Ethics For Health Communication

1) Summarize each article

“Ethics for Health Communication” by Strasser and Gallagher, summarizes a workshop held by the International Green Cross in France on ethics of health communication in 1992. It outlines ethical principals governing communications between various parties involved in healthcare communication (biomedical scientists medical practitioners, health professionals, mass media and the general public), in particular the influence mass media has on the public’s perception of risk/benefit in health care.

The article “Health Communication Ethics” by Ratzan is an editorial article in the Journal of Health Communication published in 1998 aimed primarily at journalists writing healthcare articles. It proposes several questions to answer when preparing an article, pitfalls to avoid and the proposal for the introduction of a “healthcare legend” to articles to clarify information for the reader.

2) Both articles emphasize the importance of ethical and accurate reporting at all levels to ensure the end user, the patient or public, receives unbiased accurate information. This is contradicted in the Strasser and Gallagher article where it advises medical practitioners may provide ‘incomplete or only partially truthful information if its not misleading, if that is in the patients best interests. This would be down to the medical practitioners discretion and could possibly be open to personal bias as discussed in both articles.

Because there is a risk of bias and unethical reporting of information at all levels, both articles put forward the need for an agreed international written code of ethics for health communication to ensure public and patient rights are protected as they currently are in other areas of healthcare (France has guidelines for journalists in place already). Both highlight the example that journalists may introduce personal bias into their communications ie by only positive results from research. Strasser and Gallagher stress the importance of balanced reporting eg ensuring potential harm to the public is reported.

Both emphasize communications should be comprehensible for the general public. The average reading age is around 8th grade and material should be prepared with that in mind. However, Ratzan also highlights a concern about the “dumbing down” of medical communications, so balanced thoughtful quality reporting is important.

(1) Brief critique of each article:

The Ratzan article is a personal reflection from a physician health communicator’s viewpoint. Ratzan particularly targets journalists in his article and gives suggestions for them to take into account when preparing a story and some common pitfalls. He emphasizes reporting should be high quality and writers are responsible for accuracy. They have a duty of care towards the general public.

The Strasser and Gallagher article discusses healthcare communications at all levels, not just the role of journalists. So medical practitioners talking to patients is covered as well as scientists talking to mass media and mass media reporting to the general public. Scientists are instructed that their information should not be presented out of context and no essential material should be withheld. Yet physicians are told they may selectively withhold certain information if that is in the patients best interest provided it is not misleading or inaccurate. This appears to be contradictory advice assuming no physician bias. Journalists are advised to present all the facts, positive and negative results, benefits of treatment and side effects. Journalists’ loyalties should be to their readers rather than their sources’.

2) 1) Ethical Issues:Communication (D. Fleming)

– This is a short article from the Center for Health Ethics at The University of Missouri written in 2004 for providers about the importance of effective patient centered communication. He encourages providers to recognize the influence of their own personal background, ethnicity, culture and beliefs on how they might communicate important information to patients and their families. Three published guidelines for are briefly reviewed.

Ethics and Patient-Provider Communication (Marks and Shive)

– This is a more detailed article from Health Promotion Practice in 2008 which concludes “much more needs to be done to ensure health providers effectively communicate health promotion messages without bias” following a review of available literature, the authors research and an analysis of data from a national survey (Health Information National trends Survey 2003).

(1) Compare and contrast content of both articles

Both articles conclude that clear, understandable, verbal patient centered communication by providers leads to improvement in the welfare of the patient (adherence to health recommendations, self management, better quality of life and patient satisfaction). Both note there is room for improvement. Both articles highlight the patients need for individualized care, the importance for full disclosure of information, patient involvement in decisions about their care etc. Better informed patients leads to greater patient satisfaction and adherence to health protocols, and consequently better health outcomes.

Both articles point out the need for sensitivity to ethic, cultural, religious and personal differences when conflict may occur between patients and providers especially when difficult decisions may need to be made in the case of severe illness or end of life. The Marks and Shive article looked at this in more details and found differences between ethnic races, age, employment status, and quality of health (analysis of Health Information National Survey Provider Communication Questions).

(3)

Q: How are the guidelines for health communication professional and patient-provider communication similar/different

Each article highlights the need for improved communication from all parties involved in health communication. The question 1 publications both conclude it would be beneficial to have a written code of ethics to guide health communicators. The health provider articles were published later following the 1999 The Health Education Code of Ethics which was designed to aid health educators specifically in promoting the highest possible standards of care for all (ref 1st paragraph of Mark and Shrive article), yet still improvement is needed in many areas of communication, particularly for minority populations.

