Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients

Tyler G James; Meagan K Sullivan; Michael M McKee; Jason Rotoli; David Maruca; Rosemarie Stachowiak; JeeWon Cheong; Julia R Varnes

doi:10.1111/hex.13842

Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients

Health Expect. 2023 Dec;26(6):2374-2386. doi: 10.1111/hex.13842. Epub 2023 Aug 9.

Authors

Tyler G James^{1

2}, Meagan K Sullivan³, Michael M McKee¹, Jason Rotoli⁴, David Maruca⁵, Rosemarie Stachowiak⁵, JeeWon Cheong², Julia R Varnes⁶

Affiliations

¹ Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.
² Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA.
³ Department of Psychiatry, University of Florida, Gainesville, Florida, USA.
⁴ Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA.
⁵ Unaffiliated Researcher, Florida, USA.
⁶ Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, USA.

Abstract

Background: Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients.

Methods: This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach.

Results: Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes.

Conclusions: This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine.

Patient or public contribution: This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.

Keywords: deaf and hard of hearing; emergency medicine; healthcare seeking; patient-centred care; patient-provider communication.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Deafness*
Emergency Service, Hospital
Humans
Language
Persons With Hearing Impairments*
Sign Language

Abstract

Publication types

MeSH terms

Grants and funding