effective communication in health and social care essay

Essay on Effective Communication In Health And Social Care

Students are often asked to write an essay on Effective Communication In Health And Social Care in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Effective Communication In Health And Social Care

Introduction.

Effective communication is very important in health and social care. It helps doctors, nurses, patients, and their families to share information. This can make patient care better and safer.

The Importance of Communication

Good communication helps to build trust between health care workers and patients. It also helps to make sure that patients get the right treatment. When people can talk openly and honestly, they can understand each other’s needs and feelings better.

Types of Communication

There are two types of communication: verbal and non-verbal. Verbal communication is when people talk or write. Non-verbal communication is when people use body language or facial expressions.

Barriers to Communication

Sometimes, there can be things that make communication hard. These can be language differences, loud noises, or even stress. Health care workers need to know how to overcome these barriers to give good care.

In conclusion, effective communication is key to good health and social care. It helps to share information, build trust, and overcome barriers. Everyone in health care should work on their communication skills.

250 Words Essay on Effective Communication In Health And Social Care

What is effective communication.

Effective communication is the process of sharing information clearly and without confusion. In the fields of health and social care, it is a key tool. It helps in understanding a person’s needs, building trust, and providing quality care.

Why is it Important?

In health and social care, communication is very important. It helps doctors, nurses, and social workers understand what a patient needs. If communication is clear, it can help in making the correct diagnosis and providing the right treatment. It also helps to build trust between the patient and the care provider.

There are two types of communication: verbal and non-verbal. Verbal communication is when we use words to share information. Non-verbal communication includes things like body language, facial expressions, or gestures. Both types are important in health and social care.

Sometimes, things can stop effective communication. These are called barriers. Barriers can be things like language differences, loud noises, or even a person’s emotions. It’s important for health and social care workers to understand these barriers and find ways to overcome them.

Improving Communication

To improve communication, health and social care workers should listen carefully, speak clearly, and use simple language. They should also pay attention to non-verbal cues, like a person’s body language or facial expressions. By doing these things, they can ensure that communication is effective and that they are providing the best care possible.

500 Words Essay on Effective Communication In Health And Social Care

Effective communication is the ability to share information in a way that is easy to understand. In health and social care, it is very important. It helps doctors, nurses, social workers, and patients to understand each other. This can lead to better care for patients and a good work environment for health workers.

Why is Effective Communication Important in Health and Social Care?

In health and social care, people need to share a lot of information. This can be about a patient’s health, their care plan, or how they are feeling. If this information is not shared clearly, it can cause problems. For example, a doctor might not understand a patient’s symptoms, leading to wrong treatment. Or a social worker might not understand a person’s needs, leading to poor care.

Effective communication can prevent these problems. It can ensure that everyone understands the information being shared. This can lead to better health outcomes and more satisfied patients. It can also make health and social care workers feel more confident and capable in their jobs.

How to Achieve Effective Communication?

Achieving effective communication in health and social care is not always easy. It requires effort and practice. Here are some tips:

1. Use Simple Language: Use words that are easy to understand. Avoid using medical jargon or complex terms.

2. Listen Carefully: Pay close attention to what the other person is saying. Do not interrupt them. Show that you are interested and understanding.

3. Be Clear and Concise: Be straight to the point. Avoid giving too much information at once. Make sure your message is easy to understand.

4. Use Non-Verbal Communication: Use body language, facial expressions, and gestures to support your words. This can make your message more clear.

5. Confirm Understanding: Ask the other person if they understood what you said. If not, explain it again in a different way.

The Role of Technology in Effective Communication

Technology can also help with effective communication in health and social care. For example, electronic health records can make it easier to share and understand patient information. Video calls can make it easier for patients and health workers to communicate, especially during times like the COVID-19 pandemic.

In conclusion, effective communication is very important in health and social care. It can improve patient care, make health workers feel more capable, and even save lives. Therefore, it is something that everyone in this field should strive for.

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Effective Communication in Health and Social Care

Last updated on 19th April 2023

In this article

Communication is the process used to exchange information and it is considered effective when both parties, the sender and the receiver, give the same or very similar meaning to the message being conveyed.

Health care is the treatment of ill health and medical conditions.

Social care is the care and support of vulnerable people (with or without ill health and medical conditions) such as elderly people or children.

Communication in health and social care settings can be divided into two types:

• Communication between health and social care workers.
• Communication between the patient (and/or family members) and health and social care workers.

Communication within health and social care settings is considered effective when the receiver, either the patient, family member, or the health and social care worker, understands clearly the message being conveyed by the sender.

For this to happen the message has to be clear, consistent, transparent as well as accessible and inclusive.

Why is effective communication needed in health and social care?

Effective communication within health and social care settings is very important because it can have a direct, or indirect, impact on the health and social care provided, the overall wellbeing of the patient and on the relationships with patients, family members or colleagues.

Many people may have difficulties in understanding information provided because of language barriers, limited literacy, physical conditions (such as brain damage) or age.

Admission to a nursing home, a foster care home or health facility is a stressful event that involves a noticeable change in lifestyle that requires support. Those affected by a disease are often overwhelmed by fear for their own health and can become irritable, and therefore need reassurance from others.

The World Health Organisation has outlined how the relationship between patients and healthcare workers has evolved over the years with a change in expectations. In the past, patients were used to a healthcare worker being dogmatic and paternalistic. Today, patients usually look to their healthcare worker to help them navigate through a complicated system and expect communication to be based on shared decision-making.

Knowing how to communicate with patients and learning the dynamics of interpersonal relationships is essential for health and social care workers to perform their work at the highest standard.

The Department of Health (now Department of Health and Social Care), together with National Health Service England, published in 2010 Benchmarks for Communication which focuses on the specific needs, wants and preferences of people and carers.

But why are effective communication skills so important in health and social care?

Effective communication enables:

• The exchange of clear information and instructions on care needs.
• The provision of direct (or indirect) emotional support to the patient (or family members) or colleagues.
• The development of positive relationships.

How to promote effective communication

Communication skills are a top priority for health and social care workers. For this reason they are usually required to go through some specific training on the subject.

In order to promote effective communication in health and social care settings it is fundamental to consider that this environment can be the source of anxiety and fear for patients.

For different reasons:

• Worries about health and life.
• Distance from family and daily habits.
• Considerable limitation of personal space and privacy.
• Impersonal and cold environment.

Patients usually react to this environment with the same behaviour used in any other situation of anxiety and stress, and for some individuals who are very emotional, they may need more time to decrease their anxiety to acceptable levels.

For these reasons, to ensure efficient communication, health and social care workers must understand the difficulties that patients face in adapting to their new environment and support them using different strategies, such as:

• Listening to the patients and creating some space to let them vent their emotions.
• Reassuring and calming patients in moments of fear.
• Helping patients to stay active and facilitate connection with others, if applicable, to prevent isolation.

Supporting patients in this phase is key to creating a safe environment in which they are ready to pay attention to any form of clear communication related to their care and what is being done in the facility for them.

How to communicate effectively

Communication in health and social care settings can take different forms and styles depending on:

• The patient status (for example, a patient visiting a dental surgery for a check-up versus a patient being hospitalised to cure cancer, or a child versus an elderly person).
• The message being conveyed (for example, information concerning medicine dosages, delivery timings and changes to the current regime versus information related to the daily menu in the health and social care facility).

Regardless of the form or style, any communication within health and social care settings has to be clear, accurate, consistent, transparent as well as accessible and inclusive in order to be effective.

To achieve clarity it is recommended to:

• Use plain, direct language and avoid idioms or jargon.
• If necessary, repeat phrases, re-phrase the sentences or use simpler words.
• Use pictograms or visuals to explain a difficult concept and get a point across.
• Double-check if the person has understood.
• Observe the body language for clues.
• Encourage people to ask questions or request further information. Ask if they would like anything in writing as a reminder or reference.
• Use an interpreter if a language barrier exists.

Every form of communication within health and social care has to be correct and precise to prevent any error that can potentially have a negative impact on the health and wellbeing of patients.

Consistency

For patients, as well as for health and social care workers, consistency in the means of communication is key to avoid confusion and reduce the risk of missing important details.

Transparency

According to National Health Service England, transparency is key to public and patient participation and is the means by which high-quality and sustainable health services are provided. The same principle applies to social care services.

Accessibility

Many people may have difficulties in understanding information provided because of language barriers, limited literacy, physical conditions (brain damage) or age.

National Health Service England believes it is important that information is presented in an accessible way and, where appropriate, in a range of languages and formats that are easily used and understood by the intended audience.

Providing accessible information helps people to make more informed choices about their healthcare and improves communication and engagement among staff.

Inclusivity

The provision of accessible information can reduce inequalities and barriers to good health. Individuals who have limited or no English, or who use sign language or the deafblind manual alphabet, should have access to a professional interpreter.

What are the different types of effective communication needed in health and social care?

Communication in health and social care settings can take place in many forms:

• Verbal communication.
• Non-verbal communication (or body language).
• Written communication.
• Formal communication.

How is verbal communication effective?

In any health and social care setting and circumstances it is good practice to:

• Establish eye contact.
• Create space for questions and double-check if the message has been understood.
• Accompany verbal language with coherent body language.
• Face the receiver at the same height, not from a dominant position.
• Try to take a positive approach.
• Show care, maintaining professionalism and respect at all times.
• Call the receiver by their name.

Depending on the circumstances, to ensure effective communication you may need to:

• Speak clearly and slowly.
• Use very short, simple and concrete words and phrases.
• Give one message at a time.
• Use affirmative sentences.
• Encourage the patient to speak.
• Take time to capture the emotions the patients or family members express and create space if required.
• Avoid pointing out mistakes unnecessarily.
• Adapt to the patient’s language style if needed to ensure understanding.
• Use an interpreter if there is a language barrier.

How is non-verbal communication (body language) effective?

According to the World Health Organisation healthcare workers’ body language has been shown to be crucial in the way patients interpret the information they are given.

Health and social care settings can create stress and anxiety for patients and therefore it is key that the workers’ language conveys confidence, credibility, empathy and reassurance.

How is written communication effective?

Written communication is vital in health and social care settings as it is used for different purposes:

• To record personal details.
• To keep medical/patient records.
• To issue medical prescriptions or referrals.
• To create letters, emails, text messages to inform and remind about appointments at the hospital, doctors, dentist, etc.
• To draw up care plans.
• To issue newsletters and inform notice boards.
• To hand over duties.

Clarity, accuracy and legibility is especially important in written communication, which may contain detailed information concerning, for example, drug dosages, delivery timings and changes to the current regime. Written communication directed to patients and families should avoid jargon to avoid ambiguity and to ensure it is clearly understood.

Written communication should be kept for future reference, stored securely and remain confidential.

How is formal communication effective?

Formal communication is a style of speaking that is used in professional or official settings using neutral words which are understood by the majority of people and expressed in a way that is considered acceptable and respectful by the majority.

Communications within health and social care settings may include sensitive information such as illness diagnosis, treatments or care needs. It is therefore fundamental that this type of information is clearly understood and respected.

An example of formal communication within health and social care settings is a letter from a doctor including test results.

The degree of formality that health and social care workers are required to keep depends on the circumstances. For example, a doctor discussing a diagnosis with a patient and their family members will require a level of formality higher than that used by the care assistant encouraging a patient to eat some food.

For formal communication to be effective within health and social care settings it is important to avoid jargon or, if it is necessary to use technical language, it may be helpful to add images or pictograms to get the point across and ensure the language used is understood.

How is effective communication used?

Knowing how to communicate with the patient and learning the dynamics of interpersonal relationships has become essential for health and social care workers.

Effective communication is used to:

• Improve care services.
• Enhance patient experience.
• Create more transparency and openness.
• Reduce complaints.
• Build trust on the health and social care system.
• Reduce stress.
• Create a better working environment for carers.
• Increase self-confidence, professional standing, career prospects and job satisfaction.

What is poor communication and what are the knock-on effects?

The opposite of effective communication is poor communication.

Poor communication exists when the receiver assigns a different message to that which the sender wanted to convey.

This happens when the message is inaccurate, unclear, lacks transparency and is inaccessible. Inconsistency in the means of communications can also cause confusion and important information can be missed.

According to National Health Service England over 70% of the root cause analysis mentioned communication as a contributing factor in errors in healthcare.

Effective communication is key to patient safety, and it is also crucial to managing an incident once it has occurred.

Verbal communication

Even if the patient and the health and social care worker speak the same language, sometimes, what is clear for the health and social worker is difficult to understand by the patient or the family members. Health and social care workers are often so overwhelmed by the demands of their work that they rush the conversation, they do not create space for questions or do not take time to ensure the message is being understood.

Non-verbal communication (body language)

Health and social care workers’ body language should convey confidence, credibility, empathy and reassurance. However, sometimes, even if this is the intention, when overworked health and social care workers are feeling tired, exhausted and emotionally overwhelmed, they may unintentionally show their state through their body language, frightening already vulnerable patients and adding to their anxiety and stress.

Written communication

Inaccurate written information, incomplete handovers, illegible handwriting and unclear instructions can have a very damaging effect on patients that could be given incorrect diagnoses, treatments or care. According to the World Health Organisation, all too often, medical notes are not kept up to date, and in addition to illegibility, transcription is problematic. These contributing factors have been shown to be at the root cause of many adverse drug reactions.

Formal communication

Whilst medical records and communication need a certain level of formality, at times, the level of formality on which a treatment or diagnosis is discussed is too high and includes technical words that are difficult to understand for individuals not working in the field.

The impact that poor communication in health and social care settings can have goes beyond the health and wellbeing of the patients and includes:

• Diminished trust on the health and social care system.
• Disciplinary action, dismissal and legal proceedings.

The risk of unsafe health and social care is far from patients’ thoughts when they consult a doctor.

The general expectation is for person-centred care where health and social care professionals work collaboratively with the people who use their services to help them make informed decisions about their own health and care. You can learn more about how to promote person-centred care on our knowledge base.

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Communication Skills in Social and Health Care Essay

Introduction, key communication theories, principles of communication skills, barriers to effective communication, professional expectations: communication and record-keeping.