Respect for personal autonomy is highlighted in all articles, ie to recognize that an individual (patient) will ultimately decide how to use the data or information, and that quality communication is essential to inform that individual so they can make an informed decision. One point at odds between a pair of articles is where Strasser and Gallagher advocate “a physician may not be morally obliged to tell a patient the whole truth”(176) if in the physicians view benefit may be achieved and harm avoided. Yet Flemings article (1) stresses the importance of full disclosure of information to the patient, and Marks and Shrive (32) highlight the consequences of poor communication can result in misunderstanding, reduced quality of life and even legal ramifications. Physicians have to balance carefully the discussion of treatment risks and options to enable the patient to understand fully and allow them to make a decision that is right for them individually.

Q: What do you think is the main underlying difference between the type of communication that health communication professionals and healthcare providers use.

Health communication professionals are generally specialists with qualifications in research, strategic development, and evaluating effectiveness and are trained to deliver effective communication of public health messages indirectly to the public via mass media, eg verbally presented via TV, or written in a magazine. The health professional/practitioner/provider on the other hand is an individual who provides preventive, curative, promotional or rehabilitative health care services verbally directly to the patient.

3) In the article “Communicating Bad News” by The EPEC (Education for Physicians on End-of-life Care) explains a step-by-step process in which teaches physicians the proper and best way to deliver bad news to their respected patients. The article teaches its readers the importance of how bad news can really affect a person’s life and which individuals can find delicate ways to deliver the specific news. An extremely important lesson, which was learned through reading the article, is actually how to approach the situation. For example, asking more questions to the patient could help them better regulate what they want to know and what they know already. With this list of steps, it allows physicians to feed their patients the knowledge they want to hear versus what the doctor wants the patient to hear. The other important lesson that was learned in the article is the importance of knowing how to approach a patient who is a child. An adult patient a doctor would approach bad news in a completely different way than they would an adult. When it comes to children it is hard to deliver bad news, as many parents may not their child exposed to the realities of life quite yet. Although this is just natural parental behavior, it is extremely damaging to the child in the future. These methods would have never crossed my mind as I have always told bad news the way I would tell good news, up and front, but with these methods and lessons I have learned it will allow to better understand a person and let the individual be ready for the news. These lessons are extremely important as delivering the news to the patient needs to be extremely delicate and being sensitive with them will hopefully help them through this hard time in the patient’s life whether it is a child or an adult.

In the article “Communicating with the Patient’s Family” by U.S. Department of Health and Human Services talks about when and how physicians are allowed to talk to patient’s family friends and guardians with health-related situations. An important lesson, which was learned through this article, is when it is acceptable to rely information about a patient to their primary guardians. According to “HIPPA” (Health insurance probability and Accountability Act of 1996) states that it is okay for doctors to communicate with the parents if the patient gives permission or if there is no way that the patient can communicate or has been deceased. Another important lesson learned is how to approach the news and what ways are the best for physicians to tell their patients. The two top ways to announce the news is either having the family come in all together or have a conversation over the phone. This way, whoever wants to be involved in this process, can be and whoever chooses not to does not have to. These lessons are extremely important as aside from dropping the bad news on the patient the other side of it is just as hard. Being able to communicate is an extremely important skill and will help the family and patient get through these hard times.

In the article “Patient-Centered Care.” It talks about how over 150 practices in patient care are now creating their own patient culture, where it’s all about the patient and focuses on anything the patient needs. An important lesson learned in this article is how well the patients actually respond to the one on one 24/7 care that these solo practices give to their patients making it a much easier place to live. Another important lesson learned throughout reading this article was the fact that they patient centers really help their patients explore themselves and try things they may never had tried before. For example, the physicians at these patient centers really communicate on a different level with their patients, in a spiritual way or a fun, loving and personal interaction. These lessons are extremely important to take note of as patients may feel alone and sad due to their illness, the support and care from the staff will help their attitude and boost the patient’s interpersonal emotions as there are really people out in the world who want to help all day and all night until their patient is comfortable and happy.

Uncertainty Management Theory is simply how humans communicate based off of their balance of anxiety and uncertainty in social situations. This relates to all the readings read previously as having tell explain bad news to anyone is extremely difficult and awkward event. Based on the theory many of the doctors or patients have relatively good communication even though many are put in tough situations.

4) A) “Community Mobilization is a key area of health communications to empower communities to achieve behavioral and social results in support of improved health outcomes.” (Class powerpoint)

B)

• Engaging community organizations and leaders

• Participatory research

• Community group meetings

• Partnership meetings

• Action Plan

• Culturally competent

C) This model is used to assist different community in creating an environment in which the society can empower themselves in order to address their own and their community health issues

B) community guide

a) The CDC describes Community Mobilization as: “Community mobilization engages all sectors of the population in a community-wide effort to address a health, social, or environmental issue”

b) According to the CDC, a successful community coalition effort is established by creating regular meetings, setting attainable goals and setting yourself up for nothing but success.

c) These are similar in a sense as they both want to be helping a community improve on their health.

d) Interpersonal communication is evident throughout this article as many of the patients/doctors or country wide communities, in order to see change there has to be communication skills and on an interpersonal level as many of the situations that need to be talked about are awkward and hard to talk about.

e) The CDC offers a unique material and event list in which many individuals need in order to mobilize the community. Some of these materials come from pure communication skills, being able to be a leader and educate a society on the importance of health. Some events as well could be university grants or pharmaceutical grants which will help these society’s get a better understanding of mobilization communities.

