Oshita Jennifer Y, Schliep Megan E, Douglas Natalie F, Savard Liliane B, Feuerstein Julie L, MacLean Charles D, Morris Megan A
NYU Langone, New York, NY.
University of Vermont, Burlington.
Am J Speech Lang Pathol. 2025 May 6;34(3):1493-1527. doi: 10.1044/2024_AJSLP-24-00234. Epub 2025 Apr 29.
The Americans with Disabilities Act (ADA) of 1990 protects the civil rights of people with disabilities, including their right to effective communication and equitable health care access through accommodations. The ADA website lists examples of accommodations (e.g., qualified notetaker, hearing amplifiers, cued speech interpreters), but no literature is cited to support this list. Scientific evidence is critical to advancing both the effectiveness and widespread implementation of accommodations. We scoped the literature on interventions supporting equitable communication access (accommodations) for adults with communication disabilities (CDs) in health care settings. We asked what accommodations have been studied, for what CD populations, and how they have been studied.
We used a scoping review approach and conducted searches using MEDLINE, CINAHL, and Embase databases. Two reviewers independently screened abstracts and full texts indexed between January 1, 2003, and August 1, 2024. Data on accommodation type, CD-related health condition, setting, health care workers involved, evidence type, study design, and outcome were collected.
Screening of 1,614 articles identified 58 investigations of 10 communication accommodations in health care settings. The range in number of publications rose from 0-2 to 2-9 over the 11-year period. The three most studied accommodations were , , and (each 21%-22% of studies). Most investigations addressed populations with single CD-related conditions (e.g., aphasia), were descriptive (52%), and had sample sizes ≤ 50 participants. Speech-language pathologists infrequently provided or implemented accommodations (12% of all health care workers involved, by type of worker). Findings were typically positive, but outcome measures were heterogeneous.
The 10 researched accommodations addressed a wider range of CD populations as compared to accommodations found in policy documents, highlighting an opportunity to align policy and evidence. While accommodation studies generally yielded positive results, their small sample sizes, descriptive focus, and limited quantity suggest this research is early in its development. We outline potential strategies to advance knowledge on the implementation and effectiveness of communication accommodations in health care settings.
1990年的《美国残疾人法案》（ADA）保护残疾人的公民权利，包括他们通过合理便利获得有效沟通和平等医疗保健服务的权利。ADA网站列出了一些合理便利的例子（例如，合格的笔记记录员、听力放大器、手语翻译），但未引用任何文献来支持该列表。科学证据对于提高合理便利的有效性和广泛实施至关重要。我们对支持医疗保健环境中患有沟通障碍（CD）的成年人获得公平沟通机会（合理便利）的干预措施的文献进行了综述。我们研究了哪些合理便利被研究过、针对哪些CD人群以及它们是如何被研究的。
我们采用了综述方法，使用MEDLINE、CINAHL和Embase数据库进行检索。两名评审员独立筛选了2003年1月1日至2024年8月1日期间索引的摘要和全文。收集了有关合理便利类型、与CD相关的健康状况、环境、涉及的医护人员、证据类型、研究设计和结果的数据。
对1614篇文章的筛选确定了对医疗保健环境中10种沟通合理便利的58项调查。在这11年期间，出版物数量从0 - 2篇增加到2 - 9篇。研究最多的三种合理便利是 、 和 （每项研究占21% - 22%）。大多数调查针对的是患有单一与CD相关疾病的人群（例如，失语症），属于描述性研究（52%），样本量≤50名参与者。言语病理学家很少提供或实施合理便利（按医护人员类型计算，占所有涉及的医护人员的12%）。研究结果通常是积极的，但结果测量方法各不相同。
与政策文件中发现的合理便利相比，所研究的10种合理便利涉及更广泛的CD人群，这突出了使政策与证据保持一致的机会。虽然合理便利研究总体上产生了积极结果，但其样本量小、描述性重点突出且数量有限，表明这项研究尚处于早期发展阶段。我们概述了一些潜在策略，以推进对医疗保健环境中沟通合理便利的实施和有效性的认识。
