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Healthcare professionals should seek to facilitate meaningful conversations with their patients, creating space for informed decision-making and revealing what matters most to them as individuals.1
People with aphasia frequently encounter barriers to participation in the way that we approach our clinical interactions, the format of their appointments, the written information we provide and even in navigating our built environment.2
It may not be obvious when someone is experiencing difficulty understanding what you are saying. For example, they may nod along in conversation. We are at risk of assuming someone has made a decision when they have not understood fully.
By adapting how we communicate, we can improve the quality of our interactions with people with aphasia and reduce their risk of being excluded from decisions about their healthcare.
Whilst there is no one-size-fits-all approach, in this article, we will outline some general principles of supportive communication for people with aphasia and provide tips for effective communication in the clinical environment.
Some general principles for communicating with patients with aphasia include:2,3
- Address the person with aphasia directly. If you need to ask others for information, acknowledge this and seek permission
- Be prepared for instances of communication breakdown, and adapt the way that you communicate to help overcome this
- Aphasia does not impact intelligence. Communicate in a way that acknowledges this and use supportive communication strategies to help reveal their capacity
- Schedule more time for the conversation than you would for patients who do not have a communication disability
Preparing for the conversation
Taking simple steps to prepare for the conversation can be helpful:
- Bring a pen and paper for writing down keywords or drawing
- Reduce background noise and distractions
- If the person with aphasia uses augmentative and alternative communication (AAC) methods (e.g. picture-based communication book or iPad app) then ensure this is available during the conversation
- Ensure that they are wearing their hearing aids or glasses if required
Supporting someone with receptive aphasia to understand you
Use short, clear sentences and emphasise keywords (e.g. “you are in hospital”).
Use visual methods of getting your message across, such as writing down keywords, using gestures, and pointing to pictures or objects. For example:
- Using a picture-based communication aid to support someone in understanding they are going for a scan (Figure 1)
- Writing down keywords during a conversation about discharge from hospital (Figure 2)
Give patients with aphasia plenty of time to process your message.
After important conversations, provide a short summary (e.g. keywords or pictures) for patients to keep.
Supporting someone with expressive aphasia to get their message across
Give patients with expressive aphasia adequate time to express their message. Avoid responses and body language that may make them feel rushed (e.g. interrupting or finishing their sentence).
When patients have difficulty finding the words they want to say, encourage them to try other communication methods (e.g. pointing to objects and pictures, gesture, writing, drawing).
When asking questions, try giving them a choice of written words or pictures to support their response.
Ask yes/no questions. If they cannot respond verbally, encourage them to use another method (e.g. nodding or shaking their head, thumbs up or down, pointing to a yes/ no communication board).
Check that you have understood correctly by summarising their message and confirming this with the patient.
Never pretend that you have understood. Show that you value their message by persevering and acknowledging when communication is difficult.
If appropriate, a speech and language therapist can provide specific strategies or support communication during important conversations such as capacity assessments, discussion of the ceiling of care or communication of a diagnosis.
Useful resources for communicating with patients with aphasia include:
- Aphasia Institute: Supported Conversation for Adults with Aphasia (free e-learning module)
- The hospital communication book (useful images for hospital/healthcare-related conversations)
- Stroke Association guidelines on making written information accessible for people with aphasia
Clinical Lead Speech and Language Therapist for Stroke Services
Dr Chris Jefferies
- Scottish Government. What Works to Support and Promote Shared Decision Making: A synthesis of recent evidence. Published March 2019. [Online]. Available from: [LINK]
- Burns, M., Baylor, C., Dudgeon, B. J., Starks, H., & Yorkston, K. Asking the stakeholders: Perspectives of individuals with aphasia, their family members, and physicians regarding communication in medical interactions. American Journal of Speech-Language Pathology (2015); 24(3), 341-357.
- Manning, M., MacFarlane, A., Hickey, A., & Franklin, S. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PloS one (2019); 14(3), e0214200.
- Tomáš Vendiš. CT scanner located at the Lochotín University Hospital in Pilsen, Czech Republic. License: [CC BY-SA 4.0]