C)

a) “The Samaritan Women Founded in 2007, e Samaritan Women (TSW) is a Christian nonprofit organization whose mission is to promote health, healing, and hope through four ministry efforts: operating a transitional residence for women in recovery including counseling and life skills, offering a vocational program in culinary arts with an innovative “from seed to table” curriculum, managing a large urban farm that grows produce to support local shelters and neighbors in need, leading a state-wide social justice initiative against human tracking.”

http://www.thesamaritanwomen.org

b) This is a community mobilization initiative because it targets a specific community and tries to tailor resources to their personal needs. The Samaritan Women is a Christian nonprofit that helps sex trafficking victims recover and get back on their feet. The organization provides interpersonal communication with the different resources they provide. For example, they have counselors that can meet with victims and provide them with therapy and other much needed guidance.

c) The key elements which are needed for community mobilization include:

1) Operating transitional and restorative shelter programs for women recovering from domestic human trafficking

2) Inspiring Individuals

3) Providing education and tools to individuals

d) Two elements which I believe should be included in order to create a successful mobilization community would be to establish trafficking events to raise awareness for the Samaritan women. Another element would be to create an app which shows popular trafficking areas so women know where to avoid these situations.

5) Guidelines for Middle Eastern Patients

1. Address the family member with the most authority first, this is usually the oldest and most educated of the family.

a. It is important to be consistent with the authoritarian values of Middle Eastern families. Respect is one of if not the most important value of Middle Eastern families. It is important for the families to feel respected, and to feel like their culture and beliefs are respected too.

2. Assign same sex caregivers

a. It is really important especially for Women of Middle Eastern backgrounds to maintain their modesty at all times. The power dynamic

3. Avoid eye contact with the opposite sex because it can be interpreted as a sexual advance.

a. Male and Female roles in Middle Eastern families are very different. Males will sometimes even answer questions for their wives.

4. Bad news should be handled with extreme care.

a. Bad news should be presented to a patient in different stages and information is not often given to the patient directly. This is in order to be extremely compassionate and respectful of religious and cultural values. Every culture handles and interprets death differently and it is important to be considerate of that.

5. Establish Trust.

a. Middle Easterners are not one’s to over share when it comes to healthcare information. They may not willingly answer questions or give necessary information. Establishing trust especially early on will help Middle Easterners feel more comfortable answering and giving information.

6. Be Flexible.

a. Americans stress the importance of being on time, it is cultural respect. Americans will plan everything around an appointment, whereas Middle Easterners are less concerned with punctuality. An American would find it rude to be late for an appointment, when a Middle Easterner would be personally offended if a Doctor found it rude that they were late.

7. Get to know the patient on a more personal level.

a. Middle Easterners don’t like to freely giveaway information about family history, their sexual history, their genetic history, mental illness history etc. If the patient gets to know the doctor on a more personal level it will help them feel comfortable to open up about their medical history – which is crucial in diagnosis and prognosis of a patient.

8. Be aware of the space relationship for Middle Easterners

a. Middle Easterners have different cultural customs when it comes to hand gestures, and special awareness. Middle Easterners tend to maintain a distance twice as close as Western Culture.

9. Understand that Middle Easterners have a strong relationship with authority

a. In Middle Eastern culture the authority of a doctor is never questioned. This may prevent a patient from asking questions or freely giving information that may contradict a doctor’s knowledge. Make sure the patient feels comfortable, and keep in mind that the male and female power roles are different. A male patient could have a hard time accepting the authority of a female doctor.

10. Preventative healthcare is not common in the Middle East, so be prepared that a patient due to religion may deny a prognosis.

a. Middle Easterners strongly believe that when death comes it is meant to happen and may not want to receive treatment, as that may be an attempt to cheat death. Middle Easterners also fear hospitals as they are bad omens and families often fear that their family members will not be treated accordingly to their religious preferences.

Guidelines for Latino Patients

1. Use appropriate titles when talking to patients.

a. When talking to older generations, especially when a young doctor is talking to older patients it is important to use titles. Respect is really important in Latino culture. The appropriate formal title would be señora and señor.

2. Be aware of how power dynamics between male and female may affect patient care.

a. Males often make choices about healthcare and treatment for their families. Since this is the case, directly ask question to females to make sure they are able to speak for themselves, and in a manner that does not appear to question the authority of the male.