Bibliography

Social care and medical experts should develop appropriate communication skills if they are to establish meaningful relationships with the people they serve. Such professionals need to consider the emerging needs of their clients and their respective family members. A powerful philosophy of communication will make it possible for these human services providers to engage their colleagues efficiently and focus on the wider organisational goals. This essay describes the major theories and principles of communication in social and health care.

The field of communication has compelled different scholars to present superior theories that can guide people to engage each other and focus on the best outcomes. Medical and social workers can rely on such models to identify the challenges their clients face and provide high-quality and personalised support. Mackinova et al. (2019) identify functional communication theories as models that explain how societies have real structures that individuals will observe objectively. Interactionism theories have also emerged that identify humans as social beings capable of interacting verbally and non-verbally. Messina (2017) identifies interpretive theories as powerful concepts that try to analyse and describe how people appreciate their experiences when interacting with others. The nature of these models explains why individuals tend to apply various skills and strategies depending on various factors, such as age, closeness to one another and the anticipated outcomes.

Social exchange theory revolves around interpersonal relationships to explain how individuals tend to communicate to satisfy their partners’ interests. Self-interest emerges as a positive attribute under this model and it explains why and how fast individuals would exchange critical information (Eginli and Tas, 2018). Social learning theory is another framework that describes non-verbal communication and how people learn through imitation, observation and emotional reactions (Morley and Cashell, 2017). The environmental and cognitive influences will have significant implications for the communication process. Social penetration theory has emerged as another powerful model that explains how people communicate. While it mainly focuses on intimate relationships, it describes how self-disclosure develops gradually and has the potential to leave one of the parties vulnerable.

In the fields of social care and health, symbolic interactionism theory emerges as a powerful concept that describes how the idea of the self emerges. These principles will support this model: meaning, language and thought (Skarbalienė, Skarbalius and Gedrimė, 2019). Self-concept will become nonexistence without effective communication (Morley and Cashell, 2017). Uncertainty reaction theory describes how verbal and non-verbal communication has the potential to reduce uncertainties when two or more strangers meet. Communication becomes a powerful tool for improving assurance and bringing the two individuals closer depending on the existing factors.

Similarly, there are specific communication theories that are attributable to record keeping. For instance, the above concepts can be applied to the entire practice whereby the client allows the practitioner to collect personal data and information and file it for future reference and the continuous provision of personalised services. Social exchange theory becomes a fundamental approach for dictating the entire process of records management (Rodríguez, 2017). Within the two professional fields, it is agreeable that there are various aspects that all stakeholders need to take seriously, such as patient confidentiality, promotion of personal liberties and privacy (Mackinova et al. , 2019). The ultimate aim is to ensure that the practitioner is satisfied with the situation while the client receives high-quality services.

When adopting each of the above communication theories in records keeping, medical and social care practitioners need to apply some unique principles to support the delivery of positive results. For instance, individuals should remain accountable and transparent when collecting and documenting information (Baker and King, 2016). They need to exhibit the highest level of compliance to the outlined standards and protect every client’s wellbeing. The information should be accessible to authorised persons within the practice only. The parties need to agree on when the content needs to be retained or disposed of.

Communication theories are powerful guidelines that allow individuals to focus on the best practices and understand how they can engage different partners, colleagues, or strangers. Such models provide a lens for understanding any form of conversation, the exhibited verbal and nonverbal aspects and predicting the possible outcome. However, Heras-Pedrosa (2020) acknowledges that the use of various theories of communication could not be adequate for professionals in social and health practice. Consequently, they need to consider and apply some of the major principles if they are to achieve their aims and deliver the best support to more clients.

Some of the key principles that experts need to consider include goal formulation, listening attentively to the selected colleagues and clients, remaining organised and considering the best approaches to record positive outcomes. Professionals should remain visual, use non-verbal cues effectively and adjust their communication strategies depending on the existing situations (Eginli and Tas, 2018). The integration of stories and consideration of the participants’ social and cultural aspects ensure that timely results are eventually recorded.

Social and health practitioners need to be prepared for possible challenges and barriers that might emerge in their respective settings. Such occurrences are capable of defying the implemented communication models and affecting the recorded outcomes. The first barrier that could arise when providing medical or social support services to different individuals is that of job dissatisfaction. Professionals who become unhappy with their workplaces might be unable to engage their clients or consider new ways of delivering timely outcomes (Rodríguez, 2017). The result is that the beneficiaries will not record desirable social or medical experiences.

The second challenge that could disorient the intended level of communication is the occurrence of conflicts. In healthcare settings, medical experts might be unable to share ideas or focus on shared goals. This scenario means that the organisation will be characterised by ineffective communication. The third barrier to effective communication is the existence of language differences (Pang and Hutchinson, 2018). This issue should encourage leaders in different settings to identify new ways of addressing the record cultural differences to ensure that beneficiaries received the intended support.

The fourth barrier to effective communication is associated with personal factors. For instance, some individuals might be unwilling to share their past experiences or be involved in the entire process. This development will result in communication breakdown and make it impossible for the professionals to meet the demands of the patients. Another notable barrier is when the targeted individuals have diverse backgrounds and lack appropriate strategies to cope and support each other (Parsi and Elster, 2015). In societies characterised by racism and stereotypes, some ethnic groups might be unwilling to receive medical support from professionals from other races. This scenario will have detrimental implications on the overall level of communication. Practitioners in these two fields should, therefore, be aware of these possible barriers and develop powerful philosophies to overcome them and eventually achieve their maximum potential.

Nurses, clinicians and social workers need to practice following the outlined codes to meet the demands of the targeted clients and uphold the integrity of their respective professions. Leaders, supervisors and regulatory bodies expect the professionals to fulfil specific expectations in the areas of communication and record-keeping (Hurtig, Alper and Berkowitz, 2018). Such guidelines are designed in such a way that all experts are capable of prioritising people, preserving the highest level of safety, promoting professionalism and ensuring that the beneficiaries record meaningful experiences.

Focusing on communication, these individuals are expected to avoid exhibiting their cultural differences when engaging clients with diverse backgrounds. They need to listen attentively, ask professional questions and avoid overstepping their mandate (Ahmed et al. , 2017). Such experts should be able to listen attentively and allow members of the family to be part of the process. Practitioners should avoid forming relationships with the people or patients they are supposed to serve. This requirement compels them to avoid asking personal questions or expecting their clients to offer favours to receive the intended services.

Practitioners need to remain professional by using the right words and avoiding derogatory statements that could harm or affect the experience of every targeted client. They should consider the principles of communication outlined above to avoid challenges that might emerge. Such caregivers need to use various communication technologies and skills that are capable of supporting the provision of person-centred care (Brady et al. , 2017). They should engage clients continuously to enhance safety and quality. Individuals should receive the relevant information in a language and process that allows them to be aware of what is going on and be involved in decision-making (Nursing and Midwifery Council, nd). The Nursing and Midwifery Council Code of Standards capture most of these attributes and encourage professionals to follow them if they are to record positive results.

The presented guidelines provide additional principles and professional expectations for these experts when engaging in record keeping. First, they should be consistent, accurate and factual when capturing and documenting information (Manojlovich et al. , 2019). Second, the files need to be updated continuously depending on the individual’s progress. Third, the information should be available to the client or patient and the other family members. Fourth, all members of the team should be able to access, read and interpret the content accurately. Fifth, the information has to be written and documented professionally to ensure that no one can delete it. All workers need to adhere to the outlined record keeping procedures to maximise the level of professionalism.

The above discussion has identified some of the communication principles and theories that professionals in the fields of social care and health need to take seriously. Such practitioners should apply such concepts effectively to engage their clients, solve emerging challenges and identify new procedures for improving the overall image of these two fields. All the recordkeeping protocols outlined in the essay are also worth following to augment the communication process and eventually ensure that positive results are recorded.

Ahmed, S., et al. (2017) ‘Experiences of communication barriers between physicians and immigrant patients: a systematic review and thematic synthesis’, Patient Experience Journal, 4(1). Web.

Baker, L.M. and King, A.E.H. (2016) ‘”Let’s get theoretical: a quantitative content analysis of theories and models used in the Journal of Applied Communications’, Journal of Applied Communications , 100(1).

Brady, A., et al. (2017) ‘Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours’, International Journal for Quality in Health Care, 29(7), 929-934.

Eginli, A.T. and Tas, N.O. (2018) ‘Interpersonal communication in social networking sites: an investigation in the framework of uses and gratification theory’, Online Journal of Communication and Media Technologies, 8(2), 81-104. Web.

Heras-Pedrosa, C. (2020) ‘Exploring the social media on the communication professionals in public health. Spanish official medical colleges case study’, International Journal of Environmental Research and Public Health, 17(13), pp. 4859-4875.

Hurtig, R.R., Alper, R.M. and Berkowitz, B. (2018) ‘The cost of not addressing the communication barriers faced by hospitalized patients’, Perspect ASHA Spec Interest Groups, 3(12), 99-112.

Mackinova, M. et al. (2019) ‘Language communication skills in health and social care workers’, Iranian Journal of Public Health, 48(4), pp. 773-774.

Manojlovich, M., et al. (2019) ‘Contextual barriers to communication between physicians and nurses about appropriate catheter use’, American Journal of Critical Care, 28(4), 290-298.

Messina, B.A.M. (2017) ‘One billion people in the elevator: the ethical challenges of social media and health care’, Journal of Healthcare Communications, 2(3), pp. 29-32.

Morley, L. and Cashell, A. (2017) ‘Collaboration in health care’, Journal of Medical Imaging and Radiation Sciences, 48(1), pp. 207-216.

Nursing and Midwifery Council (nd) We are the nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland. Web.

Pang, K. and Hutchinson, C. (2018) ‘An application of the communication theory of identity: third culture kids’, Pepperdine Journal of Communication Research, 6(5), pp. 20-27. Web.

Parsi, K. and Elster, N. (2015) ‘Why can’t we be friends? a case-based analysis of ethical issues with social media in health care’, AMA Journal of Ethics , 17(11), pp. 1009-1018.

Rodríguez, P.A. (2017) ‘Conceptual model of communication theories within project process’, INNOVA Research Journal, 2(3), pp. 42-51.

Skarbalienė, A., Skarbalius, E. and Gedrimė, L. (2019) ‘Effective communication in the healthcare settings: are the graduates ready for it?’, Journal of Contemporary Management Issues, 24(1), pp. 137-147.

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Promoting Effective Communication in Health and Social Care

Communication plays an instrumental role in health and social care and is a core aspect of your working relationships. Being able to communicate effectively is a skill that has a range of benefits, perhaps most importantly that it helps you to deliver person-centred, high-quality care. 

However, communication isn’t as straightforward as it might first appear. It’s not simply about what we say, but about relationships, understanding, and ensuring that our needs are met and our wishes are addressed. It is a two-way process involving one person expressing themselves and being understood by another.

This article outlines the role of communication in health and social care, examining its benefits and providing you with the knowledge you need to overcome any barriers and communicate effectively.

What is the Role of Communication in Health and Social Care?

The role of communication in health and social care is an incredibly important one. The nature of health and social care environments means that you will be interacting with multiple people on a daily basis, and it’s essential that you are able to communicate effectively with them.

It’s important to remember that communication looks different to everyone. There are many ways that people communicate, including verbal communication (speaking aloud), written communication, such as sending emails or keeping records, and non-verbal communication, such as hand gestures or facial expressions. However, there are also many additional ways that people communicate, depending on what works best for them and their needs. For example, individuals may communicate using sign language, Makaton or Braille. It’s important that all types of communication are supported.

Interested in Learning More?

If you’re looking for an in-depth and effective way to improve communication in a health care setting, our Communication Skills in Health & Social Care Course will provide you with the information and guidance you need to develop your existing skills and use a variety of communication methods.

Finally, developing good communication skills is essential if health and social care workers are to develop other skills. For example, you would be unable to offer person-centred care if you couldn’t communicate well with the individual in your care and understand their needs and preferences. Similarly, you need to be able to communicate well with individuals in order to uphold their privacy and dignity and promote their independence.

Why is It Important for Healthcare Professionals to Have Effective Communication?

Being able to communicate well helps to ensure that you can carry out your role effectively. It is central to finding out service users’ needs and wishes, delivering high-quality care, and building good relationships with service users, any visitors and your colleagues.

Service Users

Being able to communicate effectively is crucial for having good relationships with your service users. You will be able to find out their needs and wishes and avoid any potentially distressing misunderstandings and miscommunications. What’s more, if you communicate effectively with a service user, they are much more likely to have confidence in what you tell them and put their trust in you.

Communicating poorly with service users can have a range of consequences. For example, if you adopt closed body language such as crossing your arms, they may feel like you are unapproachable or unfriendly. Similarly, if you miscommunicate and share inaccurate information, a person’s care and support could be affected – for example, if they have an allergy and you miscommunicate this to kitchen staff.

Your Colleagues

Communication is also the foundation of your working relationships. Your job role will likely involve you sharing relevant information with colleagues about service users, making decisions, listening to the views of others and acting on them.

Communicating effectively with colleagues is key if you are to deliver your mutual goal of providing high-quality care to individuals. For example, if an individual wants to change something about how their care is delivered, then it is also important that you share this information effectively with colleagues who care for the individual so that they are aware and meet the individual’s needs. Additionally, it’s crucial that you communicate this change formally in the individual’s care plan so that it is documented and everyone who cares for them can see it. 

Finally, being able to communicate effectively is central to the relationship you have with visitors, such as an individual’s family. A key part of communication is confidentiality – respecting all individuals’ personal data and protecting it by ensuring that it is only shared with others on a need-to-know basis and with consent.

If an individual gives you consent to share information with somebody, it’s crucial that you communicate this information in a professional manner. Speak to the person out of earshot of other people to avoid sharing information with those who don’t need to know.

It’s also important that your communication is empathetic and understanding. There may be times when you have to deliver bad news to a service user’s family and it’s crucial that you communicate sensitive topics in a suitable and professional manner.

What are the Barriers to Communication in Health and Social Care?

