Type of article:Quality Communication Can Improve Patient-Centred Health Outcomes Among Older Patients: A Systematic Review

Type of article:Quality Communication Can Improve Patient-Centred Health Outcomes Among Older Patients: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Type of article:Quality Communication Can Improve Patient-Centred Health Outcomes Among Older Patients: A Systematic Review Samer Sharkiya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2789752/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Aug, 2023 Read the published version in BMC Health Services Research → Version 1 posted 11 You are reading this latest preprint version Abstract Background : Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This systematic review investigated the effects of quality and effective communication on patient-centred outcomes among older patients. Methods : Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like "effective communication," "elderly," and "well-being." Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool. Results : The search strategy yielded seven studies. Four studies were qualitative (one phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, one was an experimental study, and the final was a quantitative study (unclear design). The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes. Conclusion : Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates. effective communication elderly well-being. Figures Figure 1 1.0 Introduction Excellent communication is critical for all health professionals. Medical practice heavily relies on communication to share ideas (Skarbalienė et al., 2019 ). Without effective communication, the entire health system would not operate efficiently, leading to all stakeholders experiencing adverse outcomes (Alnaser, 2020 ). Communication is critical because it affects the quality of healthcare output, impacts the patient's health and satisfaction, and benefits both patients and providers (Holm et al., 2021 ). Chichirez and Purcărea ( 2018 ) argue that communication is a critical clinical competence because it establishes trust between providers and patients, creating a therapeutic relationship. Quality communication in clinical settings should be bi-directional because patients must inform providers about their health complaints. Providers must understand and interpret this information to address health issues correctly and convey sufficient information to individuals to enable them to take preventive interventions to maintain health (Ratna, 2019 ). Physician-patient communication plays several functions, including making decisions, exchanging information, improving the physician-patient relationship, managing the patient's doubts, addressing emotions, and enhancing self-management (Świątoniowska-Lonc et al., 2020 ). What matters in the communication process for patients is being a partner in the communication process and a sense of having their needs acknowledged by healthcare professionals. According to Świątoniowska-Lonc et al. ( 2020 ), features of effective or quality communication are involving patients in decisions, allowing patients to speak without interruptions, encouraging a patient to ask questions and answering the questions, using a language that the patient understands, paying attention to the patient and discussing the next steps. This communication also includes listening, developing a good interpersonal relationship, and making patient-centred management plans. TOV ( 2018 ) defines well-being as how individuals positively experience and evaluate their lives. Experiencing life positively would involve feeling good, having control over one's life, functioning well, having positive emotions, a sense of purpose, experiencing positive relationships, and developing potential (Ruggeri et al., 2020 ). Well-being constitutes subjective and psychological well-being. Subjective well-being comprises the cognitive component of satisfaction with life as a whole and having positive emotions and not having negative emotions (Hausler et al., 2017 ). Subjective well-being encompasses psychological well-being, personal growth, self-acceptance, environmental mastery, purpose in life, personal relationships, and autonomy. The two forms of well-being are related by significantly distinct. Cuffy et al. ( 2020 ) argue that the quality of patient-physician communication influences several aspects of the patient-provider relationship and patient-reported outcomes. For instance, effective communication is associated with enhanced patient satisfaction, regulating emotions, and increasing compliance, leading to improved health and better outcomes (Ghosh et al., 2020 ; Surbakti & Sari, 2018 ). According to Birkhäuer et al. ( 2017 ), quality communication enhances patients' trust in their providers, making patients more satisfied with the treatment and better quality of life. A trusting provider-patient relationship causes individuals to believe they receive better care (Chandra et al., 2019 ). This perception enhances a patient's perceived well-being. Freudenberger et al. ( 2018 ) posit that the degree and quality of providers' communication with each other and patients affect how individuals appraise their care experience. For instance, productive communication between healthcare professionals and patients makes patients rate their overall care more highly. Effective provider-patient communication influences several aspects related to patient well-being. For instance, Choi et al. ( 2016 ) report that effective provider-patient