Health Professionals' Communication Competences as a Light on the Patient Pathway: The Assertiveness, Clarity, and Positivity (ACP) Model

Introduction

Health professional communication competences are light on the patient pathway. The practice of good communication competences in health professions influences a significant and trustworthy relationship between practitioners and patients (Ranjan, Kumari & Chakrawarty, 2015, p. 1) and communication is assumed to be the “need of the hour” (p. 1) and the “key to a healthier tomorrow” (Ratzan, 1994). The literature tends to emphasize communication as a catalyst for results (Levinson, Roter, Mullooly, Dull & Frankel, 1997; Ong, de Haes, Hoos & Lammes, 1995, p. 903; Stewart, 1995) and that skilled physician communication is a key component of patient experience (Boissy et al., 2016), since it is an effective bridge for the construction of the therapeutic relationship (Ha & Longnecker, 2010). Ha and Longnecker (2010), reinforcing this association, refers that effective doctor-patient communication is a central clinical function in building the therapeutic relationship, “which is the heart and art of medicine”.

The diagnosis of communication within the context of health is problematic and challenging: a) the (many) barriers to good communication in the medical relationship, including patients’ anxiety and fear, doctors’ burden of work, fear of litigation, fear of physical or verbal abuse, unrealistic patient expectations, deterioration of doctors’ communication skills, nondisclosure of information, doctors’ avoidance behaviour, discouragement of collaboration, resistance by patients (Ha & Longnecker, 2010); b) Only 12% of U.S. adults have a high level of health literacy, i.e., nearly nine of ten adults lack the skills needed to fully manage their health care and prevent disease (Kutner, Greenberg, Jin & Paulsen, 2006) and also Europeans have low levels of health literacy (HLS-EU, 2012); c) in today’s medical practice, human communication is often misused (Kreps, 1996, p. 43); d) nurses, for example, overestimate the health literacy of their patients (Johnson, 2014, p. 43) and this overestimation may contribute to the widespread problem of poor health outcomes and hospital readmission rates (Dickens, Lambert, Cromwell & Piano, 2013); e) it was pointed out that, even in non-stressful clinical encounters, patients are still reluctant to admit any lack of understanding and feel compelled to follow the recommendations as they see it, instead of asking for clarification (Baker et al., 1996; Dickens et al., 2013; Martin et al., 2011; Parikh, Parker, Nursers, Baker & Williams, 1996); f) studies on communication / interaction and health literacy remain limited (e.g., Ishikawa & Kiuchi, 2010) and large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted (Boissy et al., 2016). Consultation is an unequal, non-voluntary and emotive act that deals with vital issues (Ong et al., 1995, p. 903) and health communication-patient communication skills are critical for engaging a patient, to improve therapeutic compliance, and to overall patient satisfaction and quality health care (Beck, Daughtridge & Sloane, 2002; Epstein et al., 2005; Evans, Stanley & Burrows, 1992, p. 155; Han et al., 2017, p. 1). Ranjan, Kumari and Chakrawarty (2015) recommend the inclusion of formal training in communication competences in the medical curriculum and practice.