Hospital staff: how to communicate with a patient who is hard of hearing or Deaf

Ask about preferences

Start by asking how the patient would like to receive information rather than choosing for them. A person with hearing loss may use writing, lip-reading, a device, or sign language; not everyone with hearing loss is Deaf or uses sign language. You might ask: “What would work best for you: written text, lip-reading, an interpreter, or something else?” Check whether an interpreter or other support is needed. Record the answer so the next shift can use it. This spares the patient from having to explain their needs at every conversation and keeps staff from relying on assumptions.

When a patient does not understand

If the patient has not understood, simply repeating the same words more loudly may not help. Explain the point another way and check understanding in a format the patient uses. A nod alone does not show that the information was understood; you can ask the patient to say how they understand the next step. The aim is to clarify the explanation, not to test the patient. A review of 13 studies involving hospitalised people with hearing loss describes a range of barriers to communicating with staff. It did not, however, test a single technique shown to work for everyone. How you explain and check understanding therefore needs to be tailored to the individual.

Set up the conversation

The setting can make communication difficult even when staff feel they are speaking clearly. Before sharing information, face the patient, ensure there is enough light, and reduce noise where possible. Avoid speaking while turning towards equipment or doing another task, especially if the patient lip-reads. The FUEL framework describes the cognitive effort involved in listening under difficult conditions. It helps explain why the surroundings and the way a conversation is conducted matter, but it is not an experiment proving the clinical effectiveness of these individual suggestions. Even after improving the setting, ask the patient whether they could access the information.

An important clinical decision

For an important clinical decision, it is not enough to provide information: the conversation must take place through a channel the patient can actually use, in line with procedure. Present the available options in the patient’s chosen format and check which ones they have understood before moving on. Saying that the doctor explained everything clearly does not establish whether the patient had a chance to understand what those options mean. If communication support is needed, arrange an appropriate way to provide it rather than assuming a child accompanying the patient can interpret. This matters especially when the discussion affects the next stage of care and the patient needs answers to their questions.

What the evidence can tell us

Evidence about communication needs to be read with attention to what it covers. A review of 13 studies involving hospitalised people with hearing loss describes patients’ experiences and barriers to communication; it is not a test of a particular intervention’s effectiveness. There is also a review of communication with people with hearing loss for which an erratum was published. The existence of these publications alone is no basis for promising that one recommendation will improve clinical outcomes. Accounts of difficulties reported by patients are a different kind of evidence from measurements of a specific method’s effect. Hearing loss alone also does not tell you whether someone uses sign language. The starting point remains to establish the person’s preferences and check that the information has been received.

Handing over to the next shift

Accessible communication should not end when the shift of the person who established the patient’s preferences ends. In the handover, note the way of communicating that worked and whether any necessary equipment is available. Record only what is needed to maintain communication, without unnecessarily disclosing information about the patient. Also establish how the patient can call for help without speaking, and pass this on to the staff taking over their care. If the chosen approach requires equipment, a note about the preference is not enough unless its availability has been checked. This handover lets the next shift know how to begin a conversation and how the patient can signal that they need to make contact.

Check whether communication is accessible

A procedure may provide for accessible communication, but it is worth checking how it works from the patient’s perspective. After a conversation, ask whether the patient actually received an answer and whether it reached them in their chosen format. If an interpreter is needed, check availability outside normal working hours too, rather than assuming support will be there at any time. Compare what the procedure promises with what patients experience during a hospital stay. A systematic review of 13 studies describes barriers reported by people with hearing loss but does not prove that any particular solution is effective. Asking the patient helps establish whether communication was accessible in that conversation, rather than only on paper.

Accessible communication starts by asking about the patient’s preferences. It also means checking that they received an answer in their chosen format and passing that information on to the next shift.

Using Empatyzer to prepare for accessible conversations in hospital

A doctor preparing to explain the next stage of a visit to a Deaf patient can use Em beforehand to draft a short, clear explanation and a written version in plain language. They can also prepare a question about the patient’s preferred way to receive information instead of assuming that text will be suitable. In “About Me”, they can reflect on a habit of speaking while turning away from the person they are addressing. This helps them prepare for a face-to-face conversation but does not replace asking about the patient’s needs. Micro-lessons can help build the habit of checking understanding in the format the patient chooses. After preparing, the doctor asks about the patient’s preference, explains through an accessible channel, and makes sure the patient has received an answer to their question. If the next shift will continue the conversation, the agreed way of communicating should be handed over. Empatyzer helps staff prepare; it does not decide for the patient which form of communication is right for them.