While it’s clear to see how important communication is, there are a number of barriers that may prevent you, and those who you care for and support, from communicating effectively. These can include:

• Emotions and attitudes – these can play a large role in communication. For example, if you rush a conversation with a service user because you are busy, or come across as abrupt, you may make them feel frustrated and unlikely to want to communicate. Similarly, if an individual feels upset or angry, they may not want to communicate with you or may struggle to communicate without letting their emotions take over.
• Language – if you and the service user speak different languages, this may make it difficult to communicate. Additionally, even having a strong accent or speaking in a dialect associated with where you live can make it difficult for others to understand you.
• Health conditions – some individuals in your care may have a health condition that makes it difficult for them to communicate. For example, if they have had a stroke, or if they have dementia, this may have affected their ability to think rationally and reason clearly. Additionally, if someone is experiencing a mental health condition such as depression, they may find it difficult to express how they are feeling.
• Physical barriers – someone may be physically unable to communicate, such as if they are breathless or in pain. Additionally, the use of PPE, such as face coverings, can make it especially difficult for some people to communicate -for example, if they are deaf and rely on lip reading, if they use facial expressions to help them understand, or if they have hearing difficulties and can’t hear people clearly through the face covering.
• Environment – certain environments can make it difficult to communicate in – for example, if the room is noisy and you struggle to hear others. Additionally, if the environment is uncomfortable for the service user, such as if it is too dark or too warm/cold, they may be less likely to want to communicate.

How to Promote Effective Communication in Health and Social Care

While there are many barriers to effective communication, you need to overcome them if you are to offer person-centred care. Recognising when someone is struggling to communicate and putting actions into place that will help them can vastly improve their quality of life.

Remember that communication is a two-way process: it involves both giving and receiving messages. Therefore, to be able to promote effective communication, you need to consider the way you give messages as well as receive them from others. If you are wanting to promote more effective communication, you should think about the following:

Consider the Environment and Distance

Think about the way that you position yourself in relation to a service user. For example, your chairs should be facing each other if you are sitting and having a conversation. Additionally, it’s important to think about how close you are to them in distance. If you are too close, they may feel uncomfortable and as though you are invading their personal space.

The nature of health and social care means that you may sometimes have to get closer to an individual, such as if you are taking a blood sample or providing personal care. Ensure you always inform the individual of what you are about to do before you move closer to them.

Listen Actively

When an individual communicates with you, it’s important that you employ active listening skills. This means listening closely to what they are saying and then employing certain techniques, such as nodding to encourage them to keep talking, changing your facial expression so that you are smiling or raising your eyebrows in response to what they have said, and adopting open body language such as open arms and uncrossed legs. This is important for making an individual feel valued and as though they are being listened to. 

Give Them Time

Give people enough time to communicate and don’t rush them. For certain individuals, such as some who have learning disabilities, they may take longer to process information and gather their thoughts, so giving them plenty of time is crucial. Additionally, there may be some people who have reduced energy levels, such as if they are in hospital with illness, who may need a bit longer to think before they respond. Ensure that you are guided by the individual and communicate at a pace that is comfortable for them.

Ask Questions

Don’t be afraid to ask if you don’t quite understand what someone is saying, rather than guessing what you think they mean or making assumptions about what you think they’ve said. For example, concluding that someone has expressed they want their care to be delivered in a certain way based on assumptions can be damaging if they meant something completely different. 

Similarly, if you haven’t heard someone, ask them to repeat themselves rather than pretending to hear or guessing what you think they said. Physical barriers to communication, such as the use of face masks, can make this especially difficult, so ensure that you ask questions to avoid any miscommunications or misunderstandings.

Listen to More Than Just Words

Communication is about so much more than simply what somebody says. It also includes:

• Tone of voice – this is about the way somebody speaks. Tone of voice is important for conveying meaning; if somebody is feeling low they may speak in a monotonous tone, or if somebody is excited their tone may be more varied and enthusiastic.
• Pace – this refers to the speed at which somebody speaks. For example, somebody may speak quickly if they are excited.
• Body language – this can be open or closed. Closed body language, such as fiddling or turning away, can indicate that someone is disinterested or nervous.
• Gestures – these can emphasise what is being said or act as an alternative to speech. For example, somebody may use hand movements to express or emphasise what they are feeling.
• Facial expressions – these can show emotions or reactions, such as smiling when you are happy or raising your eyebrows when you’re interested.

However, it’s important not to make assumptions about how somebody is feeling or what they’re trying to communicate. For example, we may think that if somebody is maintaining eye contact they are engaged, and if they are looking away they are disengaged. However, in some cultures eye contact is considered impolite. Avoid making assumptions and ensure you take the interaction as a whole, asking questions if you are unsure.

Communication is a central part of health and social care, and being able to communicate effectively with service users, colleagues and visitors is a crucial part of delivering high-quality and person-centred care. Avoid making assumptions about what you think people mean, address any barriers to communication, and remember that communication is a two-way process.

Further Resources:

• Person-Centred Care Training
• Compassion in Care: What are the Six Cs?
• What is Person-Centred Care and Why is it Important?
• How to Maintain Confidentiality in Health and Social Care
• Champions in Healthcare: Role and Responsibilities
• Using a Personal Development Plan in Health and Social Care
• Guidance on Complaints Procedures in Health and Social Care
• Defining the Different Types of Discrimination in Health and Social Care
• What are Difficult Conversations in Health and Social Care?
• Duty of Care in Health and Social Care: Responsibilities & Examples
• What are Inequalities in Health and Social Care?
• How to Promote Empowerment in Health and Social Care
• What is the Role of Active Participation in Health and Social Care?
• How to Support Professional Development in Health and Social Care

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Her favourite article is Promoting Effective Communication in Health and Social Care

• Open access
• Published: 03 September 2021

A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward

• Abukari Kwame 1 &
• Pammla M. Petrucka 2  

BMC Nursing volume  20 , Article number:  158 ( 2021 ) Cite this article

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Providing healthcare services that respect and meet patients’ and caregivers’ needs are essential in promoting positive care outcomes and perceptions of quality of care, thereby fulfilling a significant aspect of patient-centered care requirement. Effective communication between patients and healthcare providers is crucial for the provision of patient care and recovery. Hence, patient-centered communication is fundamental to ensuring optimal health outcomes, reflecting long-held nursing values that care must be individualized and responsive to patient health concerns, beliefs, and contextual variables. Achieving patient-centered care and communication in nurse-patient clinical interactions is complex as there are always institutional, communication, environmental, and personal/behavioural related barriers. To promote patient-centered care, healthcare professionals must identify these barriers and facitators of both patient-centered care and communication, given their interconnections in clinical interactions. A person-centered care and communication continuum (PC4 Model) is thus proposed to orient healthcare professionals to care practices, discourse contexts, and communication contents and forms that can enhance or impede the acheivement of patient-centered care in clinical practice.

Peer Review reports

Providing healthcare services that respect and meet patients’ and their caregivers’ needs are essential in promoting positive care outcomes and perceptions of quality of care, thus constituting patient-centered care. Care is “a feeling of concern for, or an interest in, a person or object which necessitates looking after them/it” [ 1 ]. The Institute of Medicine (IOM) noted that to provide patient-centered care means respecting and responding to individual patient’s care needs, preferences, and values in all clinical decisions [ 2 ]. In nursing care, patient-centered care or person-centered care must acknowledge patients’ experiences, stories, and knowledge and provide care that focuses on and respects patients’ values, preferences, and needs by engaging the patient more in the care process [ 3 ]. Healthcare providers and professionals are thus required to fully engage patients and their families in the care process in meaningful ways. The IOM, in its 2003 report on Health Professions Education , recognized the values of patient-centered care and emphasized that providing patient-centered care is the first core competency that health professionals’ education must focus on [ 4 ]. This emphasis underscored the value of delivering healthcare services according to patients’ needs and preferences.

Research has shown that effective communication between patients and healthcare providers is essential for the provision of patient care and recovery [ 5 , 6 , 7 , 8 ]. Madula et al. [ 6 ], in a study on maternal care in Malawi, noted that patients reported being happy when the nurses and midwives communicated well and treated them with warmth, empathy, and respect. However, other patients said poor communication by nurses and midwives, including verbal abuse, disrespect, or denial from asking questions, affected their perceptions of the services offered [ 6 ]. Similarly, Joolaee et al. [ 9 ] explored patients’ experiences of caring relationships in an Iranian hospital where they found that good communication between nurses and patients was regarded as “more significant than physical care” among patients.

According to Boykins [ 10 ], effective communication is a two-way dialogue between patients and care providers. In that dialogue, both parties speak and are listened to without interrupting; they ask questions for clarity, express their opinions, exchange information, and grasp entirely and understand what the others mean. Also, Henly [ 11 ] argued that effective communication is imperative in clinical interactions. He observed that health and illness affect the quality of life, thereby making health communication critical and that the “intimate and sometimes overwhelming nature of health concerns can make communicating with nurses and other healthcare providers very challenging” [ 11 ]. Furthermore, Henly [ 11 ] added that patient-centered communication is fundamental to ensuring optimal health outcomes, reflecting long-held nursing values that care must be individualized and responsive to patient health concerns. Given the prevalence of face-to-face and device-mediated communications and interactions in healthcare settings, we must explore and clarify who, what, where, when, why, and how interactions with individuals, families, and communities are receiving care and health services [ 11 ].

The value of effective communication in nurse-patient clinical interactions cannot be overemphasized, as “research has shown that communication processes are essential to more accurate patient reporting and disclosure” [ 12 ]. Respectful communication between nurses and patients can reduce uncertainty, enhance greater patient engagement in decision making, improve patient adherence to medication and treatment plans, increase social support, safety, and patient satisfaction in care [ 12 , 13 ]. Thus, effective nurse-patient clinical communication is essential to enhancing patient-centered care and positive care outcomes.

Patient-centered communication, also known as person-centered communication or client-centered communication, is defined as a process that invites and encourages patients and their families to actively participate and negotiate in decision-making about their care needs, as cited in [ 7 ]. Patient-centered communication is crucial in promoting patient-centered care and requires that patients and their caregivers engage in the care process. As McLean [ 14 ] observed, patient-centered care can be enhanced through patient-centered communication by valuing patients’ dignity and rights. Through open communication and collaboration, where information and care plans are shared among care providers, patients, and their families, care provision becomes patient-centered [ 14 ].

Given the interconnected nature of patient-centered care and communication, we must identify the barriers and enablers of patient-centered care and communication and proposed efficient ways to enhance that because patient-centered communication is essential in achieving patient-centered care. Our aim in this paper is to identify the barriers and facilitators of patient-centered care and communication and propose and present a patient-centered care and communication continuum (PC4) Model to explain how patient-centered care can be enhanced in nurse-patient clinical interactions. As Grant and Booth argued, critical reviews are often used to present, analyse, and synthesized research evidence from diverse sources, the outcome of which is a hypothesis or a model as an interpretation of existing data to enhance evidence-based practice [ 15 ]. Thus, this critical literature review study explores the questions: what are the barriers and facilitators of patient-centered care and how can patient-centered care be enhanced through effective clinical communication?

An earlier version of this study was submitted as part of author AK’s doctoral comprehensive exams in February 2021. An interdisciplinary doctoral committee recommended many of the included literature and the questions explored in this study based on the current discourse of patient-centered care advocated for in many healthcare facilities and in recognition of the universal healthcare access objective of the health sustainable development goal. Additional searches for literature were conducted between September and November 2020 using keywords such as barriers and facilitators of nurse-patient interaction, patient-centered care, patient-centered communication , and nurse-patient communication . Databases searched included CINAHL, PubMed, Medline, and Google Scholar. Included studies in this critical review were empirical research on nurse-patient interactions in different care settings published in English and open access. All relevant articles were read, and their main findings relevant to our review questions were identified and organized into themes and subthemes discussed in this paper. Other published studies were read, and together with those that addressed the review question, a model was developed regarding how to enhance patient-centered care through effective communication.

Barriers to Patient-Centered Care and Communication

Nurses constitute a significant workforce of care providers whose practices can severely impact care outcomes (both positive and negative). Nurses spend much time with patients and their caregivers. As a result, positive nurse-patient and caregiver relationships are therapeutic and constitute a core component of care [ 9 , 13 ]. In many instances, nurses serve as translators or patients’ advocates, in addition to performing their primary care duties. Although good nurse-patient relationships positively impact nurse-patient communication and interaction, studies have shown that several factors impede these relationships with significant consequences on care outcomes and quality [ 6 , 16 , 17 ]. Thus, these barriers limit nurses’ and other care providers’ efforts to provide healthcare that meets patients’ and caregivers’ needs. We categorize the barriers to patient-centered care and communication into four kinds: institutional and healthcare system-related, communication-related, environment-related, and personal and behaviour-related barriers. Although these barriers are discussed in separate subheadings, they are interlinked in complex ways during clinical practice.

Institutional and Healthcare System Related Barriers

Many barriers to providing patient-centered care and communication during nurse-patient interactions emanate from healthcare institutional practices or the healthcare system itself. Some of these factors are implicated in healthcare policy or through management styles and strategies.

Shortage of nursing staff, high workload, burnout, and limited-time constituted one complex institutional and healthcare system-level barrier to effective care delivery [ 18 , 19 ]. For instance, Loghmani et al. [ 20 ] found that staffing shortages prevented nurses from having adequate time with patients and their caregivers in an Iranian intensive care unit. Limitations in nursing staff, coupled with a high workload, led to fewer interactions between nurses, patients, and caregivers. Similarly, Anoosheh et al. [ 16 ] found that heavy nursing workload was ranked highest as a limiting factor to therapeutic communication in nurse-patient interactions in Iran.

