The information provided could have a considerable importance in helping patients to make treatment-related decisions and comply with the preparation instructions. Giving information, both sensory and procedural, to patients prior to examination could also have beneficial effects, such as reducing anxiety and resulting in the examination being less stressful. Procedural information is defined as an explanation of how and why procedures are carried out, and sensory information as an explanation of sensations that patients may expect during test. (Johnson et al. 1973; Wilson et al. 1982)
O’Connor & Butler G. investigated aspects of patient care during barium enema and demonstrated that there were several areas where the patients perceived that the amount of information given was inadequate. One fifth of patients involved in the study stated that they had not been given enough explanation of what was happening during the examination and approximately 50% of patients were not told when or from whom they would receive the results of examination. 44% of patients were given no indication of the length of the procedure (O’Connor & Butler G. 1999).
By not giving explanations and information to the patients about the procedure the radiographer increases the anxiety experienced by the patient and consequently will result in the examination being stressful (Teasedale, K. 1993).
A barium enema procedure can be uncomfortable, tiring and anxiety provoking (). It has been suggested that procedure-associated anxiety is a result of pain and discomfort during procedure (Levy, N. et al. 1989). Little is known how much pain and discomfort patients experience during barium enema examination (Lawrence, S. et al. 2001) because it’s very subjective sensation that can be described only by individual experiencing it. Studies showed that health care providers are extremely poor at judging patient pain and discomfort (Steine, S. 1993). However, specific factors may be used to predict which patients may have more pain. Younger patients, women, patients with chronic abdominal pain, and patients who had difficulty with the test preparation are more likely to experience pain during examination (Steine, S. 1993). Mishel (1984) proposed that was lack of information and clarify about events that accounted for patient’s evaluation of them as stressful, rather than the event itself Thus, it’s important for health care providers to not only inform patients about expected pain and discomfort during barium enema examinations, but also to understand and evaluate how patients perceive the test.
It is not enough just to provide information that may be beneficial to patients. The timing of when information is provided, the form in which it is presented and choice of information givers are all important issues that must be addressed (Clements, H. et al. 1998). The information should be presented in a language patients understand and a range of ways of providing it should be available (Wells, H. 2004). A study carried out by Street (1991) revealed that features of patient’s characteristics, such as educational level, age, gender, might influence the amount of information given to the patients.
More educated patient’s communicate more actively (in terms of asking questions, expressing concerns) and are more likely to eliciting more information and understand the procedure and recommendations (Willems, S. et al. 2005). This might be because of the smaller cultural distance (due to a similar background) between them and the health care provider (Street, R. 1991).
Patients from a lower educational level communicate and elicit a less involving behaviour from the heath care provider. They ask fewer questions, express fewer concerns and show less anxiety, (Street, R. 1991) which discourages the patient to adopt a more active communication style.
Health care providers behave differently with patients from lower educational level, (Willems, S. et al. 2005) possibly because they inaccurately assume that these patients are not particularly interested in learning about their health or do not understand the information (Street, R. 1991).
Similar findings were reported with older people. It has been found that older patients’ needs, based on both insufficient information given (Ellis, P.M. & Tattersall, M.H. 1999, Rothenbacher, D. et al. 1997) and information presented in a manner too difficult to understand, (Lobb, E.A. et al. 1999) is largely inadequate.
Another factor that appears to affect information giving in the health care setting is gender. Evidence suggests that female patients receive more total health care communication and more information than men (Weisman, C.S. & Teitelbaum, M.A. 1989). Women asked more questions, which encourages the health care provider to give more information compared with those who asked fewer questions and had lower preferences for information (Barsevick, A.M. & Johnson, J.E. 1990).
Patients are often dissatisfied with the information they receive (Ley, P. 1988). According to Davis and Fallowfield (1991) patient dissatisfaction relates to criticisms of professional communication skills. The importance of communication has been established and a number of studies (Arborelius, E. et al. 1992, Henbest, R.J. et al. 1989, Henbest, R.J. et al.1990, Henbest, R.J. et al. 1993) suggest that is essential to comply with certain factors in order to attain successful communication. The factors are:
- The patient is given the opportunity to express the reason for the visit, including symptoms, thoughts, feelings and expectations. By exploring these beliefs the health care provider is given the opportunity to challenge any misperceptions that may otherwise affect compliance (Russell, G. 1999).
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The patient is treated as a person with a problem, not in terms of diseases and pathology.
- The patient feels that she/he has been understood
Understanding and being understood in communication is an important aspect of the quality of patient care. Patients need to understand and recall information that they have been given in order to follow recommendations correctly. However, studies have indicated that because patients are given a great deal of information under conditions in which they may feel tense or anxious, such as barium enema, they may forget up to two-thirds of what they been told (Ley, P. et al. 1993). Ley (1988) also demonstrated a relationship between the amount of information presented and the amount of information recalled. His research showed that the more items of information given, the greater the proportion forgotten, but he makes the following point: “Note that it is the proportion forgotten that increases and this is quite compatible with patients given more information about their disease knowing more about their condition than those given less. The finding is not an argument for providing patients with less information” (Ley, P. 1988). Reading (1981) showed that information is recalled best within three hours of receiving it, and more accurately if given in both verbal and written form. The written description of the barium enema prior to examination and a verbal discussion during examination will help to achieve patient compliance and satisfaction. Research also shows that if the health care provider use simple everyday language, categorises information, presents specific rather than general information, repeats important points and write these down, then the patients recall of information can be significantly improved (Ley, P. et al. 1993). Improved recall leads to better compliance and communication.
The communication between the patient and the health care provider has a strong influence on the patient’s satisfaction and compliance (Lassen, L. 1991). The Ley (1981, 1989) cognitive hypothesis model of compliance (see appendix 2) predicted that there is significant correlation between understanding, memory, satisfaction and compliance. Patients who are satisfied with information are more likely to comply with their treatment and involve themselves with it, than those who are not satisfied (Ali, A. & Horne, R.A. 1996).
Buller & Street (1991) indicates that patient satisfaction is somehow related to provider communicator style. The communication techniques with positive regard, such as openness, interest, willingness to listen, involvement, warmth, similarity and equality (Ben-Sira, 1980, Hall, J.A. et al. 1981, Leventhal, H. et al. 1984) result in greater levels of patient satisfaction, than those which are negative.
A positive regard relates to a higher level of satisfaction and increased compliance, negative regard to lower level of satisfaction and non-compliance.
Non-compliance can be associated with a number of factors involving patient, the treatment and the health care professional and can take many forms. For example, the patient may not understand the importance of barium enema examination or may fear of its side effects, feel embarrassed, anxious and stressful or face constraints or cultural barriers etc. These must be recognised and removed, because communication cannot take place if there are barriers to the communication process. Consideration of the needs and understanding of the patient with careful and clear reporting, clear expression and the avoidance of medical language can help to overcome barriers to communication (Ball, J. 2003).
It is essential to study communication between the patient and the health care provider because of the importance of patient satisfaction and its consequences regarding compliance and other effects concerning efficacy (Fossum, B. et al. 2004). The different methods, context, structure, language, knowledge, continuous evaluation of the service and an understanding of the needs of the patient to whom the information is being transmitted can be used to provide and maintain optimal communication and satisfaction. This can be done by providing patients with clear, honest explanations and advice and by being sensitive to their individual needs (Pitts, M. 1991). It’s not easy, because there is no single attribute that determines or predicts good communication.
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Appendix 1
COLON ANATOMY
Diagram of the stomach, colon and rectum from public domain source at
Appendix 2
Ley’s (1981) model of compliance