...communication is the heart and art of medicine and a central component in the delivery of health care. - J. F. Ha and N. Longnecker (2010, p. 38)
As this lead-in quotation implies, communicative interactions between patients and health care providers are critical for many reasons, not the least being their potential to increase informed decision-making and decrease misunderstanding. Medical interactions are not alone, however, in the importance of their potential to influence other people's thinking and actions; daily living exchanges in many contexts can have a significant impact on a person's participation and autonomy, presenting unusual challenges to adults with communication vulnerabilities.
This issue of Topics in Language Disorders raises awareness of communicative barriers and the importance of providing appropriate means to support participation by adults who are communication vulnerable due to neurogenic conditions that affect their speech production, language skills, or memory and cognition. Issue editor, Dr. David Beukelman, conceptualized the issue on the topic of Communication Support for Adults Who Are Communication Vulnerable and assembled authors who could address the topic from varied angles. The result is an issue with implications for supporting communication with vulnerable adults in health care settings and other communication contexts. As the term "support" implies, clinicians and policy makers need to allow for flexible choices and the possibility of new technologies when considering how to support communicative participation.
Supports discussed in this issue include frameworks for health care providers, as well as technologies and strategies for providing direct communication support (or augmentation) for people with a variety of conditions. Authors discuss theoretical concerns, argue for policy modifications, and provide practical information aimed at reducing communication breakdowns and increasing participation by those who are vulnerable to marginalization and loss of autonomy due to their communication challenges. Contributors describe aspects of clinical decision-making, collaborative practice, and patient-provider communication across a range of acquired neurogenic conditions, all of which may result in complex communication challenges. They provide theoretical and background information, along with illustrative case examples to highlight clinical implications of the information shared.
The challenges discussed are diverse, as are neurogenic communication disorders of adulthood. Conditions may be chronic or newly acquired, and they may affect speech production alone, speech and language, language alone, or cognitive-communicative components that extend beyond language. This is not to mention other barriers that may be related to hearing loss, language difference, or limited health literacy. As issue editor, Beukelman developed the issue to cover a range of topics, with challenges to patient-provider communication serving as a unifying theme, but with implications beyond the acute care setting and beyond the populations discussed.
First, Burns, Baylor, Dudgeon, Starks, and Yorkston (2017) discuss accommodation theory as it relates to effective communication in medical settings for people with complex communication needs. They use case examples to illustrate problems associated with under- and overaccommodation, emphasizing the need for accommodations with the appropriate level and type of support matched to a varied of communication disorders. Nordness and Beukelman (2017) follow with a description of effective policies and procedures related to patient-provider communication for medical settings. King and Simmons-Mackie (2017) next provide an overview of communication supports designed to benefit people with various types of aphasia. They describe the application of these supports as part of aligning with best clinical practices and national accreditation requirements. Then, Lanzi, Burshnic, and Bourgeois (2017) describe the implementation of communication supports as part of a comprehensive, person-centered care plan across the continuum of care for people with dementia. Finally, Hanson and Fager (2017) describe essential elements of effective patient-provider communication for medical settings designed to facilitate information exchange between medical professionals and people with complex communication needs resulting from motor speech disorders, some of which can make spoken output impossible but leave language comprehension intact.
The articles in this issue should contribute to research and policy discussions about improving communication supports and their availability in health care settings and other contexts. As reviews of current best practice, these contributions can serve as a resource for professional development of health care providers and related professionals who consult with them, including speech-language pathologists and other clinicians who work directly with adults with complex communication needs. In addition, the articles can serve as an educational resource for professionals preparing for interprofessional and patient-centered practice. Finally, medical professionals, as well as speech-language pathologists and other allied health professionals should find value in the strategies described to support the critical conversations they have with people with complex communication needs.
-Sarah E. Wallace, PhD
Associate Editor
-Nickola Wolf Nelson, PhD
Editor-in-Chief
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