In a study on communication barriers in two hospitals affiliated with Alborz University of Medical Sciences, Norouzinia et al. [ 21 ] found that shortage of nurses, work overload, and insufficient time to interact with patients were significant barriers to effective nurse-patient interactions. Similar factors are identified as barriers to nurse-patient communication and interactions in other studies [ 13 , 16 , 18 ]. For instance, Amoah et al. [ 16 ] reported that nursing staff shortage and high workload were barriers to patient-centered care and therapeutic communication among Ghanaian nurses and patients. Amoah and colleagues reported a patient’s statement that:

[B]ecause there are few nurses at the ward, sometimes you would want a nurse to attend to you, but he or she might be working on another patient, so in such case, the nurse cannot divide him or herself into two to attend to you both [ 16 ].

Nurses and patients and their caregivers have noted that limited time affects nurse-patient interactions, communication, and care quality. Besides, Yoo et al. [ 22 ] reported that limited visiting hours affected communications between caregivers and nurses in a tertiary hospital in Seoul, Korea. Since the caregivers had limited time to spend with patients, they had little knowledge about the intensive care unit and distrusted the nurses.

Although nursing staff shortage is a significant barrier to patient-centered care and communication that healthcare institutions and managers must know, some healthcare scholars have critique nurses’ complaints of time limitation. For instance, McCabe [ 7 ] argued that the quality of nurse-patient interactions is what matters and not the quantity of time spent with patients and their caregivers. McCabe maintained that “spending long periods with patients does not always result in positive nurse-patient relationships” [ 7 ]. He argued that implementing patient-centered care does not require additional time; hence, nurses’ perceptions of being too busy cannot excuse poor therapeutic communication during clinical interactions. Instead, nurses are encouraged to develop self-awareness, self-reflection, and a commitment to ensuring that patients receive the needed care.

Another institution-related barrier to patient-centered care and communication is the healthcare system’s emphasis on task-centered care. Care providers are more focused on completing care procedures than satisfying patients’ and caregivers’ needs and preferences. This barrier to patient-centered care and communication is acknowledged in several studies [ 7 , 14 , 20 , 22 , 23 ]. For example, McLean [ 14 ] studied dementia care in nursing homes in the United States. She found that patient-centered care and communication in one nursing home (Snow I) were severely affected when nurses, physicians, and care managers focused on completing tasks or observing care and institutional routines to the detriment of satisfying patients’ care needs. However, in the other care home (Snow II), patient-centered care was enhanced as nurses, physicians, and the care home managers focused on addressing patients’ needs and values rather than completing care routines and tasks.

Similarly, Yoo and colleagues [ 22 ] observed that nurse-patient communication was affected when the ICU nurses placed urgency on completing tasks linked directly to patients’ health (e.g., stabilizing vital signs) than communicating to addressed patients’ specific needs. This evidence shows that when nurses are more task-focused, patients and caregivers are treated as bodies and objects, on which medical and care practices must be performed to restore health. Research has shown that when nurses focus on task-oriented care, it becomes hard to provide holistic care to patients or teach and communicate with patients even when nurses are less busy [ 20 ].

Nursing managers and their management styles can affect patient-centered care and communication. Studies have revealed that the management styles that nursing managers implement can either facilitate or impede patient-centered care [ 14 , 22 ]. When nurse managers orient their nursing staff towards task-centered care practices, it affects nurse-patient interaction and communication. Moreover, when nurse managers fail to address their staff’s mental health needs and personal challenges, it influences how nurses attend to patients’ care needs. For example, nurses have indicated that nurse-patient communication is affected when nurse managers are unsupportive or unresponsive to their needs [ 20 ].

In a study exploring nursing and midwifery managers’ perspectives on obstacles to compassion giving and therapeutic care across 17 countries, Papadopoulos et al. [ 24 ] discovered that nurses and midwifery managers’ characteristics and experiences could facilitate or impede compassion and therapeutic interactions in nursing care. Negative personal attitudes, including selfishness, arrogance, self-centeredness, rudeness, lack of leadership skills, the desire for power, and feelings of superiority among nurses and midwifery managers, were obstacles to compassion building. The study further showed that managers who emphasize rules, tasks, and results do not prioritize relationship-building and see their staff as workers rather than team members [ 24 ]. Therefore, nurse managers and care administrators must monitor nurse-patient interaction and communication to address nurses’ concerns and support them, especially in resource-constrained and high patient turnover contexts [ 25 , 26 ].

Communication-Related Barriers

Effective communication is essential to providing patient-centered care. Studies have shown that poor communication between care providers and patients and their caregivers affects care outcomes and perceptions of care quality [ 7 , 16 , 27 , 28 ]. A consistent communication-related barrier in nurse-patient interaction is miscommunication, which often leads to misunderstandings between nurses, patients, and their families [ 20 ]. Other communication-related barriers include language differences between patients and healthcare providers [ 6 , 16 , 27 ], poor communication skills, and patients’ inability to communicate due to their health state, especially in ICU, dementia, or end-of-life care contexts [ 13 , 22 ]. For instance, in their maternity care study, Madula et al. [ 6 ] noted that language barriers significantly affected effective communication between nurses/midwives and expectant mothers. A patient in their study indicated that although many nurses were polite and communicated well, some nurses had challenges communicating with patients in the Chitumbuka language, which affected those nurses’ ability to interact effectively with patients [ 6 ].

Furthermore, Norouzinia et al. [ 21 ] asserted that effective communication could not be established when nurses and patients have a language difference. Moreover, the meanings of certain non-verbal communication acts (e.g., head nodding, eye gaze, touch) can invoke different interpretations across different cultures, which could impede the interactions between patients and nurses. Even in healthcare contexts where nurses and patients speak the same language, “differences in vocabulary, rate of speaking, age, background, familiarity with medical technology, education, physical capability, and experience can create a huge cultural and communication chasm” between nurses and patients [ 12 ]. In ICU and other similar care settings, nurses find it difficult to effectively communicate with patients because the mechanical ventilators made it hard for patients to talk [ 22 ].

To overcome the communication-related barriers, healthcare institutions must make it a responsibility to engage translators and interpreters to facilitate nurse-patient interactions where a language barrier exists. Moreover, nurses working in ICU and other similar settings should learn and employ alternative forms of communication to interact with patients.

Environment-Related Barriers

The environment of the care setting can impact nurse-patient communication and the resulting care. Thus, “good health care experiences start with a welcoming environment” [ 29 ]. Mastors believed that even though good medicine and the hands working to provide care and healing to the sick and wounded are essential, we must not “forget the small things: a warm smile, an ice chip, a warm blanket, a cool washcloth. A pillow flipped to the other side and a boost in bed” [ 29 ]. The environment-related barriers are obstacles within the care setting that inhibit nurse-patient interaction and communication and may include a noisy surrounding, unkept wards, and beds, difficulties in locating places, and navigating care services. Noisy surroundings, lack of privacy, improper ventilation, heating, cooling, and lighting in specific healthcare units can affect nurse-patient communication. These can prevent patients from genuinely expressing their healthcare needs to nurses, which can subsequently affect patient disclosure or make nursing diagnoses less accurate [ 13 , 18 , 21 ]. For instance, Amoah et al. [ 16 ] revealed that an unconducive care environment, including noisy surroundings and poor ward conditions, affected patients’ psychological states, impeding nurse-patient relationships and communication. Moreover, when care services are not well-coordinated, new patients and their caregivers find it hard to navigate the care system (e.g., locating offices for medical tests and consultations), which can constrain patient-centered care and communication.

Reducing the environment-related barriers will require making the care setting tidy/clean, less noisy, and coordinating care services in ways that make it easy for patients and caregivers to access. Coordinating and integrating care services, making care services accessible, and promoting physical comfort are crucial in promoting patient-centered care, according to Picker’s Eight Principles of Patient-Centered Care [ 30 ].

Personal and Behaviour Related Barriers

The kind of nurse-patient relationships established between nurses and patients and their caregivers will affect how they communicate. Since nurses and patients may have different demographic characteristics, cultural and linguistic backgrounds, beliefs, and worldviews about health and illnesses, nurses’, patients’, and caregivers’ attitudes can affect nurse-patient communication and care outcomes. For instance, differences in nurses’ and patients’ cultural backgrounds and belief systems have been identified as barriers to therapeutic communication and care [ 12 , 13 , 21 ]. Research shows that patients’ beliefs and cultural backgrounds affected their communication with nurses in Ghana [ 16 ]. These scholars found that some patients refused a blood transfusion, and Muslim patients refused female nurses to attend to them because of their religious beliefs [ 16 ]. Further, when nurses, patients, or their caregivers have misconceptions about one another due to past experiences, dissatisfaction about the care provided, or patients’ relatives and caregivers unduly interfere in the care process, nurse-patient communication and patient-centered care were affected [ 16 , 21 ].

Similarly, nurse-patient communication was affected when patients or caregivers failed to observe nurses’ recommendations or abuse nurses due to misunderstanding [ 20 ], while patients’ bad attitudes or disrespectful behaviours towards nurses can inhibit nurses’ ability to provide person-centered care [ 31 ]. The above-reviewed studies provided evidence on how patients’ and caregivers’ behaviours can affect nurses’ ability to communicate and deliver patient-centered care.

On the other hand, nurses’ behaviours can also profoundly affect communication and care outcomes in the nurse-patient dyad. When nurses disrespect, verbally abuse (e.g., shouting at or scolding), and discriminate against patients based on their social status, it affects nurse-patient communication, care outcomes, and patient disclosure [ 6 , 32 ]. For instance, Al-Kalaldeh et al. [ 18 ] believe that nurse-patient communication is challenged when nurses become reluctant to hear patients’ feelings and expressions of anxiety. When nurses ignore patients’ rights to share ideas and participate in their care planning, such denials may induce stress, discomfort, lack of trust in nurses, thereby leading to less satisfaction of care [ 18 ].

Furthermore, when nurses fail to listen to patients’ and caregivers’ concerns, coerce patients to obey their rules and instructions [ 16 , 17 , 20 ], or fail to provide patients with the needed information, nurse-patient communication and patient-centered care practices suffer. To illustrate, in Ddumba-Nyanzia et al.‘s study on communication between HIV care providers and patients, a patient remarked that: “I realized no matter how much I talked to the counselor, she was not listening. She was only hearing her point of view and nothing else, [and] I was very upset” [ 17 ]. This quote indicates how care provider attitudes can constrain care outcomes. Due to high workload, limited time, poor remunerations, and shortage of personnel, some nurses can develop feelings of despair, emotional detachment, and apathy towards their job, which can lead to low self-esteem or poor self-image, with negative consequences on nurse-patient interactions [ 13 , 18 ].

Given the significance of effective communication on care, overcoming the above personal and behaviour related barriers to patient-centered care and communication is crucial. Nurses, patients, and caregivers need to reflect on the consequences of their behaviours on the care process. Thus, overcoming these barriers begins with embracing the facilitators of patient-centered care and communication, which we turn to in the next section.

Facilitators of patient-centered care and communication

Patient-centered care and communication can be facilitated in several ways, including building solid nurse-patient relationships.

First, an essential facilitator of patient-centered care and communication is overcoming practical communication barriers in the nurse-patient dyad. Given the importance of communication in healthcare delivery, nurses, patients, caregivers, nursing managers, and healthcare administrators need to ensure that effective therapeutic communication is realized in the care process and becomes part of the care itself. Studies have shown that active listening among care providers is essential to addressing many barriers to patient-centered care and communication [ 7 , 13 ]. Although handling medical tasks promptly in the care process is crucial, the power of active listening is critical, meaningful, and therapeutic [ 22 ]. By listening to patients’ concerns, nurses can identify patients’ care needs and preferences and address their fears and frustrations.

Another facilitator of patient-centered care is by understanding patients and their unique needs [ 25 ], showing empathy and attending attitudes [ 7 , 13 ], expressing warmth and respect [ 22 ], and treating patients and caregivers with dignity and compassion as humans. For instance, McCabe [ 7 ] noted that attending, which obligates nurses to demonstrate that they are accessible and ready to listen to patients, is a patient-centered care process; a fundamental requirement for nurses to show genuineness and empathy, despite the high workload. Showing empathy, active listening, respect, and treating patients with dignity are core to nursing and care, and recognized in the Code of Ethics for Nurses [ 33 ], and further emphasized in the ongoing revision of the Code of Ethics for nurses [ 34 ].

Besides, engaging patients and caregivers in the care process through sharing information, inviting their opinion, and collaborating with them constitutes another facilitator of patient-centered care and communication. When patients and caregivers are engaged in the care process, misunderstandings and misconceptions are minimized. When information is shared, patients and caregivers learn more about their health conditions and the care needed. As McLean [ 14 ] argued, ensuring open communication between care providers and patients and their families is essential to enhancing patient-centered care. Conflicts ensue when patients or their families are denied information or involvement in the care process. As a result, the Harvard Medical School [ 30 ] identified patient engagement, information sharing, and nurse-patient collaboration during care as essential patient-centered care principles.

Finally, health policy must be oriented towards healthcare practices and management to facilitate patient-centered care and communication. These policies, at a minimum, can involve changes in management styles within healthcare institutions, where nurse managers and healthcare administrators reflect on nursing and care practices to ensure that the Code of Ethics of Nurses and patients’ rights are fully implemented. Resource constraints, staff shortages, and ethical dilemmas mainly affect care practices and decision-making. Nonetheless, if patients are placed at the center of care and treated with dignity and respect, most of the challenges and barriers of patient-centered care will diminish. Empowering practicing nurses, equipping them with interpersonal communication skills through regular in-service training, supporting them to overcome their emotional challenges, and setting boundaries during nurse-patient interactions will enhance patient-centered care practices.

In line with the above discussion, Camara et al. [ 25 ] identify three core dimensions that nurses, patients, and caregivers must observe to enhance patient-centered care: treating the patient as a person and seeing the care provider as a person and a confidant. Regarding the first dimension, care providers must welcome patients, listen to them, share information with them, seek their consent, and show them respect when providing care. The second dimension requires that the healthcare provider be seen and respected as a person, and negative perceptions about care providers must be demystified. According to Camara et al. [ 25 ], care providers must not overemphasize their identities as experts but rather establish good relationships with patients to understand patients’ personal needs and problems. Lastly, patients and caregivers must regard care providers as confidants who build and maintain patients’ trust and encourage patients’ participation in care conversations. With this dimension, patients and caregivers must know that nurses and other care providers have the patient at heart and work to meet their care needs and recovery process.

