Parent/Patient communication | Where are we at?

Effective person/patient-centred communication is a cornerstone of quality healthcare, with a focus on understanding the patient, including their personality, life history, and social context. This interview explores the significance of person/patientcentred communication within the context of sonography, emphasising its potential to enhance the patient experience and health outcomes. Both Dr Kate Russo, Specialist Sonographer at Adelaide Women’s and Children’s Hospital and Paula Kinnane FASA, Professional Development Manager at ASA, underscore the need for sonographers to engage in open, empathetic, and culturally sensitive communication, particularly during brief patient interactions, and highlight the broader social determinants of health that impact patient wellbeing.

Dr Kate Russo

Master’s Program Unit Coordinator, Advanced Communication and Clinical Education | Central Queensland University

Specialist Sonographer | Adelaide Women’s and Children’s Hospital

Kate has worked as a Specialist Sonographer at the Women’s and Children’s Hospital in Adelaide for the last 14 years, with a special interest in high risk obstetrics and fetal echocardiography. Her ultrasound career started in Brisbane in 1998 where she spent five years before moving to the United Kingdom. While in London, Kate worked primarily in obstetrics and gynaecology, developing her ultrasound skills in fetal medicine before returning to Adelaide in 2009. She has a keen interest in research, completing her PhD titled ‘Maternal cardiac function in women high-risk for pre-eclampsia’ in 2020. Kate also works as a Senior Lecturer at Central Queensland University and is the Master’s Program Unit Coordinator for Advanced Communication and Clinical Education. She is passionate about delivering high quality education for sonographers.

What is person/patient-centred communication and why is it important?

Person or patient-centred communication has been shown to improve a patient’s experience of care and leads to better health outcomes, requiring health professionals to have a holistic understanding of the person presenting for care. This includes acknowledging their personality, life history, and social structure to develop a shared understanding of the problem and the barriers to treatment and wellness. Sonographers most often have one-off patient interactions; however, your communication during that short time can have a significant impact on the patient’s wellbeing and ongoing care. This can be a positive experience or potentially harmful when there is no consideration for the whole person. This links to social determinants of health, including psychological wellbeing, socioeconomic status, education, social support, family and cultural background, gender/sexual identity, relationships and trauma. Recognising and understanding these factors will enable you to adjust your communication to ensure your patient feels respected, comfortable, listened to, and cared for.

What is considered best practice in person/ patient-centred communication?

High quality communication is fundamental to providing person/ patient-centred care, which has evolved from the paternalistic approach that ‘doctor knows best’, with no or limited consultation with the patient. Person/patient-centred care is considered a partnership between patients and healthcare providers, with a focus on enhanced patient satisfaction. To achieve this, it is important to establish a connection with your patient, explore the patient’s perspective, provide information and demonstrate interest and empathy. This requires sonographers to show openness, warmth and be attentive from the moment you greet them in the waiting room, so be mindful of your verbal and nonverbal communication.

These simple steps will assist in establishing a rapport and help put your patient at ease. Before starting the ultrasound examination, take the time to actively listen to your patient, so you can understand their concerns and expectations, without being distracted by scanning. Provide information about the ultrasound examination and check for understanding, as this is your responsibility.

Furthermore, these steps will help build trust and ensure greater cooperation. Take the time to acknowledge their feelings and emotions, as it is easy to overlook the stress and anxiety associated with entering a healthcare setting and the concerns they may have about their health and wellbeing.

Your communication during that short time can have a significant impact on the patient’s wellbeing and ongoing care

What are the barriers to person/patient-centred communication?

Barriers to person/patient-centred communication relate to an individual’s ability and skills to communicate effectively. A perceived lack of time and sonographer attitude can be barriers to person/patient-centred communication. Sonographers may not feel that they have enough time to listen to a patient about their concerns and explain what is going to happen during the examination; however, this is essential. Patients should not feel rushed or a burden, even when they run late for their appointment.

Ensure you give your patients time to speak about their symptoms and share their story without interrupting. Ask open-ended questions to encourage disclosure and gain critical insight into the patient’s experience and health. Consider the language you use when explaining the ultrasound examination based on the patient’s level of scientific knowledge. You will be able to gauge this level when listening to their story.

Technical jargon should be avoided, not only due to the potential lack of understanding but because it can make people feel inferior. It is also important to consider how your own beliefs and values may influence your communication and be aware of your biases. Judgement of others can readily be perceived without words, so be mindful that your body language, gestures and tone are not relaying an alternate message.

How can sonographers, students and the sonography profession work towards improving person/patient-centred communication?

