TIS – Talking in Symbols. Development of a Tool for Nonverbal Communication after Language Barriers in Pediatric Oncology

Abstract

Language barriers have been reported to have a detrimental effect on various outcomes in paediatric care, such as therapy adherence, and may even cause medical treatment errors. To address this issue, we developed a set of 63 cards with which a wide range of specific messages can be conveyed nonverbally in a clinical context. The conceptualization of the tool involved multiple phases. In Study 1, we held a workshop with 11 children and adolescents between 8 and 19 years that had received treatment for oncological conditions to gain an understanding of the specific challenges. In Study 2, we presented a first prototype to 3 children and 14 adults; participants were asked to rate the cards on multiple dimensions. Based on information from the previous trials, we developed a second prototype and asked 10 children and 7 adults to rate the cards on multiple dimensions. In this multidisciplinary approach in addition to our experts of clinical psychology we involved patient advocators and graphic designers in the process to achieve high feasibility and comprehensibility; based on the workshop, expert consensus surveys, data gathered in evaluation, all prototypes and the final card set were developed in close collaboration. Participants had little difficulty interpreting the cards and rated the information content as adequate. Importantly, a majority of participants indicated that they would keep using the tool during their stay at the hospital. Overall, the evaluation implied high acceptance and usability. The final card set is a promising communication tool in clinical paediatric settings with various language barriers. Further research should address how patient outcomes are impacted by using the tool.

Zusammenfassung

Sprachbarrieren gelten als Risikofaktor in der pädiatrischen Praxis und können sich auf die Compliance der PatientInnen und das medizinische Behandlungsergebnis auswirken. Um diesem Problem zu begegnen, entwickelten wir ein Set aus 63 Karten, mithilfe dessen eine Vielzahl an Botschaften vermittelt werden können, welche im Klinikalltag von zentraler Bedeutung sind. Um ein Verständnis der spezifischen Herausforderungen zu erlangen, veranstalteten wir in Studie 1 einen Workshop mit 11 Kindern, die onkologisch behandelt worden waren. Darauf aufbauend wurde in Studie 2 ein erster Prototyp entwickelt, den wir 3 Kindern und 14 Erwachsenen zur Evaluation vorlegten. Die Informationen aus Studie 1 und 2 mündeten in einen zweiten Prototyp, welcher 10 Kindern und 7 Erwachsenen zur Evaluation vorgelegt wurde. In einem multidisziplinären Zugang wurde zusätzlich zur klinischen Psychologie ebenso PatientInnenvertretung und Grafikdesign in die Entwicklung eingebunden, um hohe Handhabbarkeit und Verständlichkeit zu erzielen; aufbauend auf Workshop und Evaluation wurden die Prototypen und das finale Kartenset in enger Zusammenarbeit entwickelt. Die TeilnehmerInnen hatten wenig Schwierigkeiten damit, die Bedeutung der Karten zu erkennen und bewerteten den Informationsgehalt als angemessen. Die Mehrheit der TeilnehmerInnen gab an, das Kartenset während ihres Klinikaufenthaltes verwenden zu wollen. Die Ergebnisse deuten generell auf hohe Benutzerfreundlichkeit und Akzeptanz hin. Das finale Kartenset ist ein vielversprechendes Hilfsmittel für nonverbale Kommunikation bei sämtlichen Sprachbarrieren im Klinikalltag. Nächste Forschungsschritte sollen die Auswirkungen des Einsatzes auf PatientInnen erfassen.

Key words

communication skills - interdisciplinary treatment - practical tools - language barriers - empowerment - psychosocial care

Schlüsselwörter

Kommunikationsstrategien - Interdisziplinäre Behandlung - praktische Tools - Sprachbarrieren - Empowerment - psychosoziale Versorgung

Publication History

Article published online:
11 September 2020

• References

• 1 Clark S, Mangram A, Ernest D. et al. The informed consent: A study of the efficacy of informed consents and the associated role of language barriers. J Surg Educ 2011; 68: 143-147
• 2 Flores G.. Language barriers to health care in the United States. N Engl J Med 2006; 355: 229-231
• 3 Flores G, Laws MB, Mayo SJ. et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003; 111: 6-14
• 4 Fogel NR, Weissberg-Benchell J.. Preventing poor psychological and health outcomes in pediatric Type 1 Diabetes. Curr Diab Rep 2010; 10: 436-443
• 5 Jin J, Sklar G, Oh V. et al. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag 2008; 4: 269-286
• 6 Kazak AE, Alderfer M., Rourke MT. et al. Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors. J Pediatr Psychol 2004; 29: 211-219
• 7 Kazak AE, Rourke MT, Alderfer MA. et al. Evidence-based assessment, intervention and psychosocial care in pediatric oncology: A blueprint for comprehensive services across treatment. J Pediatr Psychol 2007; 32: 1099-1110
• 8 Kitzinger A.. METACOM 6. Symbolsystem zur Unterstützten Kommunikation. http://www.metacom-symbole.de/ 16.05.2018
• 9 Marsac ML, Hildenbrand AK, Clawson K. et al. Acceptability and feasibility of family use of The Cellie Cancer Coping Kit. Support Care Cancer 2012; 20: 3315-3324
• 10 Mayring P.. Qualitative Inhaltsanalyse. Grundlagen und Techniken. 11th ed Beltz; Weinheim: 2010
• 11 Mehrabian A.. Nonverbal communication. Routledge; New York: 2017
• 12 Minneci PC, Nacion KM, Lodwick DL. et al. Improving surgical research by involving stakeholders. JAMA Surg 2016; 151: 579-580
• 13 Mizuko M.. Transparency and ease of learning of symbols represented by Blissymbols, PCS, and Picsyms. Augment Altern Comm 1987; 3: 129-136
• 14 Nakagawa S.. A farewell to Bonferroni: The problems of low statistical power and publication bias. Behav Ecol 2004; 15: 1044-1045
• 15 Ott J, Greening L, Palardy N. et al. Self-efficacy as a mediator variable for adolescents' adherence to treatment for insulin-dependent diabetes mellitus. Child Health Care 2000; 29: 47-63
• 16 Penney K, Snyder J, Crooks VA. et al. Risk communication and informed consent in the medical tourism industry: A thematic content analysis of Canadian broker websites. BMC Med Ethics 2011; 12: 17
• 17 Ramirez D, Engel KG, Tang TS.. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved 2008; 19: 352-362
• 18 Schröder HM, Lilienthal S, Schreiber-Gollwitzer B. et al. Psychosoziale Versorgung in der pädiatrischen Onkologie und Hämatologie. AWMF-Leitlinie Register Nr. 025/002. 2013
• 19 Wigley C, Bucknall V, Fleming S.. Santa’s little helpers: A novel approach to developing patient information leaflets. BMJ 2017; 359: j5565
• 20 Zamora ER, Kaul S., Kirchhoff AC. et al. The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer. Pediatr Blood Cancer 2016; 63: 2173-2180