ACQ Vol 12 No 3 2010

124

ACQ

Volume 12, Number 3 2010

ACQ

uiring knowledge in speech, language and hearing

Comparison

“Comparison” directs us to think about whether we are

interested in comparing the effect of one environmental

modification versus another on an outcome.

Outcome

“Outcome” focuses our attention on specifically what we

want to make a difference to. Do we want a communicatively

accessible environment to make a difference to patients’

knowledge about their healthcare condition? Their level of

satisfaction with their healthcare in hospital? Their ability to

communicate about their healthcare in hospital? The quality

of healthcare they receive in hospital? Or, do we want to

make a difference to their overall health outcomes?

By exploring the question in this way it becomes

clearer that looking for the evidence for “does creating

a communicatively accessible environment make a

difference?” actually covers a vast range of more specific

questions that need to be asked. One question has been

constructed from this list of potential questions, which is:

“For people with aphasia (patient group), does providing

accessible written healthcare information (intervention)

compared with standard written healthcare information

(comparison) have any beneficial outcomes (outcomes)?”

This question is investigated in more detail below.

Searching for the evidence

Table 1 outlines the concept map used to identify the

keywords that were searched to find any literature that might

be relevant to answering this question. Medline, CINAHL,

Embase, and Scopus databases were searched. In order to

find any systematic reviews or previously appraised articles

on the topic, two pre-appraised databases; Cochrane library

and speechBITE

were also searched. The “patient group”

keywords and “intervention” keywords listed in Table 1 were

searched separately and then the results of each of these

searches were combined to identify any relevant articles.

Searching these databases with these keywords yielded

over 400 articles; however, by reading the article titles alone

it became evident that only 18 articles were relevant to the

topic. Reading the abstracts of these 18 articles indicated

that 12 were specific to people with aphasia. Of these 12

articles, 7 were concerned with understanding the nature

of the problem of providing written information to people

with stroke and aphasia, one investigated the effect of

modifying the reading level of written information and four

investigated the effect of modifying written information on

people with aphasia. No systematic reviews or articles from

the speechBITE

database that had already been appraised

were found.

Is this within our scope of practice? Speech Pathology

Australia’s scope of practice (Speech Pathology Australia,

2003) states that speech pathology services aim to improve

the communication abilities of clients, facilitate access and

participation in a range of different programs, prevent

communication disability, and improve the communication

environment. Therefore, modifying the communicative

environment of the hospital to enable patients to communicate

more effectively is well within our scope of practice.

The final issue the manager raises concerns whether

creating a communicatively accessible environment

makes any difference to patient care. This is a critical

issue. Having argued that patients need an effective form

of communication in hospital and that modifying the

communicative environment may be an efficient way to

achieve this for many, it is important to determine what, if

any evidence is available that indicates that environmental

modifications are effective. In order to answer this question,

it needs to be refined further.

Developing an answerable

clinical question

The PICO mnemonic is a useful way to explore questions

about a clinical issue more clearly (Del Mar & Hoffmann,

2010). PICO stands for:

P: Patient, problem or population;

I: Intervention, diagnostic test or prognostic factor;

C: Comparison, and

O: Outcome

The PICO mnemonic has been used to explore this clinical

issue further.

Patient, problem, or population

“Patient, problem or population” directs us to clarify who we

are interested in. Are we concerned about all patients with

communication disabilities in hospital? Are we interested in a

specific subgroup of patients, such as those with aphasia,

dysarthria, cognitive communicative impairment, or hearing

impairment? Are we interested in patients with complex

communication needs or communication difficulties

secondary to medical interventions such as tracheostomy?

Interventions

“Interventions” requires us to think about the types of

interventions we are interested in. Are we concerned about

the effect of any interventions? Are we particularly interested

to know the effect of a specific intervention on the

environment such as enhancing the knowledge and skills of

healthcare providers? Providing aphasia-friendly written

information? Increasing staffing levels? Enhancing the

acoustics on the ward? Or creating new administrative

policies?

Table 1: Concept map to generate keywords

Patient group search terms Intervention search terms

Comparative intervention

Outcomes

Possible search terms:

No particular search terms used. No particular

aphasia

“modif* (by including the asterisks the search will include Interested in effect of the

search terms used.

dysphasia

the terms modify, modified, modifying) written information” intervention only

Interested in any

“acquired language disorder” “access* (search will include accessible, accessibility)

outcome

NB: search terms of three

written information”

words or longer are written in

aphasia friendly

quotation marks so the search patient education

engine recognises the term as health education

a whole phrase.

“consumer health information”