Camara et al.‘s [ 25 ] three dimensions are essential and position patients, their caregivers, and nurses as partners who must engage in dialogic communication to promote patient-centered care. As a result, effective communication, education, and increased health literacy among patients and caregivers will be crucial in that direction.

Enhancing Patient-Centered Care and Communication: A Proposed Model

Nursing care practices that promote patient-centered communication will directly enhance patient-centered care, as patients and their caregivers will actively engage in the care process. To enhance patient-centered communication, we propose person-centered care and communication continuum (PC4) as a guiding model to understand patient-centered communication, its pathways, and what communication and care practices healthcare professionals must implement to achieve person-centered care. In this PC4 Model, we emphasize the person instead of the patient because they are a person before becoming a patient. Moreover, the PC4 Model is supposed to apply to all persons associated with patient care; thus, respect for the dignity of their personhood is crucial.

Although much is written about patient-centered communication in the healthcare literature, there is a gap regarding its trajectory and what communication content enhances patient-centered communication. Also, little is known about how different clinical discourse spaces influence communication and its content during nurse-patient clinical interactions. Using evidence from Johnsson et al. [ 3 ], Murira et al. [ 23 ], and Liu et al. [ 35 ], among other studies, we outline the components of the PC4 Model and how different discourse spaces in the clinical setting and the content of communication impact patient-centered care and communication.

The proposed PC4 Model in this paper has three unbounded components based on the purpose of and how communication is performed among care providers, patients, and their caregivers. Figure  1 illustrates the PC4 Model, its features, and trajectory.

A Person-Centered Care and Communication Continuum (PC4 Model)

Task-Centered Communication

At the lowest end of the PC4 Model is task-centered communication. Here, the care provider’s role is to complete medical tasks as fast as possible with little or no communication with the patient and their caregivers. Patients and caregivers are treated as bodies or objects whose disease symptoms need to be studied, identified, recorded, treated, or cured. As Johnsson et al. [ 3 ] observed, communication content at this stage is mainly biomedically oriented, where nurses and other healthcare professionals focus on the precise medical information (e.g., history taking, medical examination, test results, medication, etc.) about the patient. With a task-centered orientation, nurses make journal entries about their patients’ disease state and ensure that treatment plans, diagnostic tests, and medical prescriptions are completed. Communication at this stage is often impersonal or rigid (see [ 23 ] for details). Care providers may address patients and their caregivers by using informal attributes (e.g., bed 12, the woman in the red shirt, card 8, etc.), thereby ignoring patients’ and caregivers’ personal and unique identities. Patients’ and caregivers’ nonverbal communication signs are mostly overlooked.

Motivations for task-centered communication can be attributed to time limitation, high workload, and staff shortage, thereby pushing nurses and other care providers to reach as many patients as possible. Moreover, the healthcare system’s orientation towards and preference for biomedically-focused care seems to favour task-centered communication [ 7 , 14 ].

Depending on the clinical discourse space under which patient-provider interactions occur, different forms of communication are employed. Clinical discourse spaces can be public (e.g., in the ward, patient bedside), private (e.g., consulting rooms, medical test labs, nurse staff station, etc.), or semi-private (e.g., along the corridor) [ 35 ]. In these clinical discourse spaces, nurse-patient communication can be uninformed (patients or caregivers are not informed about patients’ care conditions or why specific data and routines are performed). It can be non-private (others can hear what the nurse and patient are talking about) or authoritative (care providers demonstrate power and control and position themselves as experts) [ 23 ]. Finally, in task-centered communication, healthcare providers often use medical jargon or terminologies [ 3 ] since the goal of communication is not to engage the patient in the process. Usually, patients or their caregivers are not allowed to ask questions, or their questions get ignored or receive superficial, incomprehensible responses.

Process-Centered Communication

Process-centered communication is an intermediate stage on the continuum, which could slip back into the task-centered or leap forward into person-centered communication. Through process-centered communication, care providers make an effort to know patients and their caregivers as they perform care routines. Care providers ask patients or their caregivers questions to understand the care conditions but may not encourage patients or caregivers to express their thoughts about their care needs. Patients and caregivers are recognized as persons with uniques care needs but may not have the agency to influence the care process. Care providers may chit-chat with patients or their caregivers to pass the time as they record patients’ medical records or provide care. Unlike task-centered communication, there is informative and less authoritative communication between nurses and patients and their caregivers. The goal of process-centered communication could be a mixture of instrumental and relational, with less display of power and control by nurses.

Person-Centered Communication

This is the highest point of the PC4 Model, where patient-centered care is actualized. At this stage of the communication continuum, patients and caregivers are treated as unique persons with specific care needs and are seen as collaborators in the care process. As McLean [ 14 ] observed, caregiving becomes a transactional relationship between the care provider and receiver at the person-centered stage of the continuum. The care itself becomes intersubjective, a mutual relational practice, and an ongoing negotiation for care providers and receivers [ 14 ].

The content of communication at this stage of the continuum is both “personal” and “explanatory” [ 3 ]. Nurses and other healthcare providers create meaningful relationships with patients and their caregivers, understand patients’ concerns, needs, and problems, use open-ended questions to encourage patients or caregivers to express their thoughts and feelings about the care situation. Nurses and other healthcare professionals explain care routines, patients’ health conditions, and management plans in lay language to patients and caregivers through person-centered communication. Accomplishing this level includes employing alternative forms of communication to meet the needs of intensive care unit patients, deaf patients, and ventilated and intubated patients. For instance, it has been shown that “deaf people […] frequently do not have access to clear and efficient communication in the healthcare system, which deprives them of critical health information and qualified health care” [ 36 ]. Empathetic communication practices, including active listening, showing genuine interest in patients’ care, and respect and warmth, become a significant part of nursing care [ 3 , 7 , 14 , 22 ].

Different communication strategies are employed based on the care situation and context. Chit-chatting, as a form of personal communication [ 3 ], use of humor as a communication strategy [ 7 , 8 ], and even maintaining silence [ 28 ] are essential in enhancing person-centered care and communication. Both care providers and patients or their caregivers use relationship-building and -protecting humor (see [ 28 ] for details) to address difficult situations in the care process.

Implications of the PC4 Model for Nursing Practice

Given the values of effective communication in nurse-patient interactions and care outcomes, nurses and other healthcare providers must ensure that they develop therapeutic relationships with patients, their families, and caregivers to promote person-centered care and communication. Achieving that begins with knowing and reflecting on the barriers of therapeutic communication and ways to minimize them. The PC4 Model draws nurses and all healthcare providers’ attention to patient-centered care pathways and how effective communication is necessary. Healthcare professionals, including nurses, must be aware of how their communication orientation–––either oriented toward completing tasks, following care processes or toward addressing patients’ and their caregivers’ needs––can impact patient-centered care. Healthcare providers must observe the care context, patients’ unique situations, their non-verbal language and action, and whether they belong to historically marginalized groups or cultures.

Mastors [ 29 ] has offered healthcare providers some guidance to reflect on as they communicate and interact with patients and caregivers. Thus, (a) instead of asking patients, “What’s the matter?“ care providers must consider asking them, “What’s important to you?“ With this question, the patient is given a voice and empowered to contribute to their own care needs. Care providers should (b) check with patients in the waiting room to update patients whose waiting time has been longer than usual, based on the care context. They should also (c) try to remember their conversations with patients to build on them during subsequent interactions. This continuity can be enhanced by nurse managers reexamining how they deploy care providers to patients. The same nurse can be assigned to the same patients for the duration of the patient’s stay to help patients feel valued and visible [ 29 ].

Knowledge of cultural competence, sensitivity, humility, and interpersonal communication skills will help achieve and implement the PC4 Model. As Cuellar [ 37 ] argues, “[h]umility is about understanding and caring for all people [and] being empathetic.“ Cultural competence is a “dynamic process of acquiring the ability to provide effective, safe, and quality care to the patients through considering their different cultural aspects” [ 38 ]. The concept of cultural competence entails “cultural openness, awareness, desire, knowledge and sensitivity” during care [ 39 ]. It demands that care providers respect and tailor care to align with patients’ and caregivers’ values, needs, practices, and expectations, based on care and moral ethics and understanding [ 39 ]. Active listening and showing compassion as therapeutic relationship-building skills are essential, and continuous education and mentorship will be crucial to developing these skills among healthcare providers.

We invite qualitative and quantitative studies, especially on language use and communication strategies, to explore and evaluate the PC4 Model. Providing in-depth and experiential data on ways to increase its effectiveness as a tool to guide healthcare providers is highly desired. More knowledge can support healthcare providers in offering evidence-based patient-centered care in different healthcare settings and units.

Conclusions

Effective communication is an essential factor in nurse-patient interactions and a core component of nursing care. When communication in the nurse-patient dyad is patient-centered, it becomes therapeutic. It allows for trust and mutual respect in the care process, thereby promoting care practices that address patients’ and caregivers’ needs, concerns, and preferences. We have identified the barriers and facilitators of patient-centered care and communication and proposed a person-centered care and communication continuum (PC4 Model) to demonstrate how patient-centered communication intersects with patient-centered care.

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Abbreviations

Intensive Care Unit

Institution of Medicine

Person-Centered Care and Communication Continuum

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Acknowledgments

We express our gratitude to the first author’s doctoral committee members for their valuable comments, suggestions, and critique of an earlier version of this paper. We are also grateful to the anonymous reviewers for the insightful comments and suggestions that have helped us improve the study’s quality.

Authors' information

Abukari Kwame is a Ph.D. candidate in Interdisciplinary Studies in the College of Graduate and Postdoctoral Studies, University of Saskatchewan, interested in patients' rights in nurse-patient clinical communications and interactions in the hospital setting. He holds two Master of Philosophy degrees in Indigenous Studies and English Linguistics. Abukari's research interests include language use in social interaction, health communication, First/Second language acquisition, African traditional medical knowledge, and Indigenous and qualitative research methodologies.

Pammla M. Petrucka is a professor in Nursing and has international research experience with many of her graduate students from Africa, Asia, and the Caribbean. Pammla has published extensively in the field of nursing. Her research interests are vast, including child and maternal health, Indigenous peoples' health, global health, and vulnerable populations, with extensive experiences in qualitative research and indigenous research methodologies. Pammla is co-editor of the BMC Nursing journal and a reviewer for many other academic journals.

The authors have not received any funding for the conduct, preparation, and publication of this paper.

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Kwame, A., Petrucka, P.M. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs 20 , 158 (2021). https://doi.org/10.1186/s12912-021-00684-2

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The Role of Empathy in Health and Social Care Professionals

Maria moudatsou.

1 Department of Social Work, Hellenic Mediterranean University, 71410 Heraklion, Greece; rg.oohay@muostaduom

2 Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (Quality of Life Lab), Hellenic Mediterranean University, 71410 Heraklion, Greece; moc.liamg@uoluoporvatsitera

3 Centre of Mental Health, 71201 Heraklion, Greece

Areti Stavropoulou

4 Nursing Department, University of West Attica, 12243 Athens, Greece

Anastas Philalithis

5 Department of Social Medicine, Medical School, University of Crete, 70013 Heraklion, Greece; rg.cou@lalihp

Sofia Koukouli

The current article is an integrative and analytical literature review on the concept and meaning of empathy in health and social care professionals. Empathy, i.e., the ability to understand the personal experience of the patient without bonding with them, constitutes an important communication skill for a health professional, one that includes three dimensions: the emotional, cognitive, and behavioral. It has been proven that health professionals with high levels of empathy operate more efficiently as to the fulfillment of their role in eliciting therapeutic change. The empathetic professional comprehends the needs of the health care users, as the latter feel safe to express the thoughts and problems that concern them. Although the importance of empathy is undeniable, a significantly high percentage of health professionals seem to find it difficult to adopt a model of empathetic communication in their everyday practice. Some of the factors that negatively influence the development of empathy are the high number of patients that professionals have to manage, the lack of adequate time, the focus on therapy within the existing academic culture, but also the lack of education in empathy. Developing empathetic skills should not only be the underlying objective in the teaching process of health and social care undergraduate students, but also the subject of the lifelong and continuous education of professionals.

1. Introduction

Communication skills have been described as the most important ability for a health professional. Efficient communication depends upon the therapist feeling certain that they have really heard and recorded the health care user’s needs so as to provide personalized care [ 1 ]. It is important for health professionals to understand people’s feelings, opinions and experiences in order to assess their real needs and act accordingly, offering tailor-made services. Reaching that goal makes the development of empathetic skills necessary [ 2 ].

The concept of empathy is a common denominator for many health professionals such as nurses, doctors, psychologists, and social workers [ 3 , 4 , 5 , 6 ]. The person-centered approach for the unconditional acceptance of the health care user and empathy have for years been the fundamental values in the education and implementation of clinical social practice [ 3 , 7 , 8 , 9 ].

2. Material and Methods

The aim of the present paper was to analyze the concept of empathy and emphasize its importance to the health professions. The research questions under consideration have been the following: 1. What does empathy mean and which are its dimensions; 2. What are the role and meaning of empathy in health and social care professions for the therapeutic journey of the health care user; 3. How can we assess the levels of empathy in professionals (assessment tools); 4. Which factors influence empathy?

A literature search was conducted by searching PubMed and Scopus databases, to identify studies of the last fifteen years published in English and Greek language. The key-words used were ‘empathy’ and ‘health professionals’. Out of the search, 78 studies were identified that better answer the aim and purposes of the present paper. These studies were discussed and evaluated by the authoring team in order to reach consensus on the eligibility of each one with the proposed research questions. After agreement was reached, re-examination and analysis of the studies’ findings lead to the formulation of four thematic categories, namely, a) Concept definition and dimensions, b) The role of empathy in health and social care professionals, c) Assessing empathy, and d) Factors that influence empathy.

3.1. Concept Definition and Dimensions

Empathy is the ability to understand and share other people’s feelings [ 10 ]. It is a core concept as, according to the psychodynamic, behavioral and person-centered approaches, it facilitates the development of a therapeutic relationship with the health care user, providing the basis for therapeutic change [ 11 ].