3. While American’s can be very task orientated, Latino’s focus on the construction of relationships, and expect a level of friendliness and personal care.

a. If the doctor appears to be rushing, and not taking their time with a Latino patient they may become very offended and not feel like they are receiving proper patient care.

4. Personal contact and communication are key in Latino culture.

a. A warm handshake or a pat on the shoulder could help a Latino patient feel more comfortable, because they will feel as though they are in a safe and confortable environment.

5. Take your time when consulting a patient.

a. Latino patients like to build relationships with their doctors and it helps them to create an environment where they feel comfortable and able to freely speak.

6. Be assertive and confident when you speak.

a. If a doctor does not come across as confident in their treatment and how they present themselves a patient will likely not want to comply with the course of treatment. Patients will be more likely to comply with a follow up and post care treatment if they are confident in the doctor’s abilities.

7. Be aware that Latino patients do not stress the importance of being on time for appointments as Westerners do.

a. Punctuality is not as important to Latino’s as it is to Westerners. A patient may miss or show up late for their appointment and still expect to be able to see their healthcare provider. Be understanding and willing to work with Latino patients if they are late and don’t give warning before hand.

8. Be aware of how cultural values and beliefs may affect patient treatment and how receptive patients are to treatment.

a. Latino’s as a culture tend to believe more in fate and destiny than Westerners are. Latino’s often believe in karma and the uncertainty of life. Latino’s tend to live each day by day and are less stressed and concerned with being in control of their lives. This can be frustrating for doctors when trying to treat patients with serious illnesses and possible fatal outcomes.

9. Understanding that the values, socio economics, education, religion and cultural perspective all vary from that of Latino’s, and can seriously affect the way patients view and want to receive treatment.

a. Latino’s simply view life differently and as a result, medicine. If a doctor is able to see through the eyes of a Latino patient then, they will be able to be the most effective doctor for that patient.

10. Make sure patients feel secure enough to ask questions.

a. Latino’s often assume positions of authority for healthcare providers and often feel disrespectful when asking questions about a doctor’s course of treatment or recommendations because it can appear as disrespectful. Make sure patients do not feel as though their doctor is superior to them. Asking questions can help doctor’s get crucial information that they need in order to help a patient complete their treatment.

6) GROUP PROJECT (15 points)

(a) Who is your client? (3 points)

• Little Lobbyists are a group of activists comprised of families and and children affected by current legislation that will impact their access to healthcare. Some children are ambassadors for other children who can not go to Capitol Hill and use their own voice. They want legislators to understand that they are not all that different from other families and even those of the legislators themselves. Their mission is to advocate for healthcare needs. Some children have complex medical needs and pills, treatment, hospital visits, all cost lots of money. When a family doesn’t have lots of funds they simply cannot afford to pay for those basic needs, all year, every year. Changing the legislation of healthcare rights could drive families broke and not able to provide necessary care for their children.

(b) What does the client need/want from your group this semester? (3 points)

This semester our client wants my group to conduct social media market research and help them brand themselves online. Social media is one of if not the most powerful platform nowadays and it is important for Little Lobbyists to concrete their brand and messaging to drive traction on the main social media channels, Instagram, Facebook, Twitter, and possibly Snapchat.

(c) What are the client’s main communication objectives? (3 points)

• Their main objective is to advocate and empower families to speak up for healthcare and not be afraid to fight for simple and basic needs. To show insight into the lives of the families affected by complex needs and provide understanding. Little Lobbyists want to fight for legislation with compassion and education and pride themselves on being a respectful and peaceful group of activists.

(d) Who are the client’s primary and secondary audiences? (3 points)

• The primary audience is legislators and policy makers that have a direct impact on healthcare laws. Legislation could change very soon and Little Lobbyists need to communicate effectively with policy makers in order to seek change and compassion.

• The secondary audience is the media and general public. This audience is also hugely important because the more people that are aware, more people will be educated about the message that Little Lobbyists are trying to spread. A larger social media following and funding for different events, protects, etc.

(e) What are some of the strategies and tactics that they are currently using or have used in the past to reach their audiences and objectives? (This question might require you to dig for information online or based on the client’s visit to the class.) (3 points)

• Some strategies that Little Lobbyists have used in the past the reach their audience are going to schools and different events to advocate for their healthcare for children with complex needs. They also have an active Twitter, Facebook, and Instagram page. Their Instagram page has pictures from events and of the children themselves.

• In the future and with the help of my group they want to redesign their Instagram page and concrete a brand on social media. They don’t currently have a system for when they post, or what they post. My group will help them build a social media strategy plan for the different social channels. With a strong brand, Little Lobbyists will gain traction online and gain access to more powerful resources. If people are aware of the issue that Little Lobbyists present then they have the opportunity to care, but without knowledge of knowing what Little Lobbyists is, people can not help.