Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include improving communication between healthcare workers and patients with disabilities.
The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:
- Doctors’ offices
- Walk-in clinics
- Wellness centres
- Nursing homes
- Outpatient rehabilitation centres
- Health regulatory colleges
Therefore, all these settings should improve communication between healthcare workers and patients with disabilities.
Improving Communication between Healthcare Workers and Patients with Disabilities
The committee recommends that hospitals have policies, procedures, and practices ensuring that patients with disabilities can communicate with their healthcare providers. For example, patients may need to make appointments in a variety of ways, including:
- By phone, using:
- Hearing aids
- Speech-to-speech relay service
- By text or email
- Using Video Relay Service (VRS)
In addition, some patients need communication supports during appointments, such as Sign language interpretation, when consulting their doctors. Similarly, patients may need their doctors to explain diagnoses in plain language. Likewise, patients may use communication boards. Some patients bring their own communication board to their appointment. Alternatively, other patients use a hospital’s communication board containing words, phrases, or pictures related to their services. Hospital staff should know how to provide these and other supports upon request, so that all patients can communicate during appointments.
Moreover, patients may need written information in accessible formats, such as:
- Accessible digital files, such as Microsoft Word or HTML
- Large print
Staff should know how to provide these formats upon request for patients who need them. Furthermore, staff should also assist patients in filling out forms, either in hard-copy print or on electronic devices that are not accessible.
Capacity to consent
Healthcare providers must also have policies in place ensuring that all patients can make informed choices about their healthcare. When patients have access to the communication supports and the formats they need, they learn about different treatment options available. Moreover, they also understand the consequences of different treatment options, and make informed choices based on their understanding of those consequences. Making independent healthcare choices, based on full understanding of different options, is called capacity to consent.
In Ontario, healthcare providers assume that most adults have the capacity to consent. However, if patients with disabilities cannot communicate with their healthcare providers, because supports are not available, those providers might assume that these patients lack the capacity to consent. Therefore, hospitals should train their staff to recognize that these patients do have the capacity to consent, when their accommodations are implemented properly. Moreover, hospitals should also have processes to ensure that patients can clearly give informed consent.
For instance, hospital staff, and professionals who assess people’s capacity to consent, should have training to identify and provide the supports a patient needs to:
- Learn about their health conditions, treatments, and consequences
- Communicate their consent
In addition, staff should document patients’ needs for communication supports, so that these supports can be provided in situations requiring informed consent. Finally, hospitals should have processes in place to ensure that people have access to formal, independent supports to consent during:
- Conflicts of interest between a patient and their usual support person
- High risk situations, such as medical assistance in dying
All these policies and procedures will ensure that all patients can clearly communicate their needs and make their own healthcare decisions.