communication improves social, somatic, and psychological health. During communication, the provider may enhance positive motivations and involve the individual in treatment decisions. Communication helps patients to acknowledge their illnesses, the associated risks, and the advantages of consistent treatment. Świątoniowska-Lonc et al. ( 2020 ) note that mutual communication between providers and patients stimulates or strengthens patients' perception of control over their health, the knowledge to discern symptoms and self-care and identify changes in their condition. Effective communication leads to improved perceived quality of health care. Chandra et al. ( 2018 ) report that physician-patient communication influences the perceived quality of healthcare services. Similarly, Chandra and Mohammadnezhad ( 2021 ) argue that effective communication is a blueprint to ensure that providers provide high-quality care. Patients perceive effective communication to equate to high-quality care because they obtain sufficient information regarding their health and care plan, empowering them to enhance their health and contribute to care decisions. Patient-centred communication enhances patients' perception of the quality of care by creating positive relationships between professionals and patients and shifting from authoritarian interactions to more participatory ones. Research has found that how patients perceive their communication with healthcare professionals is significantly better at predicting patient outcomes (Peimani et al., 2020 ). Improved patient outcomes create positive perceptions of the quality of care and personal health. This systematic review aims to review studies that have previously investigated the influence of quality communication on patient-centred outcomes among older adults, such as well-being, physical/emotional/psychological health, patient satisfaction, self-esteem, adherence to providers' recommendations, and independence/autonomy. The specific objectives include (a) exploring the strategies used to ensure quality and effective communication with older patients in various healthcare settings, (b) exploring the patient-centred health outcomes reported by previous studies investigating quality communication between providers and older patients, and (c) to link quality communication strategies with older patients to patient-centred health outcomes among older patients. The primary rationale for conducting this systematic review is that although many studies have examined the relationship between quality communication and various patient-centred outcomes, few studies have used older patients as their participants. As a result, more is needed about the specific quality communication strategies that could improve patient-centred outcomes among older adults. No systematic review has focused on this topic. Therefore, this is the first systematic review to explore quality communication and its impact on patient-centred health outcomes among older patients in various healthcare settings. This systematic review's findings could inform practitioners of the quality communication strategies they can use to improve patient-reported outcomes. Besides, the systematic review evaluates the quality of studies investigating this matter and makes informed recommendations for future research to advance knowledge on this subject. 2.0 Methods This systematic review was conducted in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., 2021 ). After providing the review's background, rationale, and objectives, the next step is defining the eligibility criteria. 2.1 Eligibility Criteria Table 1 below summarises the inclusion and exclusion criteria used to guide study selection in this systematic review. Table 1 Inclusion and Exclusion Criteria Inclusion Exclusion Justification Studies using a sample of older adults/patients (defined as 65 years and above) under the care of healthcare professionals Studies using a sample of older adults with communication impairment (e.g., aphasia) The systematic review focused on the quality of communication in older adults without hearing or speaking impairment. Studies focusing on effective communication interventions, both verbal and non-verbal Studies focusing on communicative interventions for patients with communication impairment This systematic review focused on older patients without any hearing or speaking impairment. Studies focusing on patient-centred outcomes, such as well-being, patient satisfaction, quality of care, emotional and cognitive well-being, health status, life satisfaction, autonomy, independence, intervention acceptance, life satisfaction, social processes, self-esteem, and self-actualisation. No outcome reported Focusing on a particular outcome like patient well-being would not have yielded any studies enough for review to address the review objectives due to the scarcity of research on this subject matter Studies published between 2000 and 2023 Older studies More recent studies (within the past five years) would have been preferred, but unfortunately, researchers have recently given attention to this topic. Studies published in the English language N/A The researcher is an English speaker, which means studies published in non-English languages could have resulted in translational errors and costs undermining the study's credibility. Primary studies using both qualitative and quantitative research designs Secondary studies, like other literature reviews The inclusion of secondary studies would have introduced bias into this systematic review. Studies conducted in any country in the world Studies conducted in sanctioned countries for violating international law norms and traditions, such as human rights violations Considering the lack of research on this subject, focusing on a single country would not have yielded studies for review. 