Empathy was first mentioned in a psychotherapeutic context in the 1950s [ 7 ]. The person-centered approach defined it as the temporary condition that a health professional experiences in his/her effort to understand a health care user’s life without bonding with them [ 3 , 12 ].

The contemporary concept of empathy is multidimensional and consists of affective, cognitive, and behavioral aspects [ 6 , 11 , 13 ]. Throughout history, the development and integration of this concept evolved along three different time periods. Until the end of the 1950s, the cognitive dimension was mostly prevalent. From 1960 onwards, emphasis was given to the affective dimension, whereas since 1970, empathy has been defined in all its multi-dimensionality; that is, the behavioral aspect has been added to the everyday practice of the health care professionals [ 14 ].

The affective dimension consists of the concepts of caring and that of the sincere, unconditional acceptance of the health care user (congruence) [ 8 , 15 , 16 ]. Caring refers to the assistance and support as byproducts of an emotional interaction. The concept of the full and sincere unconditional acceptance refers to the approval of the ‘other’ and a consensus between people, without preconceptions or stereotypes.

The cognitive dimension pertains to the interpersonal sensitivity and the ability to understand the position the other person is in (perspective taking) [ 17 , 18 ]. Interpersonal sensitivity means objectively understanding the other person’s situation. It is a deep process of getting to know someone, based in both verbal and non-verbal cues. The ability to understand the other person’s situation refers to the flexibility and the objective understanding of the point of view of the other person (walk in their shoes, comprehending the way they perform cognitively, emotionally, and mentally) [ 17 , 18 ].

Altruism and the therapeutic relationship both belong to the behavioral dimension which develops empathy into practice [ 19 , 20 ]. Altruism is a socially directed behavior aimed at relieving difficulties, problems, and the pain associated with them [ 11 ].

Sympathy, empathy, and compassion are closely related terms that are often used interchangeably. Sympathy has been defined as an emotional reaction of pity toward the misfortune of another, especially those who are perceived as suffering unfairly [ 21 ]. Empathy is understood as a more complex interpersonal construct that involves awareness and intuition, while compassion is a ‘complementary social emotion, elicited by witnessing the suffering of others’ and is related with the feelings of concern, warmth associated to motivating of support [ 22 ]. Empathetic listening might result in compassion fatigue because of prolonged exposure to stress and all it evokes [ 23 ]. Self-care practice, well-being, and self-awareness are fundamental in enhancing empathy and reducing compassion fatigue [ 23 , 24 ].

3.2. The Role of Empathy in Health and Social Care Professionals

In a qualitative research study, nurse students, who were asked their opinion on empathy, emphasized the three dimensions of the concept [ 3 ]. Participants described it as the nurse’s ability to understand and experience other people’s feelings, thoughts, and wishes, as well as the nurse’s capacity to comprehend the emotional and cognitive state of the person they work with. To sum up, empathy is perceived as a combination of the emotional, cognitive and practical skills involved when caring for a patient [ 3 ].

Empathy is one of the fundamental tools of the therapeutic relationship between the carers and their patients and it has been proven that its contribution is vital to better health outcomes [ 8 , 25 , 26 ]. As it allows the health care providers to detect and recognize the users’ experiences, worries, and perspectives [ 27 ], it strengthens the development and improvement of the therapeutic relationship between the two parts [ 28 ]. It is widely acknowledged that the health professional’s empathetic ability leads to better therapeutic results [ 29 ].

The empathetic relationship of the health professionals with their health care users reinforces their cooperation towards designing a therapeutic plan and a tailor-made intervention, increasing thus the patient’s satisfaction from the therapeutic process. This way, quality of care is enhanced, errors are eliminated, and an increased percentage of health care recipients positively experience therapy [ 30 , 31 , 32 , 33 , 34 ]. Furthermore, it has been noted that the empathetic relationship developed during the process of care reinforces the therapeutic results, as the users better comply with the therapeutic course of action [ 34 ].

Studies performed in various groups of patients with different health problems generated positive results regarding the progress of their health. Specifically, studies of patients with diabetes showed that there is an association between empathy and the positive therapeutic course of disease [ 31 , 35 ]. Moreover, patients with cancer demonstrate less stress, depression, and aggressiveness when receiving empathetic nursing care [ 36 ]. The empathetic relationship between a midwife and a future mother increases the latter’s satisfaction and lessens the stress, the agony, and the pain of the forthcoming labor as the mother feels security, trust, and encouragement [ 37 ].

Understanding based on empathy is critical to the relationship between the health professional and the recipient of care. When that happens, health care users feel secure and trust the professional’s abilities. Therefore, the distance between the expert and the patient shortens and both of them come closer, enjoying mutual benefits [ 12 ]. Moreover, a relationship based on empathy helps the therapists lessen their stress and burnout in the workplace and adds to their quality of life [ 37 , 38 ]. It has been shown that physicians who have higher levels of empathy experience less burnout or depression [ 39 , 40 ].

Empathy is especially important to the social care professions. It has been noted that the ability of the social worker for empathy and understanding of the users’ experiences and feelings plays a crucial role in social care as empathy is one of the most important skills that these professionals may employ to develop a therapeutic relationship [ 5 , 41 ].

Health care users who experience empathy during their treatment exhibit better results and a higher possibility for a potential improvement [ 42 ]. Moreover, social workers with higher levels of empathy work more efficiently and productively as to the fulfillment of their role in creating social change [ 13 ]. This happens because empathy helps the social worker understand and feel compassion towards their health care users so as the latter can feel secure to express their thoughts and problems. This way, a basis for trust is created, one that leads to therapeutic change and the improvement of the care recipient’s overall social functionality [ 13 ]. Social functionality levels are assessed by the social worker and refer to the ability of a person to accomplish their everyday activities (preparing and keeping meals, seeking accommodation, taking care of their selves, commuting) as well as their ability to fulfill social roles (parent, employee, member of a community) according to the requirements of their cultural environment [ 43 ].

Empathy contributes to the precise assessment of the situation the health care user is in. It offers the therapists the chance to make good use of non-verbal cues (behavior modeling, body movements, tone of voice, etc.) and helps them manage the user’s emotions. What is more, empathy enhances the user’s ability to comprehend reality and improve the quality of their life [ 13 ].

3.3. Assessing Empathy

Although both health care users and health professionals consider empathy as very important for the development of the therapeutic relationship and a necessary skill for a therapist, studies show a reduction of empathy in professional relationships. Often, health care users believe that health professionals do not understand the situation that health care users are in, whereas research findings showed that health professionals and health care users have different views on the communication abilities of the former, as if they come from different worlds [ 44 , 45 ]. It is especially important that—according to research findings deriving from medical student samples—empathy seems to increase in the first year of studies, but starts decreasing around the third year and remains low up to graduation [ 46 , 47 ].

As mentioned before, there are different dimensions, but also levels of empathy. Accordingly, there are different assessment scales for professionals and patient-users [ 48 ].

One of the most important tools for the quantitative assessment of empathy is the Jefferson Scale of Empathy (JSE) which was originally used to evaluate empathy in medical students [ 27 , 49 ]. Subsequently, its use was extended to other professional groups also, for example physicians, health professionals in general and students of other health professions [ 27 , 49 , 50 , 51 ]. The Jefferson scale has been used in many countries, such as the USA, Poland, Korea, Italy, Japan and has been standardized for its validity and reliability [ 12 , 49 , 50 , 52 , 53 ]. It is self-administered and completed by physicians and other health professionals who provide care to patients in clinical settings. Moreover, students of medical, nursing, and other health care sciences may also complete it. The scale includes 20 questions and the overall score ranges from twenty to one hundred and forty; higher scores indicate a better empathic relationship in the medical and therapeutic care [ 26 , 49 , 53 , 54 ].

More specifically, for social work, the Empathy Scale for Social Workers (ESSW) is a questionnaire designed for the quantitative assessment of empathy in social care professionals and students. It can be very useful in practice settings to support decision making processes, assist career choice decisions, continuing education, and supervision needs in the field of social care. Its usefulness is also underscored for potential social work supervisors, as it helps identifying the types of empathy needed while supervising clinicians and staff. The scale is a screening and self-evaluation tool completed by social work students and practitioners [ 13 ]. It consists of 41 questions and every question is marked on a five point scale and higher scores indicate higher levels of empathy [ 13 ].

3.4. Factors that Influence Empathy

As mentioned before, although research has showed the value of empathy, there are still many difficulties in regards to its implementation in the clinical practice [ 32 ]. A relatively high percentage of health professionals, about 70%, find it difficult to develop empathy with their health care users [ 32 ].

Age, self-reflection, appraisal, and emotions’ expressions were associated with women’s social workers empathy. Social workers had a higher score of empathy whenever they had previous work experience [ 55 ]. Additionally, there are studies that support that being female is associated with higher levels of empathy [ 56 , 57 ].

Research outcomes suggest that protective factors of social workers’ empathy are prosocial behavior toward work and positive personal and environmental resources [ 58 ]. Self-esteem, work engagement, and emotional regulation are also positively associated with empathy [ 58 , 59 ]. On the other hand, empathy is limited due to daily stress, that is a risk factor for burnout and compassion fatigue [ 59 , 60 ].

Empathy is positively correlated with reflective ability and emotional intelligence both in professional social workers and social work students [ 55 , 61 ]. According to a study in social work students in India, empathy and emotional intelligence were extracted as predictors of resilience through regression analysis. The authors underlined the need to enhance these attributes in social work students through the provision of appropriate curricular experiences [ 62 ].

The lack of empathy—or the low empathy levels—depends on several reasons. The most important are the large number of health care users that professionals have to deal with, the lack of adequate time, the focus on therapy, the predominant culture in medical schools, and the lack of training in empathy [ 30 ].

Further reasons include presumptions, a sense of superiority from the health professionals, and a fear of boundary violation. Time pressure, anxiety, a lack of self-awareness, and a lack of appropriate training, as well as the different socio-economic status, all the above do not favor empathy either [ 13 ].

According to scientific views from the Medicine field, empathy can be learned and Medical schools should educate their students in this respect [ 63 , 64 ]. Many studies have pointed out the necessity for future professionals to receive training in order to enhance their empathetic skills [ 64 , 65 ].

Although empathy is a core, quality principle for the health care professions, there are studies that show that health professionals cannot adequately express it and implement it [ 66 , 67 ]. According to studies in undergraduate nursing students, empirical education through learning processes can positively influence empathy [ 4 , 68 ]. Education is considered, both by students and professionals, as especially important for the reinforcement of empathetic skills [ 4 , 69 , 70 ].

Nevertheless, research data on the effectiveness of education in empathy are limited [ 71 , 72 , 73 ]. In a research study, conducted in the USA regarding the effect that empathy education has on health professionals, it was found that education contributes a great deal to the improvement of the therapeutic relationship [ 32 ]. In the same study, trained professionals are more likely to detect the emotion and progress of their health care users and therefore further explore and meet their needs. Education can be offered through hands-on work, multimedia use, role play, and experiential learning [ 32 ].

In a qualitative study, health professionals made suggestions regarding the enhancement of empathy. These suggestions included more holistic, educational interventions in behaviors that are central to the patient’s needs, with an emphasis on personal development, professional training, and supervision programs, rather than education in behavioral and communication skills [ 74 ].

‘Diversity Dolls’ is a hands-on educational method for the reinforcement of empathy that is used among social care students in a Greek university, so that students can instill empathetic skills in socially vulnerable populations [ 75 ]. It is believed that the use of such based-on-art methods helps social care students to feel safe, to explore, and give meaning to the real circumstances people live in, through pleasant, participatory, interactive activities [ 76 ].

Globally, creative educational methods such as journaling, art, role-play, and simulation games globally are becoming more popular in the health and social care fields helping students to increase their knowledge and skills in relation to empathy [ 75 , 76 ].

Teaching techniques and classroom methodologies familiarize social workers to empathetic skills [ 55 ]. In a study, among social work students, the results suggest that empathetic modeling from professors and field supervisors enhance social work students’ empathy. Social work educators should not focus on traditional teaching but they ought to concentrate on interactive and creative education that enhances the empathetic modeling and relationship between educators and students [ 77 ]. Apart from teaching social work students with mental flexibility, regulation of emotional and perspective taking, social workers should be taught empathy throughout the phenomenological psychological approach (seminars that utilize transcribed audio recordings of interactions) [ 78 , 79 ]. Additionally, regular supervision has a key role in enabling social workers to process their own feelings and to deal with empathy [ 80 ].

4. Conclusions

Empathy among health care users and professionals significantly contributes to how both groups behave as well as to their therapy and overall well-being. The development of empathetic skills constitutes an important priority in the education of health and social care students and should be encouraged. Educational programs should primarily be performed in a hands-on way that will strengthen the students’ personal and social skills and allow them to effectively communicate with their patients.

Moreover, health care professionals should be supported through continuous and personal development education programs as well as through supervision sessions that will allow them to develop empathetic skills. Political will is a prerequisite for the financing and encouragement of further actions.

Author Contributions

All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Home — Essay Samples — Sociology — Effective Communication — Developing Effective Communication in Health and Social Care

Developing Effective Communication in Health and Social Care

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The behaviourist approach, psychodynamic perspective, humanistic approach.

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• Published: 12 April 2024

Building public engagement and access to palliative care and advance care planning: a qualitative study

• Rachel Black   ORCID: orcid.org/0000-0001-8952-0501 1 ,
• Felicity Hasson   ORCID: orcid.org/0000-0002-8200-9732 2 ,
• Paul Slater   ORCID: orcid.org/0000-0003-2318-0705 3 ,
• Esther Beck   ORCID: orcid.org/0000-0002-8783-7625 4 &
• Sonja McIlfatrick   ORCID: orcid.org/0000-0002-1010-4300 5  

BMC Palliative Care volume  23 , Article number:  98 ( 2024 ) Cite this article

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Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required.

Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted ( n  = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement.

Three themes were generated from the data: “Visibility and relatability”; “Embedding opportunities for engagement into everyday life”; “Societal and cultural barriers to open discussion”. Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement.

