In the United States, 14 percent of all adults report a speech, language, voice, and/or hearing disability—collectively known as communication disabilities (CD). Compared with people without CD, people with them experience health and healthcare disparities, including higher rates of chronic conditions such as asthma and diabetes, poorer ratings of the quality of their health, and greater difficulty accessing high-quality care. One of the primary challenges that patients with CD face in accessing high-quality health care is communicating effectively with providers; patients with CD report poor quality of communication with their healthcare providers. Specifically, they report feeling disrespected and excluded from medical conversations and decisions. Effective patient–provider communication confers multiple benefits to patients with and without CD, including improved care experience, quality of health and medication, and treatment adherence. Specific evidence-based strategies, including writing down key words, using meaningful gestures, and maintaining eye contact, improve communication outcomes for patients with CD. In video-recorded clinical encounters, healthcare providers rarely used these strategies with patients with CD.
The INTERACT trial will compare the effectiveness and implementation of two evidence-based interventions to increase primary care providers’ use of evidence-based communication strategies with patients with CD. By increasing providers’ use of the strategies, we aim to improve patients’ experience with care and their reported health-related quality of life. We will compare a healthcare team–directed intervention with a healthcare team–directed intervention plus patient-directed intervention. In the healthcare team–directed intervention, the team will receive training on evidence-based communication strategies for patients with CD. In the patient-directed intervention, patients with CD will complete a patient prompt list that elicits the communication strategies that they prefer their healthcare team to use throughout their visit. Our outcomes will be guided by the Reach Effectiveness Aim Implement Management (RE-AIM) implementation science framework. Collecting both effectiveness and implementation outcomes will facilitate the sustainability and generalizability of the interventions. Our two main outcomes will be patients’ reported experience with care and health-related quality of life.
As secondary outcomes, we will measure patients’ reported self-efficacy for managing their chronic conditions, providers’ use of patient-centered communication, and providers’ and staff members’ experiences with implementing the interventions. As an exploratory outcome, we will measure patients’ emergency room and hospitalization use within six months following their participation in the intervention. The proposed project was developed from multiple qualitative studies that the team conducted with people with CD, as well as a multiyear engagement with key stakeholders, including local and national disability advocates, patients with CD and their caregivers, policy makers, and healthcare providers and administrators. Throughout the project, we will continue to engage our local and national partners to ensure that the study procedures and outcomes are meaningful to all stakeholders.
Training and Education Interventions
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.