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Background There is a growing interest in exploring the nature of communication in veterinary medicine and understanding how veterinary practitioners communicate with their clients and other professionals. This is the first integrative review of literature on veterinary communication. Applying the PRISMA model, the PubMed, PsychInfo and ERIC databases were searched using keywords such as ‘veterinary’, ‘vet’, ‘communication’ and ‘interaction’ for related articles published between 1 January 2000 and 31 December 2018. Results Keyword searching through the databases yielded 1572 related studies. Only 48 of these studies were included in our analysis after an in-depth review by two independent reviewers using the critical appraisal skills Programme frameworks with high inter-rater reliability (Cohen’s kappa coefficient κ > 0.8). The existing body of research on veterinary communication can be classified into three major areas: (a) client–veterinarian communication, (b) cross-disciplinary communication in a professional veterinarian team and (c) training of veterinary communication skills. This review details the complexity and heterogeneity of agenda in the field of veterinary communication. The included studies indicate that veterinary practitioners are not equipped with specific communication skills to address different agendas in veterinary communication. The veterinary curriculum should include a component on communication training that can help veterinary students acquire necessary communication skills that allow them to effectively communicate with clients and other professionals Conclusion This review detailed the complexity of agendas in the field of veterinary communication. The results indicate that veterinary practitioners can further benefit from training on specific communication skills that address the agendas found in veterinary communication research. Furthermore, the veterinary curriculum should include a component on communication training that equips veterinary students with the necessary communication skills that allow them to effectively communicate with different stakeholders such as clients and colleagues with and across the field of veterinary science.

Effective clinical nursing handover involves the transfer of responsibility and accountability for patient care between nurses, leading to better patient safety and continuity of care. Nurses in bilingual contexts, such as Hong Kong – where nurses are trained in English but communicate in Cantonese – may find it challenging to deliver a safe clinical handover. This article reports a pilot study in which a simulation-based approach is being developed to enhance nursing handover with structured and interactive interactions, using handover protocols such as ISBAR (introduction, situation, background, assessment, recommendation and readback) and CARE-team (connect, ask, respond, empathise) protocols in a bilingual context. The study has a pre‐ and post-evaluation design involving a questionnaire survey before and after a 4‐hour workshop. Fourteen selected bilingual nurses in Hong Kong were trained according to the ISBAR and CARE-team protocols, and their perceptions of complete and structured handovers were evaluated before and after training using the questionnaire. The nurses reported that they were more self-confident in their handover experiences, with a deeper understanding of ISBAR and CARE-team protocols after the simulation-based training intervention, leading to better (i.e., more structured and interactive) clinical handover between nurses. Overall, the staff perceived their handover communication to have improved using simulation-based training.

Background Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. Methods Fifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. Results Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members. Conclusions When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of   communication for critical conversation should be promoted.

ObjectiveTo explore the linguistic features of translanguaging in bilingual handover practices and elicit the views of hospital staff on factors that hinder or facilitate effective handover practice in a bilingual environment.Methods78 hospital staff were recruited from hospital wards and emergency departments of two Hong Kong hospitals. They were interviewed to determine their perceptions of their handover communication in a bilingual context, and their responses were subjected to interpretative phenomenological analysis.ResultsBased on the staff interviews, three dimensions with potential applications to effective clinical handover are identified. A revised Identify, Situation, Background, Assessment and Recommendation protocol accounting for linguistic pluralism (i.e., the translanguaging process) is suggested to underpin the future research agenda around effective clinical communication in a bilingual context.ConclusionsResearch on handover communication in multilingual contexts is limited. This study outlines linguistic pluralism at the handover stage and details the complexity of handover communication for staff in a bilingual context. It urges for more research with a specific focus on identifying avoidable linguistic issues that emerge from the clinical context and developing a suitable protocol to standardise staff’s translanguaging processes to ensure a safe and efficient handover process in a bilingual environment.

Background Clinical handover is a pivotal, high-risk communicative event because it involves the transfer of responsibility and accountability for patients and their care. Nurses’ perceptions and their communication skills inevitably impact on their ability of clinical handover. Limited studies have explored nurses’ handover practice in the Hong Kong context. This study aimed to identify factors associated with and specific impact paths between the quality, communication skills and nurses’ perceptions on clinical handover. Methods A questionnaire survey was conducted immediately after the nurses’ training in effective handover communication. A convenience sample of 206 bilingual nursing staff from a local hospital in Hong Kong participated in this paper-and-pencil survey adopted from the Nurses Handover Perceptions Questionnaire survey. Results The path analysis revealed that except the opportunity to ask questions and high perceptions of the ISBAR communication protocol, other factors were significantly correlated with improved quality of handover. In addition, nurses who had updated information were likely to ask more questions and obtain a better understanding of the patient care plan during handover. Conclusions The quality of nursing handover depended on the degree of nurses’ grasp of the patient care plan. The ISBAR communication protocol was considered helping nurses to improve their communication skills with other colleagues and indirectly enhance patient’s safety. However, although ISBAR facilitated nurses to structure clearer handover communication, it was not the most important predictive factor for determining handover quality.

