Correct communication to meaningful and effective treatment

Interactions and communication when working with people in professional life place many professional, ethical, but also emotional demands on a person. Interaction and communication are the most basic characteristics of human society. These elements of social ties interfere with each other and are an integral part of the work of a health worker. A condition for meaningful and effective treatment is proper communication between doctor and patient. If the patient does not understand the nature of his illness, does not understand the treatment of his illness, does not trust the doctor and the nursing staff, the treatment results can be disappointing for both parties. Communication does not only take place directly with the patient, but also with his relative or support person (2). Sometimes it leads to a more thorough explanation of the seriousness of the oncological disease and its prognosis to relatives than to the patient.

It would be very simplistic to assume that the success of the healing process depends only on health professionals. Human, empathetic communication of health care or rehabilitation facility workers, who are not directly health care workers, is often cited as a significant influence on a successful service. The holistic approach of the health care professional towards the patient should be a matter of course, despite the fact that high demands are placed on the health care professional during working hours. At first glance, the often hidden communication products that are significant for the outcome of the interaction are the patients' expectations, experiences and attitudes. (10) These are created not only during the provision of health care, but also before it (11).

Theoretical knowledge and practical skills of patients are also dependent on health education and health promotion, which is usual or normal in the environment in which they live (13,15,16,18). Health awareness is usually low in the group of patients with malignant tumors of the head and neck. The preparation of people to perform the work of a health care professional, the social environment in which services are provided, the emotional charge related to the provision of health care and professional stress are specific characteristics that determine the exceptionality and difficulty of the management of human resources participating in the provision of health care (3, 4, 7, 14, 15, 16, 18, 19, 20).

Empirical coverage of terms used Communication Watzlawick gives two definitions of communication, a broader one and a narrower one. Watzlawick's broader definition of communication considers everything that takes place in contact between two or more people to be communication. Watzlawick's narrower definition of communication is more technological and focuses specifically on the transmission of messages. He considers communication to be the transmission of messages between two or more people, the exchange of information between them, and the process of sending and receiving messages (3).

In the 1950s, Albert Mehrabian defined that when a message is transmitted by a broadcaster, the receiver perceives the effect of words from the message 7%, voice and intonation 38%, and non-verbal expressions 55% (16).

Communication and its techniques are one of the very important dimensions of interpersonal relationships. A doctor's success lies not only in his professional knowledge and practical experience, but also in effective communication. All components of interpersonal relationships in communication such as communication, interaction and perception are interconnected.

Under the influence of the changes implemented in our society, the inevitable need for further education of adults in the field of personal and interpersonal communication skills has become apparent in recent years (8).

Communication barriers between doctor and patient Misunderstanding of information The problem of communication between the doctor and the patient is the difference in the intellectual potential of the doctor and the patient. The recipient does not understand the communicated content if the broadcaster uses overly technical language, foreign words, complicated expressions, metaphors, inappropriate examples and the like. (3)

If the doctor informs the patient about the diagnosis of his disease and uses only professional medical terms, the patient imagines the content of what is being communicated, because for various reasons he does not want to admit the fact. Part of the exercise of the profession of a doctor in the sense of the law is to provide information about the state of health and instructions to the patient in an understandable language (22). A very important communication phase is verification. In this phase, the doctor explains to the patient in detail terms that the patient does not understand, and at the same time verifies whether, after explaining the terms, the patient has understood his diagnosis and the proposed treatment.

Deficiencies in communication and legal awareness of the patient and doctor The patient has the right to decide whether or not to consent to the treatment based on the information and instruction of the doctor (except for exceptions arising from the law, when the treatment is possible even without the patient's consent).

Teaching must be provided at an adequate level for the patient's understanding. The type of instruction, its method and the result are documented by the doctor in the record. They must be part of the patient's documentation (in terms of the Act on the provision of health care) (1, 7, 21, 23, 24).

Mistrust and noncompliance

The patient comes to the doctor with his usual health problem. He is determined to listen to the doctor's information, instructions and follow the instructions to solve his health problem (4, 5, 6). There are many reasons why the patient does not want, does not know, or cannot comply with the doctor's recommendations or orders (compliance - noncompliance). A significant cause of noncompliance is mistrust of the doctor. Based on empirical research (1, 4, 5, 6, 20), it can be said that ineffective communication can also cause mistrust of the doctor. The creation of a relationship (trust or mistrust, cooperation or manipulation) depends primarily on the doctor's abilities, possibilities and needs to create the necessary atmosphere of communication. Sometimes the doctor consciously creates an atmosphere of fear and strictness in an effort to achieve the effect of compliance.

Research methodology Target group 100 respondents took part in the survey in the form of a questionnaire. The questionnaire contained 26 questions, of which 6 were open. We selected respondents from oncologically ill, hospitalized patients of the ENT clinic at the Faculty Hospital with Polyclinic St. Cyrila and Metodo Petržalek, Antolská no. 11, Bratislava in 2008 and 2009. The group consisted of 87 men and 17 women. 12% of patients had university education, 71% secondary education and 12% primary education.

