1997) in the York Centre for Reviews and Dissemination [30] and Cochrane Library [31] databases using keywords: Communication, communication skills, education, training, and evaluation. Titles and abstracts were screened so as

Findings: systematic scoping review of literature on AHPs

The five papers which met the inclusion criteria [25], [32], [33], [34], [35] are summarised in Table 1. None were randomised controlled trials (RCTs), all involved small numbers of participants, and all reported positive effects. Three [25], [32], [33] reported training interventions with physiotherapist or speech and language therapist trainees, two reported interventions with qualified clinicians of various backgrounds including occupational therapy, speech therapy, recreation therapy,

Findings: review of indirect evidence from systematic reviews in medicine and nursing

Two reviews using Cochrane protocols and seven non-Cochrane systematic reviews were identified. Table 2 details their scope, design, objectives, and findings. All were narrative reviews, none were meta-analyses. The following summary focuses on matters likely to be relevant to AHP communication training, summarising findings and arguments about: effects, recipients, modalities, content, length, and evaluation of training.

Discussion

Little direct evidence was found upon which to base guidance on curriculum design for pre- and post-qualification training to improve communication skill and performance amongst AHPs. However, work in medicine and nursing offered some indicative evidence and considerations.

Summarising both direct and indirect sources, there is some evidence that some communication skills training interventions can have positive effects on trainees’ behaviours, quality of care, and patient satisfaction.

Acknowledgements

Role of funding: This work was conducted as part of a programme of research funded by a postdoctoral fellowship awarded by the National Coordinating Centre for Research Capacity Development (National Institute of Health Research) UK, fellowship number NCCRCD PDA/N&AHP/PD02/038. The sponsor commissioned peer review of the proposal but had no other involvement in study design and analysis.

Two research assistants provided assistance during their internships with me at the Institute for Science and

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