New Patient Tool For Communicating with Providers/Stating Preferences

printable/PDF: NICE SPEECH LADY TOOL: Prep-Communication Mechanisms Packet (Provider Visits)

or:

word document for copying/pasting/modifying — Nice Speech Lady Tools — Prep-Communication Mechanisms (Provider Visits).docx

When seeing a provider, some patients need help planning what to share. What can be helpful is writing the reason for the visit and organizing what is needed.

Some patients may have a greater need for this, especially if there are difficulties with:

focus,
memory,
pain,
receptive/expressive deficits,
recent changes in physical statuses,
stress,
lack of support,
multiple medications,
multiple diagnoses,
too much change happening at once,
mental health challenges, or
other factors.

Medical SLPs can provide these prep-forms to patients, care-partners, as well as those with more-significant communication challenges. These forms can be used for visits with:

Medical primary care providers,
Medical specialists,
counselors,
physical therapists,
occupational therapists,
speech-language pathologists,
nursing visits,
other caregivers.

Provided are options of the different versions:

Patient Version
Care Partner Version
Version for Those with Communication Challenges

Nice Speech Lady Tool — Prep-Communication Mechanism (Provider Visits) – Patient Version

My biggest issues are:
Other factors to know:
What changed recently:
What I would like you to ask about:
Something you don’t know about me:
What would help, when we communicate:
What I need when we communicate:
To explore, when time allows:
In all transparency, it would help:
My highest need at this point is:
When I walk away from this appointment, I would like:

Discussed area (from before):

Rating areas of difficulty; please circle the number in the 0-10 range:

0 = no difficulty

1 = very mild difficulty

2 or 3 = mild difficulty

4 = mild to moderate difficulty

5 or 6 = moderate difficulty

7 = moderate to severe difficulty

8 or 9 = severe difficulty

10 = profound difficulty

Nice Speech Lady Tool — Prep-Communication Mechanism (Provider Visits) – Care Partner Version

The biggest issues are:
Other factors to know:
What changed recently:
What we would like you to ask about:
Something you don’t know about the patient:
What would help, when we communicate:
What is needed during communication:
To explore, when time allows:
In all transparency, it would help:
The highest need at this point is:
When walking away from this appointment, we would like:

Discussed area (from before):

Rating areas of difficulty; please circle the number in the 0-10 range:

0 = no difficulty

1 = very mild difficulty

2 or 3 = mild difficulty

4 = mild to moderate difficulty

5 or 6 = moderate difficulty

7 = moderate to severe difficulty

8 or 9 = severe difficulty

10 = profound difficulty

Nice Speech Lady Tool — Prep-Communication Mechanism (Provider Visits) – Version for Those with Communication Challenges (Circle/Fill-in)

Big issues: PAIN. ROUTINE VISIT. SICKNESS. QUESTION. INJURY. NEW SYMPTOMS. SEE A SPECIALIST. FOLLOW-UP. TALKING, UNDERSTANDING OTHERS, MEDICATION NEEDS. OTHER:
Factors: RECENT TRAGEDY.CHANGES: EATING, SLEEP, ACTIVITY. SITUATION. PHYSICAL SYMPTOMS. OTHER.
I want to ask: HOW TO IMPROVE. WHAT TO DO ABOUT.
When we communicate: USE WRITING. USE BREAKS. USE MY A/AC TOOLS. SLOW DOWN. ASK ME YES/NO QUESTIONS. MY CARE PARTNER SPEAKS FOR ME. BE PATIENT. VALIDATE. EYE CONTACT IS HARD. I NEED TIME TO ANSWER. LISTEN; IT HELPS. INTERPRETER NEEDED. OTHER.
Let’s talk someday on: PREVENTING ILLNESS. PRIVATE/HARD TOPICS. RESOURCE NEEDS. MENTAL HEALTH. MY QUESTIONS.
I want to feel: RESPECTED. HEARD. PATIENTLY LISTENED TO. REFERRALS MADE. MY LOVED ONES ARE INVOLVED. QUESTIONS ANSWERED. PAIN/DISCOMFORT ADDRESSED. MEDICATION NEEDS TO BE ADDRESSED. IT MATTERS WHAT I ASK. CONCERNS ARE TENDED TO. I AM PREVENTING MEDICAL PROBLEMS. A PLAN IN PLACE. (other): __________

REFERENCES

Roulstone, Sue. (2011). Evidence, expertise, and patient preference in speech-language pathology. International journal of speech-language pathology. 13. 43-8. 10.3109/17549507.2010.491130.

Yu W, Li M, Ye F, et al “Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study.” BMJ Open 2017;7:e016418. doi: 10.1136/bmjopen-2017-016418

Wilson Nice, SLP, is the owner of Nice Speech Lady, a medical SLP platform for functional, practical and evidence-based SLP clinical resources.