Aim of work The goal of the work was to obtain as accurate information as possible about the patient's opinions on health care provided at the Otorhinolaryngology Clinic of LFUK, FN and SZU, Antolská 11, Bratislava. Another goal was to gain an overview of the reality and current conditions of health care provision and to identify problem areas in communication between the patient and medical professionals at the clinic.

Results The research project contained analytical cross-sections of several levels of the real state of health care provision, opinions and evaluations of patients. For the purpose of this work, we present only selected parts of the obtained documentation material directly related to the diagnosis of ENT.

Patients' knowledge of their own diagnosis 62% of respondents know their diagnosis, which was given to them by the attending physician after the first examination. 30% of them know their diagnosis, but were only told by a doctor at the ENT clinic. 6% do not know exactly, they think they have a tumor and 2% do not know exactly about their illness and diagnosis.

Patients' knowledge about their own oncological diagnosis To the question whether the respondent was or is a patient with an oncological disease, 82% answered positively, 11% negatively and 7% did not want to answer the question.

Patients' thinking about the cause of their illness Respondents - 37% - state that they developed the disease probably from an unhealthy way of life, 17% state long-term work in a harmful environment. 13% do not know exactly, but the disease also occurred in their family. 28% of respondents do not know the reasons for their illness and 5% cite other reasons such as stress, irregular sleep, night shifts, smoking, drinking alcohol and improper diet.

Patient evaluation of previous treatment According to 42% of respondents, no treatment has been prescribed for them so far. In the case of 33% of respondents, it was correct and helped them, in 8% the previous treatment was correct, but did not help. In 8% the previous treatment was not effective, in only 6% the previous treatment was not correct and in 3% it was not necessary.

Determining patients' knowledge of the need to sign an informed consent As many as 91% of respondents answered that they know what informed consent is - it follows from the law and the doctor cannot perform an intervention without the patient's consent. Only 1% of respondents said that the doctors at this clinic are insured and want to have a signed agreement that they agree with everything, even if this is not the case. 6% of the respondents answered that they are afraid of the operation, they do not understand it, but they think that the discussion will not solve anything. 2% of respondents marked the answer I don't know.

The respondents evaluated the feeling of sufficient explanation by the doctor before the treatment as follows: 79% - the doctor explained everything to them sufficiently, they felt that if they still needed it, he would explain it to them again. 13% of respondents felt that the doctor explained everything to them sufficiently, but they would need him to explain it to them more, but they were ashamed to "bother". According to 4%, the doctor explained everything to them sufficiently, but they would need him to explain it to them more, but there was no time. 4% of respondents said they don't know. In the case of others, we did not record any response.

Patients' perception of communication with the doctor 85% of respondents imagine communication with a doctor as being entitled to complete information, and both the doctor and the patient must be convinced that the patient has understood everything. 5% of them think that the patient may not need to receive complete information and up to 6% imagine that the patient does not need to receive complete information, that the doctor determines what to tell the patient and what to the relatives. 3% of respondents do not know how to imagine communication between a doctor and a patient, and 1% of respondents state that it is different - without giving an explanation.

To the question of compliance with the treatment regimen after a sufficient explanation of the diagnosis, treatment procedure and possible complications, 59% of the respondents answered positively - yes, of course, if the doctor explains it well, then I fully comply with the treatment regimen. 41% said that they try to follow the treatment regimen, but sometimes it is not possible despite the fact that the doctor explained it to them well.

Regarding the influence of public opinion on oncological diseases in the patient's decision-making when agreeing to the proposed surgical treatment, 26% of respondents answered that they definitely do. 39% probably yes, 6% probably not and 7% definitely not. 22% of respondents answered the given question that they do not know whether public opinion will influence patients' decision-making when agreeing to the proposed surgical treatment.

Conclusion Improving communication Communication is an integral part of diagnostics, therapy, rehabilitation and the entire system of health care provision. Systematic training of human resources in the field of communication is part of the improvement of the process of health care provision.

Communication is a space in which information is transmitted, processed, but also modified and distorted. The results of the analysis are proof that communication with the patient at all levels of health care provision significantly influences the patient's tendency to follow the recommended treatment regimen and his decision to cooperate. The patient's feeling of trust in the doctor, which is created during communication, will enable the creation of such an information channel that will shorten the time of diagnosis and therapy and, consequently, can significantly affect the patient's quality of life.

Effective communication skills determine health education and health promotion outcomes. Promoting health and preventing the onset of disease through the application of educational strategies, effective communication and an effective educational process are the "cheapest way" to influence compliance with the treatment regime, correct lifestyle and the correct lifestyle of the patient (1, 8, 9, 12, 18, 20). A well-educated, cooperating patient who has confidence in the treatment process, tends to increase responsibility for his health, is able to change his attitudes to support his own health. Increasing the health awareness of a population that is more dedicated to promoting their health will lead the patient to a trusted doctor at the first signs of illness and allow for more timely and effective therapy.

