ACQ Vol 12 No 3 2010

Table 1: Concept map to generate keywords Patient group search terms Intervention search terms

Comparative intervention

Outcomes

Possible search terms:

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

search terms used. Interested in any

dysphasia

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

outcome

NB: search terms of three 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. written information”

“consumer health information”

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 TM 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 TM 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?

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing