title: Exploring oral literacy in communication with hospice caregivers.
abstract: BACKGROUND
  Low oral literacy has been identified as a barrier to pain management for informal caregivers who receive verbal instructions on pain medication and pain protocols.
  
  
  OBJECTIVE
  To examine recorded communication between hospice staff and informal caregivers and explore caregiver experiences.
  
  
  METHODS
  Using transcripts of interactions (n = 47), oral literacy features were analyzed by examining the generalized language complexity using the Flesch-Kincaid grading scale and the dialogue interactivity defined by talking turns and interaction time. Means for longitudinal follow-up measures on caregiver anxiety, quality of life, perception of pain management, knowledge and comfort providing pain medication, and satisfaction were examined to explore their relationship to oral literacy.
  
  
  RESULTS
  Communication between team members and caregivers averaged a fourth-grade level on the Flesch-Kincaid scale, indicating that communication was easy to understand. Reading ease was associated (r = 0.67, P < 0.05) with caregiver understanding of and comfort with pain management. Perceived barriers to caregiver pain management were lower when sessions had increased use of passive sentences (r = 0.61, P < 0.01), suggesting that passive voice was not an accurate indicator of language complexity. Caregiver understanding and comfort with administering pain medications (r = -0.82, P < 0.01) and caregiver quality of life (r = -0.49, P < 0.05) were negatively correlated with dialogue pace.
  
  
  CONCLUSIONS
  As the grade level of talk with caregivers and hospice teams increased, associated caregiver anxiety increased. Caregivers with higher anxiety also experienced greater difficulty in understanding pain medication and its management. Specific adjustments that hospice teams can make to improve caregiver experiences are identified.
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Communication, University of Kentucky, Lexington, Kentucky, USA. Electronic address: elaine.lyles@uky.edu.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wittenberg-Lyles
authors.forename: Joy
authors.initials: J
authors.lastname: Goldsmith
authors.forename: Debra Parker
authors.initials: DP
authors.lastname: Oliver
authors.forename: George
authors.initials: G
authors.lastname: Demiris
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kruse
authors.forename: Stephanie
authors.initials: S
authors.lastname: Van Stee
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data*; D003142:Communication; D032882:Comprehension; D057220:Health Literacy / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D059408:Pain Management / Q000706:statistics & numerical data*; D015995:Prevalence; D011368:Professional-Family Relations; D014481:United States
keywords: Caregivers; health literacy; hospice team; pain management