The rapid trend towards globalization has led to the expansion of English as Medium of Instruction (EMI) in tertiary education. The academic challenges faced by non-native speakers have been broadly discussed in Anglophone countries, whilst those learning through EMI in the Chinese context are still underexplored. To examine Chinese EMI university students’ perceived language challenges in learning, as well as their language-related learning strategies, this study investigated 73 students studying at EMI universities in Hong Kong, taking account of their gender, EMI experience in higher education, and English exposure prior to tertiary education. Participants completed a survey to provide self-evaluations of their academic situation and their perceptions of their disciplinary learning. The study found that students perceived a relatively low level of language and learning challenges, and they showed a preference for using their second language (L2)-related learning strategies over strategies related to their first language. Specifically, male students tended to be more actively engaged in communication with their peers than females, and were more likely to search for additional learning support in English. In addition, first-year undergraduates perceived a greater degree of challenges in knowledge application and relied more on L2-related learning strategies than their senior counterparts. Although the importance of English exposure prior to higher education has been highlighted in many existing studies, this study found that prior exposure to English was neither connected with students’ perceived challenges nor their learning strategies.

In East Asian cultural contexts, advance directive (AD) and advance care planning (ACP) discussions are generally challenging given patients' unawareness of decision-making rights. Selected databases were searched for articles published from January 2000 to December 2020. 21 studies were included and appraised with Critical Appraisal Skills Programme Systematic Review Checklist. Five themes emerged. Future research should focus on developing a culturally appropriate AD and ACP communication framework.

After outlining why a systematic review of research in English medium instruction (EMI) in higher education (HE) is urgently required, we briefly situate the rapidly growing EMI phenomenon in the broader field of research in which content and language have been considered and compare HE research outputs with those from other phases of education. An in-depth review of 83 studies in HE documents the growth of EMI in different geographical areas. We describe studies which have investigated university teachers’ beliefs and those of students before attempting to synthesise the evidence on whether teaching academic subjects through the medium of English as a second language (L2) is of benefit to developing English proficiency without a detrimental effect on content learning. We conclude that key stakeholders have serious concerns regarding the introduction and implementation of EMI despite sometimes recognising its inevitability. We also conclude that the research evidence to date is insufficient to assert that EMI benefits language learning nor that it is clearly detrimental to content learning. There are also insufficient studies demonstrating, through the classroom discourse, the kind of practice which may lead to beneficial outcomes. This insufficiency, we argue, is partly due to research methodology problems both at the micro and macro level.

BackgroundPalliative care providers serving Chinese patients lack a culture-specific model of communication, a strong evidence base for this and clear guidance on its application. Thus, providers find it challenging to address patients’ dignity, and determine their priorities and preferences for treatments and care, at the patients’ final stage of life.AimThis study explores the culture-specific influences and current understanding of end-of-life (EOL) communication in the Chinese context.MethodsA qualitative systematic review of qualitative studies was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, PubMed and ERIC databases were searched for studies between January 1994 and July 2019, using keywords ‘end of life’, ‘terminal care’, ‘communication’ and ‘Chinese’. Included studies were appraised with Critical Appraisal Skills Programme criteria.ResultsThe search strategy yielded 982 entries and 13 studies were included. Six themes were identified in EOL communication in the Chinese context: (1) Chinese philosophies on the meaning of ‘good death’. (2) Negative attitudes towards communication on dying. (3) EOL communication as a taboo topic. (4) Clinician-centred approaches to treatment-decision making. (5) Family expectations being prioritised over patient self-autonomy in prognosis disclosure. (6) Care-providers expressing puzzlement over cultural preferences regarding EOL communication.ConclusionsThe review detailed the complexity of EOL communication in the Chinese context, urging for a communication model distinct from Western-based practices. Future research could explore a validated communication framework that addresses the local culture, thus enabling an understanding of patients’ priorities and interpreting EOL encounters from a cross-cultural perspective.

Background In the absence of a well-rounded syllabus that emphasises both interpersonal and medical dimensions in clinical communication, medical students in the early stages of their career may find it challenging to effectively communicate with patients, especially when dealing with perceived priorities and challenges across different disciplines. Methods To explore the priorities, challenges, and scope of clinical communication teaching as perceived by clinicians from different clinical disciplines, we recruited nine medical educators, all experienced frontline clinicians, from eight disciplines across seven hospitals and two medical schools in Hong Kong. They were interviewed on their clinical communication teaching in the Hong Kong context, specifically its priorities, challenges, and scope. We then performed interpretative phenomenological analysis of the interview data. Results The interview data revealed five themes related to the priorities, challenges, and scope of clinical communication teaching across a wide range of disciplines in the Hong Kong context, namely (1) empathising with patients; (2) using technology to teach both the medical and interpersonal dimensions of clinical communication; (3) shared decision-making with patients and their families: the influence of Chinese collectivism and cultural attitudes towards death; (4) interdisciplinary communication between medical departments; and (5) the role of language in clinician–patient communication. Conclusions Coming from different clinical disciplines, the clinicians in this study approached the complex nature of clinical communication teaching in the Hong Kong context differently. The findings illustrate the need to teach clinical communication both specifically for a discipline as well as generically. This is particularly important in the intensive care unit, where clinicians from different departments frequently cooperate. This study also highlights how communication strategies, non-verbal social cues, and the understanding of clinical communication in the Hong Kong Chinese context operate differently from those in the West, because of differences in sociocultural factors such as family dynamics and hierarchical social structures. We recommend a dynamic teaching approach that uses role-playing tasks, scenario-based exercises, and similar activities to help medical students establish well-rounded clinical communication skills in preparation for their future clinical practice.