2.2 Information Sources Four academic databases were searched: PubMed, Scopus, CINAHL, and PsycINFO. These databases were used as sources of information because they publish studies in healthcare sciences on a wide range of topics, including communication and the health outcomes of various interventions. Additionally, Google Scholar was searched to supplement the databases because it indexes academic journal articles in all disciplines, including healthcare. Combining Google Scholar with these databases has been recommended for an optimal search strategy (Bramer et al., 2018 ). 2.3 Search Strategy Various search terms related to the critical variables of this systematic review, namely quality communication, patient-centred health outcomes, and older patients, were combined using Boolean connectors (AND & OR). Regarding quality communication, some of the keywords that were used include "quality communication," "effective communication," "doctor-patient communication," and "patient-centred communication." The keywords that were used for patient-centred outcomes included "well-being," "patient satisfaction," "quality of care," "health status," and "quality of life." The search terms related to older patients included "nursing home residents," "older," and "elderly." Additionally, since most older patients are institutionalised, search terms like "nursing homes" and "assisted living facilities" were used in the search strategy. Table 1 below presents a sample search strategy executed on Google Scholar and PubMed between September 2022 and January 2023. Table 2 Search Strategy Boolean Connector Search Terms ("quality communication") OR ("effective communication") OR ("doctor-patient communication") OR ("patient-provider communication") OR ("affective communication") OR ("emotional support") OR ("non-verbal communication") OR ("facial expressions") OR ("comfort touch") OR ("therapeutic touch") OR ("patient-centred communication") AND ("elderly") OR ("older") OR ("geriatric") OR ("nursing home residents") AND ("nursing homes") OR ("long-term care facilities") OR ("skilled nursing facilities") OR ("assisted living facilities") OR ("geriatric centres") AND ("well-being") OR ("quality of care") OR ("emotional well-being") OR ("cognitive well-being") OR ("individualised care") OR ("health status") OR ("patient satisfaction") OR ("quality of life") OR ("individualised care") 2.4 Study Selection Process Only one reviewer (the author) was involved in screening the studies. The reviewer screened each record at least twice for confirmation purposes. Afterwards, an automation tool called ASReview which relies on machine learning to screen textual data was used as a second confirmation (van de Schoot et al., 2021 ). The software was trained on the eligibility criteria and the broader context of this study before it was used to screen the studies and confirm the reviewer's decision. Therefore, if a record were retrieved, the author would screen for its eligibility the first time and confirm it the second time. For the third time confirmation, ASReview was employed. In case of disagreement between the author's first and second attempts, a third attempt could be made to resolve it. In case of disagreement between the author's first/second/third attempts and ASReview, a fourth attempt was made to resolve it. 2.5 Data Collection Process One reviewer (the author) extracted data from the qualifying records. The reviewer could collect data from a given study in the first round, record them, and confirm them in the second round. In case of disagreement between the first and second rounds, the author would extract data from the record for the third time to resolve it. The data points on which data extraction was based include the country where the study was conducted, the study's research design (if reported), the population and setting of the study, the characteristics of the intervention (communication), and outcomes. Also, the author remained keen to identify ways the studies defined quality or effective communication in the context of older patient care. Regarding the characteristics of the intervention, some of the data sought included the type of communication (e.g., verbal or non-verbal) and the specific communicative strategies, such as touch and active listening. Regarding outcomes, 'patient-centred outcomes' was used as an umbrella term for several variables that relate to the patient's subjective well-being. Such variables include perceptions of quality of care, quality of life, symptom management, physical health, mental health, health literacy, patient satisfaction, individualised care, and overall well-being, including social processes, self-actualisation, self-esteem, life satisfaction, and psychosocial well-being. If studies reported on the acceptance and usability of communicative strategies, it was also included as a patient-centred outcome because the patient accepts a specific intervention and acknowledges its usability. 