Conclusions

Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society.

Peer Review reports

It is estimated that globally only 14% of patients who require palliative support receive it [ 1 ]. The World Health Organisation (WHO) advocates for palliative care (PC) to be considered a public health issue and suggests earlier integration of PC services within the wider healthcare system is required [ 2 ]. However, research has shown that a lack of public knowledge and misconceptions about PC may deter people from accessing integrative PC services early in a disease trajectory [ 3 ]. Integral to good PC is the facilitation of choice and decision-making, which can be facilitated via advance care planning (ACP). Evidence suggests that ACP can positively impact the quality of end of life care and increase the uptake of palliative care services [ 4 ]. While ACP is commonly associated with end of life (EOL) care, it provides the opportunity for adults of any age to consider their wishes for future care and other financial and personal planning. However, there is evidence of a lack of active engagement in advance care planning (ACP) [ 5 ]. Recent research exploring knowledge and public attitudes towards ACP found just 28.5% of participants had heard the term and only 7% had engaged in ACP [ 6 ]. Barriers to engagement in ACP discussions have been found to include topics such as death and dying are considered a social taboo, posing an increased risk of distress for loved ones; and [ 6 ] a misconception that ACP is only for those at the end of life rather than future planning [ 7 ]. Therefore, there is a need for a public health approach to ACP, to enable and support individuals to engage in conversations about their wishes and make decisions surrounding their future care.

The need for a public health approach to PC, to tackle the challenges of equity and access for diverse populations, was noted in a recent Lancet paper [ 8 ]. This is further supported in a recent review, exploring inequalities in hospice care in the UK, Australia, New Zealand, and Canada which reported that disadvantaged groups such as those with non-cancer illnesses, people living in rural locations and homeless individuals had unequal access to palliative care [ 9 ]. They postulated that differing levels of public awareness in what hospice care provides, and to whom, was an influencing factor with variations in health literacy and knowledge of health services being present in both minority and socioeconomic groups [ 9 ].

Changes in how we experience death and dying have resulted in a shift away from family and community settings into healthcare settings. The Lancet commission exploring the ‘Value of Death’, suggests it has created an imbalance where the value of death is no longer recognised [ 10 ]. The commission’s report posits the need to rebalance death, dying and grieving, where changes across all death systems are required. This needs to consider how the social, cultural, economic, religious, and political factors that determine how death, dying, and bereavement are understood, experienced, and managed [ 10 ].

New public health approaches that aim to strengthen community action and improve death literacy, through increased community responsibility are reflected in initiatives, such as ‘Compassionate Communities’ and ‘Last Aid’ [ 11 , 12 ]. However, a suggested challenge is the management of potential tensions that are present when attempting to conceptualise death in a way that mobilises a whole community [ 13 ]. Whilst palliative care education (PCE) can be effective in improving knowledge and reducing misconceptions, many PCE intervention studies, have focused on carers and healthcare professionals [ 14 ]. Initiatives such as ‘Last Aid’ attempt to bridge this gap by focusing on delivering PCE to the public, however, they are not embedded into the wider social networks of communities. It can be argued that public health campaigns, such as these are falling short by neglecting to use the full range of mass media to suit different ages, cultures, genders and religious beliefs [ 15 ]. Consequently, to understand what is required to engage the public successfully, the voice of the public must lead this conversation. Therefore, this study sought to explore public views on strategies and approaches to enable engagement with palliative care and advance care planning to help share future debate and decision making.

Within the last decades the delivery of PC and ACP have been increasingly medicalised and viewed as a specialist territory, however in reality, the care of those with life-limiting conditions occurs not only within clinical settings but within a social structure that affects the family and an entire community [ 16 ]. Therefore, death, dying and bereavement involve a combination of social, physical, psychological and spiritual events, therefore, to frame PC and ACP within a public health approach the response requires a shift from the individual to understanding the systems and culture within which we live. The Social Ecological Model (SEM) recognises the complex interplay between individual behaviours, and organisational, community, and societal factors that shape our acceptance and engagement. SEM provides a framework to understand the influences affecting engagement with PC and ACP and has been utilised as a lens through which the data in this study is explored.

Qualitative research, using semi-structured interviews were adopted as this enabled an in-depth understanding of public views on strategies to enable engagement with PC. This research was part of a larger mixed-methods study [ 17 ]. Comprehensive Consolidated Criteria for Reporting Qualitative research (COREQ) were used [ 18 ](See Supplementary file 1 ).

A purposive random sampling method, using a random number generator, was adopted to recruit participants who consented to be contacted during data collection of a larger mixed methods study. Selected individuals were contacted by telephone and email to invite them to participate. Inclusion and exclusion criteria are outlined in Table  1 . Interested individuals were provided with a participant information sheet detailing the aims of the study and asked to complete a consent form and demographic questionnaire.

A total of 159 participants were contacted, 105 did not respond, 21 declined and three were ineligible to participate. A total of thirty participants consented, however, two subsequently opted to withdraw prior to the interview.

Data collection

Data was collected from December 2022 to March 2023 by RB. The qualitative interview schedule comprised four broad topic areas: (1) participants’ knowledge of PC and ACP; (2) sources of information on PC and ACP and current awareness of local initiatives for public awareness; (3) knowledge of accessibility to PC and ACP and (4) future strategies for promoting public awareness of PC and ACP, with a consideration of supporting and inhibiting factors. The interview schedule was adapted from a previous study on palliative care to incorporate the topic of ACP [ 3 ] (See Supplementary file 2 ). This paper reports on future strategies.

Participants were asked to complete a short demographic questionnaire prior to the interview to enable the research team to describe the characteristics of those who participated. These questions included variables such as age, gender, religion, marital status, behaviour relating to ACP and experience of PC.

Data was collected via online interviews conducted using the videoconferencing platform Microsoft Teams. Interviews lasted between 20 and 60 min and were recorded with participant consent. Data were stored on a secure server and managed through NVivo 12 Software.

Data analysis

Qualitative data were transcribed verbatim automatically by Microsoft Teams and the transcripts were reviewed and mistakes corrected by the interviewer. All identifying information was removed. Transcripts were analysed using reflexive thematic analysis which involved a six-step process: familiarisation, coding, generating initial themes, developing and reviewing themes, refining, defining and naming themes, and writing up [ 19 ]. Themes were derived by exploring patterns, similarities and differences within and across the data in relation to participant’s views on the promotion of PC and ACP and the best ways to engage the public in open discussions.

The study explored the data through a SEM lens to provide a holistic framework for understanding the influences surrounding health behaviour change in relation to palliative care and advance care planning by mapping the findings to each of the SEM constructs.

The SEM for public health was conceptualised by McLeroy et al. [ 20 ]., and was based on previous work by Bronfenbrenner’s ecological systems theory [ 21 ]. The SEM looks to identify social-level determinants of health behaviours [ 22 ]. Five factor levels have been identified within the SEM; (1) Intrapersonal factors (2) Interpersonal processes (3) Institutional factors (4) Community factors and (5) Public policy [ 20 ]. In short, the SEM suggests that the social factors that influence health behaviours on an individual level are nestled within a wider complex system of higher levels. Current research literature has explored SEM as a model for understanding barriers and facilitators to the delivery of PC, adults’ preferences for EOL care and older adults’ knowledge and attitudes of ACP within differing socioeconomic backgrounds [ 23 , 24 , 25 ]. It has demonstrated the importance of a multilevel approach within these populations. However, there is a scarcity of research exploring strategies for public engagement with PC and/or ACP which are underpinned by SEM theory.

To ensure rigour in the analysis four members of the research team (RB, SM, FH, EB) independently reviewed the transcripts and were involved in the analysis and development of themes as a method of confirmability [ 26 ].

Ethical approval was gained from the University Research Ethics Filter Committee prior to commencing data collection. Participants provided written informed consent prior to the commencement of the interviews. They were advised of their right to withdraw, and the confidentiality and anonymity of all data were confirmed. All data was kept in accordance with the Data Protection Act (2018) [ 27 ].

All participants were white; 70% were female (n-19) and 70% were either married or cohabiting (n-19). The largest proportion of the sample 44% was aged under 50 years (n-12), with 22% aged between 50 and 59 (n-6) and 33% (n-9) aged between 60 and 84. Over half of the sample was employed (n-15), 15% were self-employed [ 4 ] whilst 26% were retired (n-7). Demographic data were missing for one of the included participants (see Table  2 ).

Responses to questions relating to ACP knowledge and behaviours found just 12 participants had heard of the term ACP prior to completing the Northern Ireland Life and Times Survey. Furthermore, none of the participants had been offered the opportunity to discuss ACP and none had prepared a plan of their wishes and preferences.

Main findings

Three overarching themes were generated from the data: ‘Visibility and relatability’; ‘Embedding opportunities for engagement into everyday life’; ‘Societal and cultural barriers. These findings were then mapped to the five social ecological model (SEM) levels ( individual; interpersonal; institutional; community; and policy ) to demonstrate the importance of a multilevel approach when seeking to engage the public around PC and ACP. See Fig.  1 for SEM construct mapping.

Theme 1: visibility and relatability

This theme relates to the suggestion that social taboo was a barrier to awareness and the mechanism to ameliorate this was visibility – in turn promoting reduction of stereotypes and promoting understanding and engagement. This posits the idea that the lack of understanding of PC is the root cause of much of the stigma surrounding it. The SEM construct mapping suggests a multilevel approach is required with intrapersonal (increased individual understanding), interpersonal (openness in discussion with friends and family through media normalisation) and institutional (health service policies for promotion and support) levels being identified.

Participants discussed how there is a lack of knowledge on what PC is, with many assuming that it was for people in the latter stages of life or facing end of life care. This highlighted the lack of individual education with participants suggesting that there should be more visibility and promotion on PC and ACP so that individuals are better informed.

“So, it’s really um there needs to be more education, maybe, I think around it. So that people can view it maybe differently or you know talk about it a bit more. Yeah, probably demystifying what it is. This is this is what it is. This isn’t what it is. You know, this isn’t about um, ending your life for you, you know. And this is about giving you choices and ensuring that you know, you know people are here looking after you”(P37538F45) .

However, there was a recognition that individual differences play a part in whether people engage in discussions. A number of participants explored the idea that some people just don’t want to talk about death and that for some it was not a subject that they want to approach. Despite this, there was a sense that increasing visibility was considered important as there will still be many people who are willing to increase their knowledge and understanding of PC and ACP.

“I can talk about it, for example, with one of my sisters, but not with my mom and not with my other sister or my brothers. They just refuse point blank to talk about it…. some of them have done and the others have started crying and just shut me. Shut me off. And just. No, we don’t want to talk about that. So, it just depends on the personality, I suppose” (P14876F59) .

The lack of knowledge and awareness of PC and ACP was suggested to be the attributed to the scarcity of information being made available at a more institutional level. For some participant’s, this was felt to be the responsibility of the health service to ensure the knowledge is out there and being promoted.

“I think people are naive and they know they’re not at that stage and they don’t know what palliative care is, you know. It’s all like it’s ignorance. But our health service is not promoting this. Well in my eyes, they’re not promoting it whatsoever. And they should, they should, because it would help a hell of a lot of people ” (P37172M61). “I and I think it needs to be promoted by the point of contact, whether it’s a GP, National Health, whatever it might be, I think when they’re there, there needs to be a bit more encouragement to have that conversation” (P26495M43) .

The lack of visibility within the general practice was discussed by several participants who said that leaflets and posters would be helpful in increasing visibility. One participant went as far as to say that a member of staff within a GP surgery would be beneficial.

“I suppose the palliative care because it is a bit more personal. There should be even maybe a professional that you could talk to in your GP practice, or you know, like they have mental health practitioners now in GP practices. Maybe there are I don’t know if there is or not, but there should be maybe a palliative health practitioner that talks to people when they are at that stage of their life” (P21647F29).

Participants also noted how there were generational differences in how people accessed health information. Many of the participants suggested that they would turn to the internet and ‘google’ for information, however, the suggestion was made that care should be taken to target awareness campaigns to different age groups via different methods to reduce disparities in technology skills such as those with less computer literacy.

“ I think a certain proportion of society need the visibility because they’re not always going to be self-sufficient enough to jump on the Internet even though you know we’re getting to the point now where the generational thing is. The generation have been brought up with the Internet and they’re obviously they go to it as the first point of call. But we still got the generation at the moment that don’t”. (P25046F-)

One of the participants talked about ways to increase visibility via the use of the media, including social media, and the utilisation of famous faces.

“Yeah, I think you know, they need to discuss it on Loose Women. You know, morning TV need to get on the bandwagon….But you know. It only takes like that one celebrity to mention it and then the whole media is jumping on the bandwagon.” (P19874F-) .

The UK media coverage of other successful campaigns such as those highlighting mental health and bowel cancer were noted to have been particularly helpful in raising awareness.

“if I think myself about the whole exposure that we have and as a society at the minute about mental health in general, you know a lot of the work on that has been done via social media. You know, celebrities hash tagging and talked about their experience. It’s OK to not be OK etcetera. And I feel like that is responsible for a lot of people who are now discussing their mental health” (P21647F29) .

The sentiment expressed in the above quotes regarding increased visibility in the media also suggests that unless a topic seems relevant to an individual then they won’t engage with health promotion. This concept of relatability pertains to those aspects of human empathy where they can place themselves within a situation leading it to become more relevant to them.

Many participants discussed that using real-life stories on television and in campaigns would be an effective way to connect with the public and it would make PC and ACP more relatable and highlight the importance of thinking about it.

“I think always what tends to be most effective is when it’s somebody that we could all relate to telling their own story (…)……I’m not too sure I know enough about what it involves, but really, like the consequences, that the consequences that people have suffered from not having done that. Not knowing what the wishes were, not having planned for it”. (P32288F62)

Several participants discussed how the topics of PC and ACP were not something they would identify with as being relevant to them. The suggestion was that without it being an immediate concern, for example, if they were not approaching a certain age, then they would assume that they did not need to increase their knowledge about what PC or ACP involves.

