A Cross-Sectional Study of Dementia-Related Communication Barriers in Clinical Practice in South India

TL;DR

This study examines communication challenges between healthcare providers and dementia patients in South India, highlighting the impact on care and suggesting training solutions.

Contribution

The study identifies specific communication barriers in dementia care in a South Indian context and proposes targeted strategies for improvement.

Findings

Communication barriers were prevalent across all dementia stages, with word-finding difficulties and sentence construction issues reported in 72% and 68% of patients, respectively.

Language barriers were significant, with 70% of Tamil-speaking patients facing challenges when communicating with non-Tamil-speaking doctors.

Healthcare providers with less than three years of experience faced significantly more communication challenges than experienced providers.

Abstract

Background

Dementia is a growing public health challenge in India, with increasing prevalence due to an aging population. Communication barriers are among the earliest and most profound symptoms of dementia, complicating interactions between patients and healthcare providers. This study explores the communication challenges faced by resident doctors and nurses in a tertiary care setting in Chennai, South India while managing dementia patients.

Objectives

1) To assess the communication barriers faced by healthcare providers during interactions with dementia patients (N = 50).; 2) to identify the impact of these barriers on patient care; 3) to suggest strategies for improving dementia-related communication.

Methods

A cross-sectional observational study was conducted in the neurology department of a tertiary care hospital in Chennai. The study included 50 dementia patients (30 males (60%), 20 females (40%) and 40 healthcare providers (25 resident doctors (62.5%) and 15 nurses (37.5%)). Patients were classified into mild (10 patients, 20%), moderate (25 patients, 50%), and severe (15 patients, 30%) dementia based on the Clinical Dementia Rating (CDR) Scale. Data were collected through structured questionnaires, semi-structured interviews, and observations of patient-provider interactions. The questionnaire was validated through a pilot study (Cronbach’s alpha = 0.82). Quantitative data were analyzed using descriptive statistics, chi-square tests, and t-tests, while qualitative data were thematically analyzed using Braun and Clarke’s six-phase approach.

Results

Communication barriers were prevalent across all dementia stages, with 36 (72%) patients experiencing word-finding difficulties and 34 (68%) struggling to construct complete sentences. Non-verbal communication impairments, such as reduced comprehension of gestures, were noted in 21 (42%) patients, particularly in those with severe dementia (p = 0.02). Language barriers were significant, with 35 (70%) Tamil-speaking patients facing challenges when communicating with non-Tamil-speaking doctors (p = 0.04). Among healthcare providers, 34 (85%) reported difficulties explaining treatment plans, leading to delays in diagnosis and treatment (p = 0.01). Emotional frustration was noted by 28 (70%) doctors, who cited challenges in establishing rapport with patients. Simplified language, visual aids, and caregiver involvement improved communication in 26 (65%) cases (p = 0.02). Healthcare providers with less than three years of clinical experience faced significantly more communication challenges compared to their experienced counterparts (p < 0.05).

Conclusion

Communication barriers in dementia care significantly hinder effective diagnosis and treatment. These challenges are exacerbated by linguistic diversity and cultural differences in India. Training programs focusing on dementia-specific communication skills, cultural competence, and caregiver involvement are essential to improve patient-provider interactions and enhance dementia care.