There are several approaches that can be implemented to improve our person/patient-centred communication; however, we first need to recognise the importance and value of this communication. Raising awareness through ASA, educational pathways and engaging sonographers to want to learn more about the importance of person/patient-centred communication is needed. At an individual level, we could all work on developing a better understanding of these communication principles, which can then be applied to our own practice. As health professionals, sonographers have a responsibility to develop skills and competency in all areas of ultrasound, including communication.

These ‘soft skills’ are often overlooked and opportunities at conferences are less well attended, with sonographers preferencing the development of technical skills and knowledge. I would recommend presentations that cover these topics be addressed at plenary sessions, rather than just the optional workshop in the program, so a wider audience is reached. At a departmental level, team leaders and supervising sonographers could incorporate communication competency into professional development and performance reviews, just like other skills sonographers work towards. Professional development sessions could be in the form of group discussions with sonographers sharing challenging interactions and discussing how the situation could have been better managed.

Like all learning, evaluation and reflection is needed to enable personal and professional development. For student sonographers, the role modelling of person/patient-centred communication by supervisors, mentors and other sonographers is critical to ensure the next generation of sonographers’ communication skills and attitudes align with best practice.

Paula Kinnane FASA

Professional Development Manager | Australasian Sonographers Association

Paula is a specialist obstetric sonographer and is clinically working at Royal Brisbane and Women’s Hospital in the Maternal Fetal Medicine Unit. Paula is also a Professional Development Manager with the Australasian Sonographers Association where she enjoys developing resources and initiatives to assist sonographers, ensuring they can provide the highest level of patient care. Over her career she has worked as a senior sonographer, clinical instructor, and university academic and has a passion for education. Paula was awarded a Fellowship with ASA and was the 2021 Tutor/Clinical Supervisor of the Year.

The key is to approach these situations with humility, a willingness to learn, and a commitment to respectful and inclusive communication.

For those performing ultrasound, what are some challenges that inhibit effective communication with patients?

There are many challenges that can inhibit effective communication. Some of these include:

• anxiety and nervousness – patients may be anxious, which can limit their ability to absorb information or ask questions. Some examinations can be highly emotive and it is important that sonographers support the emotional needs of the patient to facilitate meaningful communication

• limited understanding of medical jargon – using technical terms without providing layman’s explanations can lead to confusion and miscommunication

• cultural and language barriers – we live and work in a multicultural society and some patients from different cultural backgrounds may struggle to convey their concerns or understand instructions

• limited time – busy schedules can mean that sonographers have limited time with each patient, which can hinder explanations. Time is needed to build rapport to allow a patient to share personal or medical information during the procedure

• distractions – children, support people, and/or mobile phones can be a distraction. Noise or interruptions in the ultrasound room can disrupt communication and create an environment not conducive to effective communication.

To address these challenges and promote effective communication with patients during ultrasound procedures, sonographers should use clear and simple language, encourage questions, provide explanations, ensure privacy, and show empathy and understanding of the patient’s emotional state. Additionally, being aware of cultural differences and potential language barriers is crucial, and interpreters or translated materials may be necessary in some cases.

How do you ensure you are communicating in a way that does not come across as politically or culturally incorrect or insensitive?

Some tips to help communication in a sensitive and respectful manner include:

• cultural awareness – educate yourself on different cultures, customs, and beliefs to avoid unintentional insensitivity. Consider cultural competency training

• avoid assumptions – don’t make assumptions about a person’s background, beliefs, or preferences based on appearance or name. Treat everyone as unique

• active listening – listen actively and attentively and pay attention to non-verbal cues. Regularly check in with your patient during the scan to ensure they are okay

• use appropriate and inclusive language – avoid stereotypes or generalisation. Ensure you use patient/parent-focused language. Use the correct pronouns or gender identities. If you are unsure, ask respectfully

• respect personal space – be aware that personal space boundaries and comfort levels with personal contact can vary from culture to culture. Always obtain consent to undertake the examination and explain the procedure, including probe contact

• self-reflection – reflect on your own biases or beliefs. Self-awareness and feedback when you have unintentionally made a mistake are important for growth.

Remember that being culturally and politically sensitive is an ongoing process and everyone makes mistakes at times. The key is to approach these situations with humility, a willingness to learn, and a commitment to respectful and inclusive communication.

What advice can you give to those attempting to keep up with current language and terminology?

Read widely to stay informed, watch and listen to TV shows or podcasts which often reflect current terminology, attend conferences on professional topics, and stay open-minded.

Is there a need for cultural awareness training to improve patient communication?

Yes, cultural awareness training is a valuable component of healthcare education. It promotes cultural competency, reduces health disparities, enhances communication, respects individual values, builds trust, and minimises misunderstandings. It also supports informed consent and reflects patient-centred care. Training should be ongoing and adaptable to the sonographer and the patients they care for.