Every day, healthcare workers face difficult dilemmas in dealing with patients who have compromised communication. Patients who have disabilities that affect communication may have difficulty hearing, speaking, understanding, remembering what is said, making and communicating decisions about their healthcare.
Patients may have:
- pre-existing disabilities that affect communication (e.g. cerebral palsy, intellectual disability, autism spectrum disorder)
- recent onset (first time) communication disabilities (e.g. stroke, traumatic brain injury)
- communication limitations due to medical interventions (e.g. intubation, tracheostomy, ventilator, laryngectomee)
- degenerative disabilities such as dementia, ALS, MS, Parkinson’s Disease
CDAC recognizes that healthcare providers must act in accordance with their specific sector governing laws, rules and policies. In addition, they must comply with accessibility and human rights legislation relating to the duty to accommodate a patient’s accessibility needs. The United Nations Convention on the Rights of Persons with Disabilities (CRPD), is another legal source that Canada ratified in 2010. The CRPD protects the rights of people to have the supports they need to access services on an equal basis to others – that includes the right to accommodations and supports to effectively communicate in healthcare situations.
Patients who have communication disabilities need communication supports because healthcare professionals often:
- Equate their inability to speak as an inability to make decisions and control what happens in their lives
- Determine their capacity without providing them with the communication supports that they require
- Defer decisions to people that they have not authorized to speak for them, or make decisions on their behalf
- Make erroneous judgements about their capacity resulting in serious consequences
- Lack clear policies, practices and safeguards to identify and provide the supports they need to effectively and authentically communicate about their healthcare decisions.
- Understand the key concepts in providing communication supports that patients may need to reveal and exercise capacity to communicate about healthcare decisions.
- Identify and record a patient’s communication support needs.
- Identify the support person that the patient authorizes to assist with communication and/or decisions and arrange signing of confidentiality, if required.
- Ensure the patient has access to communication tools they use or need at all times.
- Use best communication practices to support a patient in one or more areas of understanding, problem solving, decision-making and/or expressive communication.
- Hear and acknowledge the patient’s questions, concerns, opinions and decisions.
- Engage a Speech Language Pathologist in critical situations and if there is evidence of undue persuasion, coercion or abuse of power.
- Document how communication supports were provided and how decisions were made.
- Communication and Capacity: Context and Guiding Principles (Barbara Collier)
- Communication Disabilities: Barriers and Impact on Choice and Control (Barbara Collier)
- Legal Context for Exercising Capacity and Provision of Communication Supports (Lana Kerzner)
- Communication Supports: Formal, Symbolic Communicators (Barbara Collier)
- Communication Supports: Informal, Non-Symbolic Communicators (Jo Watson)
Healthcare communication tools and resources: Patient Provider Website