“You have to be able to relate to it in order to think, oh, yeah, that applies to me. You need to have something in which you identify with”. (P13697F51)

Theme 2: embedding opportunities for engagement into everyday life

Throughout the discussions, there was evidence that participants felt that death literacy could be increased by providing more opportunities to gain knowledge about planning for future care and what PC involves. Education was highlighted as a potential pathway to engaging the public by targeting appropriate age groups and professions with relevant knowledge and skills. For some, this was thought to be best achieved through educating the youth and for others, the importance of educating those who are working in the healthcare profession was particularly salient. In addition, almost half of the participants suggested they would approach charity organisations for information, with participants advocating for education within secondary and tertiary levels and within community organisations. This data reflects an institutional-level construct within the SEM framework.

Educating younger generations on the topics of PC and ACP through open discussions in schools, and providing skills on how to have difficult conversations with loved ones were seen to be a valuable strategies.

“ young people don’t have that ability to accept and admit and bring it out into the open and I think they need to be perhaps encouraged more to do that through some kind of teaching in the school environment when they’re at a young and impressionable age ”. (P25046F-)

Due to the difficulties around having conversations about death, it was suggested that different healthcare professionals should be trained to have conversations with their patients.

“Yeah, it’s like you think the discussions are difficult to broach for maybe health care professionals that you know, a difficult topic even for them to bring up. Well, if you’re working with someone who’s you know with a family and where things are quite distressed and very often it can be either, it can be the stress can cause a lot of friction and you know, decision making can be very difficult for people…., but just at every level, there’s, you know, possibility to be having conversations like that with people.”(P37538F45) . “I suppose you could think about training some care professionals (…) there may be some way that as a second part of the person’s job or whatever that they’re trained so that people could go along and discuss ” (P19265F76) .

Further to education for young people and healthcare professionals, there was the recognition that community organisations are perfectly positioned to educate the public in PC and ACP. One participant highlighted the missed opportunity to educate family members and carers through an existing programme on dementia. This is particularly pertinent to ACP due to the impact of cognitive decline on decision-making.

“I went to zoom meetings for four weeks in a row with the Alzheimer’s Society. Umm regarding things to do with dementia. And you know, there was a week about your finances and things like that. I suppose. They never really talked about end of life care you know that sort of thing. Um I suppose it would have been useful had they you know, broached that subject as well. But it wasn’t, you know, there was more about looking after yourself, looking after the person. The symptoms of dementia and all this sort of thing, Alzheimer’s and then you know, um the financial and the help available to you. You know, but they didn’t mention about the end-of-life care and like the end result of dementia, I guess, is death. So, you know that that subject, you know, I was, I suppose to just those organizations that deal with um the issues of, like dementia or, as you say, all the rest for, you know, the rest of the diseases and that. You know to be up front and honest and say you know where this can lead and to make people you know, make people aware that there is a palliative care process that can be gone through.” (P19874F-) .

Furthermore, the option of a helpline was suggested with reference made to other successful charity helplines such as the National Society for the Prevention of Cruelty to Children (NSPCC) and The Samaritans. Whilst it was acknowledged there were specialist support services available for people living with a terminal diagnosis, there was a sense that a generic information support helpline would be helpful.

“You know, people need to be (aware)… they’re not alone. There is help out there. You know, you see your helpline, your children, NSPCC, your Samaritans. All on all these helplines, I have to think, I’ve never seen a helpline for palliative care or who you can contact. You don’t see things like that.” (P22964F52) .

In addition to education, the suggestion that embedding ACP discussions into other more common aspects of future planning such as will making, and organ donation was postulated as a potential way to engage the public. This demonstrated clear links to the policy and institutional level constructs within SEM. Changes within organisational policies and public law to support individuals to consider future planning would promote better engagement on a wider societal level.

Participants suggested that they would like to see some of the conversations surrounding ACP introduced into workplace policies and guidelines, as well as through other legal discussions. They noted that conversations surrounding future planning already occur when discussing legal wills and workplace pensions. The potential to expand these discussions to include ACP with solicitors and in workplaces was seen to be a missed opportunity.

“So maybe um around people who are making their wills and you know, you get will making services advertised and things like that. And I think once you get into your 30s and 40s, people start thinking about a will and things like that. So maybe aligned to something like that, you know would get younger people.” (P13790F67) . “when people talk about the pension, you know so retirement, you know, to make people aware about this as well. You know, I would say that’s probably good ways to reach people” (P21263M54) .

Current legislation and promotion regarding organ donation were discussed as being successful in engaging the public and therefore implied that the government should take a more active role in the promotion of ACP.

“If you look at the way, sort of, government have been promoting like organ donation and that. You know that sort of thing. And then people have really bought into it and you know, and there’s a lot of positivity around it. So, I think that’s sort of similar approach would be good”. (P29453F40) “You know, people talking about pension, pension plans and so on and it’s part of the natural life circle, you know. So, if it’s in connection with this, you know, so think about your future, make your plans …so probably in connection with organ donation and so on, you know, so I think they could be trigger points, you know,, people talking about this.” (P21263M54) .

Theme 3: societal and cultural barriers to open discussion

In conversations surrounding why there was a lack of openness in discussion, participants postulated that a potential factor was the influence of cultural and societal norms. This was found to overlap in the SEM levels of intrapersonal, interpersonal and community.

Rural farming communities were highlighted as potentially being more isolated and traditional in their views around death and dying, whilst those with strong religious beliefs were seen to be less likely to engage in discussions.

“You know, and there is a, I’m out in the countryside. Well, it’s (place name). So it’s a relatively rural sort of conservative place and it and it’s that… you know you’re tied to the land, you’re tied to the farm. This is your home and sending you away from it early it is seen as a bit of a shameful thing. So yeah, to try and educate folk and to try and speak into that I think would be really helpful because again, I’ve seen situations where probably the individual’s life, the end of life, has been made tougher because the family have fought to keep that person at home.…. We’re going to try and do it ourselves” (P26495M43) . “I think it’s probably a lot to do with religion more than likely because people just like to hear, because we still are very much, you know, a lot is dictated by religion. So, people just want to leave stuff in God’s hands so they don’t want to have like…that would be the kind of where my mom and dad are coming from, you know, don’t interfere with it, blah blah blah. So, it’s a very gentle like kind of reminding them, you know, well, I think we do need to think about it. And I think people are afraid that they’ll make again that um it’s kind of euthanasia you know what I mean” (P37538F45) .

Cultural differences between countries were also considered with some seeing other global communities approaching death as a celebration rather than something to shy away from.

“I think in Northern Ireland we are, and the UK and probably the world in general. We are really poor at talking about, about death, and it has to be a positive thing to be able to talk more about death. You look at other cultures where you know. Death is treated differently, you know, even in Africa things where, you know, it’s a real celebration, whereas it’s seen so differently in in Northern Ireland” (P31154F35) .

Furthermore, regions and countries that have experienced war and conflict were perceived by one participant as a potential barrier to engaging in subject matters which involve death.

“I don’t I don’t know about other countries, but those that grew up maybe during the conflict here, maybe it’s just something that, you know it’s it’s a completely different mindset to them” (P23609M39) .

Whilst it is unclear from the data why the participant felt the conflict might inhibit engagement with the subject of dying, it could be interpreted that the participant was suggesting that death is too morbid to engage with following a conflict period which saw numerous deaths. An alternative interpretation could be that people are desensitised to death and do not see death as something that an individual has autonomy over.

It was noted that in many modern societies communities are changing. People no longer interact with their neighbours in the way they used to which results in a reduced sense of community responsibility.

“I don’t know that everyone is as neighbourly as they used to be. Northern Ireland I always perceived as being open door policy and everybody looked out for everyone else. But I think as a society has changed and it has changed in Northern Ireland, and it’s become becoming more closed (…) So I think we need to try and encourage that community um experience back again so that people are mindful of their neighbours and share that responsibility and making sure that everyone’s OK” (P25046F) .

This sense of social isolation was discussed by one participant who referred to homeless people. They reflected on how current social structures may not be providing the information and support to this minority group and therefore should be considered when developing public health approaches to engaging them in PC and ACP education.

“And if you look at homeless people on the streets, where do they get the information from? Where do they get the care, the information, the attention. I know there are Street workers that work, but I don’t know again to what extent in Northern Ireland compared with the likes of London” (P25046F) .

Mapping the findings to a social ecological model framework

Following thematic analysis each of the resulting themes were mapped to the five socioecological levels identified by McLeroy et al. (1988) for health promotion programmes. Construct mapping can be found in Fig.  1 below.

Thematic interaction within the Social Ecological Model levels

The findings from this study highlight the complexity of current public perceptions of palliative care and their views on effective engagement with PC and ACP. Within medicalised western culture there is a tendency to focus on the preservation of life, with conversations about death avoided. This has resulted in death becoming a taboo, raising fear and stigma where death is equated with failure. These social taboos that exist around death, dying and bereavement are posited to stem from the lack of awareness and understanding of PC and ACP and the resulting stigma of approaching these discussions. There was evidence of influencing factors on all SEM levels, which demonstrates the need for a multifaceted public health approach that uses not only behaviour change communication but also social change communication, social mobilisation and advocacy. It can be argued this reflects the key aspects outlined in Lancet Commission report on ‘Valuing Death’, which advocated for a ‘systems approach’ [ 10 ]. This systems approach is aligned to differing levels within the SEM and the different approaches the public have identified when seeking to build public engagement and access to palliative care. Three key aspects were noted: visibility, embedding opportunities for engagement in everyday life and societal and cultural influences.

It was clear from the analysis that a major factor associated with poor public engagement was the lack of visibility within the public domain, which was hindering both the normalisation of death and understanding that PC was more than just end of life care. The findings demonstrated different ways to address the lack of visibility, such as the use of targeted social media and wider publicity campaigns. Research to date has demonstrated that palliative care education is a useful tool in improving knowledge of, confidence in and attitudes towards palliative care amongst healthcare professionals and carers [ 14 ]. Similar results have been noted for the public when exploring the potential to promote palliative care through various media challenges such as YouTube and social media [ 28 ]. This does, however, raise questions around the quality and accuracy of information offered via the media, taking cognisance of whether some of the messaging may inadvertently be adding to misunderstanding, and thus a lack of public engagement.

Secondly, the findings indicated that experience at the individual level within a social context was noted as an important element when seeking ways to increase public engagement with PC and ACP. The experience of illness, dying and loss is often overlooked, therefore, this points to the potential value of community-based education approaches, with peers enabling experience-based exchange. Such interventions have been noted in the literature on the role of volunteers and education [ 29 ]. This reflects the need for an overall public health palliative care approach that seeks to empower individuals, families and communities to draw on their own resources and community supports to adapt and cope with death and dying [ 6 , 30 ].

Thirdly, the findings from this study indicated the need for enhancing opportunities for engagement in PC and ACP within everyday life. Research indicates there is an appetite for people to talk about death, for example, in the UK, a recent YouGov ‘daily question’ survey reported 67% of adults who responded think the subject of death and dying should be talked about in schools [ 31 ]. This speaks to the need to consider schools, workplaces and key trigger points in life as times to consider engagement with PC and ACP. This reflects the overall need for death literacy in society to improve experiences at the end of life [ 10 ].

Finally, the importance of socio-cultural aspects for the public cannot be underestimated. Therefore, effective communication strategies need to be tailored to individuals, and communities and be culturally appropriate. This has been noted as an important aspect for specific communities, such as the Chinese diaspora, for example, but nuances around this for specific ethnic, political, religious, and geographical aspects need further consideration [ 32 ]. Cultural competence, defined as an understanding of how culture affects an individual’s beliefs, values and behaviour, is an important consideration [ 33 ]. A meta-analysis of 19 review articles, concluded that interventions to increase cultural competence in healthcare were effective in enhancing the knowledge, skills and attitudes of healthcare providers, leading to clinical benefits for patients/clients through improved access and utilization of healthcare [ 34 ]. The translation of such reviews for public engagement in PC and ACP warrants further exploration. It has been advocated that elements of cultural systems should be analysed with a socio-ecological framework [ 35 ]. Such consideration and integration of salient contextual cultural factors could assist public messaging and cultural communication, which would enhance more effective and sustainable public engagement in PC and ACP.

Limitations

When considering potential limitations, it is pertinent to note that due to the sensitive nature of the topic the exclusion criteria restricted the sample to those who had not experienced a recent bereavement. This may have limited the ability to gain a wider perspective, as the views of the recently bereaved may have provided further nuanced insights into how best to engage the public. Furthermore, the participant sample was limited to those involved in a larger mixed-methods study. This may have introduced bias in relation to true knowledge and attitudes due to the participants having completed the survey questionnaire prior to the interviews.

In conclusion, this qualitative study has provided insights into how the public would like to be engaged in PC and ACP. The findings highlighted that to build public engagement and access to palliative care and advance care planning a multifaceted public health approach is required. Discussions of death and dying remain difficult for many members of society, therefore, an increase in death literacy across all systems to reduce misperceptions surrounding PC and APC is needed, by increasing visibility and providing opportunities for the public to engage with PC and ACP within everyday life. Finally, socio-cultural aspects need consideration when developing strategies to ensure effective communication and engagement with all members of the community.

Data availability

The datasets analysed are not publicly available but are available from the corresponding author upon reasonable request.

Abbreviations

Advance care plan

• Palliative care

Palliative care education

Social ecological model

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Acknowledgements

The authors would like to thank all interviewees for their participation in the research.

This study was funded by HSC R&D Division of Public Health Agency in Northern Ireland.

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SMcI is principal investigator responsible for study design, project management, analysis and manuscript review and dissemination. FH, PS, EB were responsible for study design, analysis, manuscript review and dissemination. RB was responsible for qualitative data collection, analysis, manuscript drafting and dissemination. All authors reviewed and approved the final manuscript.

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Black, R., Hasson, F., Slater, P. et al. Building public engagement and access to palliative care and advance care planning: a qualitative study. BMC Palliat Care 23 , 98 (2024). https://doi.org/10.1186/s12904-024-01420-8

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• Advance care planning
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