Authors: Renata Knezović, Rebeka Ralbovská List of used literature:

1. BRUKKEROVÁ, D.: Sociology of health and illness. Slovak Medical University in Bratislava, 2005, ISBN 80-89171-29-X
2. BRUKKEROVÁ, D.: Teaching sociology at ILF. Sociology, 22, 1990, no. 2, p.113 - 232 (monothematic issue dedicated to the sociology of health and illness)
3. GABURA, J., GABURA, P.: Social communication. Civic association Social work, Bratislava 2004. ISBN 80-968927-7-0
4. GAJDOŠÍK, J., BRUKKEROVÁ, D.: A project to collect data on doctors' satisfaction with their profession. Medical Monitor, 2003, no. 3, p. 21 - 22.
5. GAJDOŠÍK, J, BRUKKEROVÁ D., KRIŠKA, M, SVOREŇOVÁ, A.: Do we sufficiently know the patient's willingness to follow the doctor's instructions? Praktický lékař, 2007, 87, No. 2. pp. 103 - 107.
6. GAJDOŠÍK, J., BRUKKEROVÁ D., KRIŠKA, M., SVOREŇOVÁ, A.: Do doctors' ideas about patients' compliance with the treatment regimen correspond to reality? Praktický lékař, 2007, 87, No. 8
7. GECÍK, K.: Legal liability in health care and medicine, Martin, 1984
8. HLÁSNA, S.: Further education of adults in the field of personal and interpersonal communication and presentation skills. In: Linguistic and didactic aspects of foreign language training in the commercial sphere. Bratislava: Lingos, 2008, p. 35-40. ISBN 978-80-89328-03-1
9. HEGYI, L., TAKÁČOVÁ, Z., BRUKKEROVÁ, D.: Health education and health promotion. Bratislava, 2004. SZU, Herba s.r.o. 150 p. ISBN 80-89171-20-6
10. HEGYI, L., TAKÁČOVÁ, Z., BRUKKEROVÁ, D.: Selected chapters from pedagogy and communication for public health. Bratislava, 2004. SZU, Herba s.r.o. 105 p. ISBN 80-89171-21-4
11. KHELEROVÁ, V.: Communication skills of a manager. Prague: Grada, 1995, p. 141, ISBN 80-7169-223-9
12. MATULNÍK, J., BRUKKEROVÁ, D.: Teaching sociology in the preparation of experts for public health. In: Búzik, B., Matulník, J.: Sociology at middle and high schools. Bratislava, SSS pri SAV, 2000, p. 56 - 60.
13. MATULNÍK, J., IMRICHOVIČOVÁ, M., BRUKKEROVÁ, D.: Current trends in the sociology of health and illness. SSS SAS, l999, 99 p. ISBN 8088774-65-9
14. NETTLETON, S.: Sociology of Health and Illness. London: Blackwell, 1994, 258p.
15. ONDREJKA, I., DRÍMALOVÁ, K., FETISOVÁ, Ž., ADAMICOVÁ, K.: The concept of quality of life and its importance in health care. Slovak doctor, 2001, no. 7-8, p. 256 - 258.
16. PEASE, A., PEASE, B.: The Big Book of Body Language. Ikar, a. pp., Bratislava 2006, ISBN 80-551-1164-2
17. SIEGRIST, J.: Lehrbuch der Medizinischen Soziologie. Munich-Berlin-Vienna: Urban und Schwarzenberg, 1974
18. SURYNEK, A., KOMÁRKOVÁ, R., KAŠPAROVÁ, E.: Basics of sociological research. Prague: Press, 2001. ISBN 80-7261-038-4
19. World Health Organization - European Bureau: Health for all in the 21st century. Copenhagen: Health for All - Euro No. 5, 1999. ISBN 80-7159-119-X
20. SZARKOVÁ, M.: Communication in management. Bratislava: Ekonóm, 2002, p. 197, ISBN 80-225-1585-X
21. TONES, B. K.: Changing theory and practice: trends in methods, strategies and settings in health education. Health Education Journal, 52, (3), 126 - 139 p.
22. TÓTH, K., BADINSKÝ, M.: Law in health care. I. ed. Bratislava: IURA Edition, 1996. ISBN 80-88715-27-X.
23. Decree of the Ministry of Health of the Slovak Republic No. 79/1981 Coll. on health workers and other departments work
24. Decree of the Ministry of Health of the Slovak Republic No. 156 and 157/2002 on professional competence and preparation for the performance of activities in the health sector

The paper was presented at the 5th annual conference entitled ,,Psychology of health 2010", which took place on May 19, 2010 in Bratislava. The conference was organized by the health psychology section of the SPS at SAV in cooperation with the health section of the Ministry of Health of the Slovak Republic. The following participated in the preparation of the event: National Institute of Heart and Vascular Diseases in Bratislava, VŠZaSP St. Elizabeth in Bratislava, WHO Office in Slovakia, KISH Košice, Department of Psychology FF KU in Ružomberok and Department of Psychology FF TU in Trnava.

Proceedings from the 5th conference of health psychology, Bratislava, 2010 was published only in electronic form Availability: http://www.prohuman.sk/psychologia/zbornik-prispevkov-z-konferencie-psychologia-zdravia-2010