2.6 Study Quality Assessment The study quality assessment in this systematic review entailed the risk of bias and certainty assessments. Risk of bias assessment formed an essential aspect of certainty assessment. The risk of bias in qualitative studies was evaluated using the Critical Appraisal Skills Program (CASP) Qualitative Checklist (Long et al., 2020 ); the Cochrane Risk of Bias (RoB) tool was used for randomised studies (Higgins et al., 2019 ); and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) was used for cross-sectional observational studies (Sterne et al., 2019 ). The Grading for Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for all study designs (Zhang et al., 2019 ). The risk of bias in each study design and its corresponding assessment tool was calculated as a percentage of the total points possible. For example, the CASP Qualitative Checklist has ten items; each awarded one point. If a study scored seven out of 10 possible points, its risk of bias would be rated as 70%. The GRADE Tool has five domains, namely risk of bias, inconsistency, indirectness, imprecision, and publication bias. The first domain, risk of bias, was populated using the findings of risk of bias assessment using the stated tools. The overall quality of a study was based upon all five domains of the GRADE Tool. 2.7 Synthesis Methods Both qualitative and quantitative studies were included in this review. The studies were highly heterogeneous in their research designs hence statistical methods like a meta-analysis synthesis were impossible (Al khalaf et al., 2011 ). Besides, the studies also had substantial heterogeneity in the study settings (some were conducted in primary care settings, but a majority were conducted in long-term care facilities/nursing homes) and outcomes. The studies measured different outcomes under the umbrella variable of patient-centred outcomes. As such, a narrative synthesis approach was considered the most suitable (Campbell et al., 2016 ). The narrative synthesis guidance by Popay et al. ( 2006 ) was used. The first step based on the guidelines should be developing a theoretical model of how the interventions work, why, and for whom. The introduction (of this systematic review) indicated that research conducted in other healthcare settings using younger populations has shown that quality and effective communication is critical in healthcare to improve patient outcomes. It works by helping the provider and the patient to exchange meaningful information that can aid in decision-making. More particularly, effective communication helps the provider establish an effective therapeutic relationship with the patient, creating a safe and effective medium through which helpful information will be exchanged. If valuable information is exchanged between the provider and the patient, better health outcomes will be reported because the patient will feel heard and understood. The information that flows from the provider to the patient can help the patient to improve health attitudes, leading to better health behaviours, including effective symptom management. Also, the information that flows from the patient to the provider will help the provider to make better medical and nursing decisions about the patient, including better symptom management. This systematic review's explanation of how effective or quality communication leads to improved patient-centred outcomes formed the theoretical basis. The second step of a narrative synthesis entails organising findings from the included studies to describe patterns across the studies based on the direction of the effect size or effects (Popay et al., 2006 ). The third step is to explore the relationship in the data by identifying the reasons for the direction of effects or effect size. This systematic review's reasons were based on the theoretical notions outlined above in this paragraph. The final step is to provide insights into the generalizability of the findings to other populations, which, in the process, further research gaps can be outlined. The results are stated below. 3.0 Results 3.1 Study Selection After running the search strategy, 40 articles were identified from PubMed, 13 from Google Scholar, 24 from Scopus, 18 from CINHAL, and 10 from PsycINFO based on the relevance of the titles. It was discovered that 26 were duplicated records between databases, which reduced the number of identified records to 79. Further, the automation tool (ASReview) marked five records as ineligible based on their title in light of the inclusion and exclusion criteria. These articles were excluded because the author confirmed in the fourth round that they were ineligible. After realising they did not focus on older adults, the author excluded three more records. Therefore, 71 records were screened using their abstracts with the help of ASReview, whereby 44 were excluded for various reasons, such as being expert opinions and professional development based on field experiences (e.g., Daly, 2017 ) and did not have a methodology. The remaining 27 records were sought for retrieval, whereby one was excluded because its full text was inaccessible. The remaining 26 articles were assessed for eligibility with the help of ASReview, whereby eight records were excluded because they did not report their research designs, contexts, and target population (e.g., Calcagno, 2008 ), another eight were secondary studies (e.g., Williams, 2013 ), and three were non-peer-reviewed preprints. Therefore, seven studies met the eligibility criteria for this systematic review. 3.2 Study Characteristics Out of the seven studies, one was an experimental study (Butt, 2001), one was a quantitative study without a specific research design (Koops van 't Jagt et al., 2016), one was a cross-sectional observational study (Gilbert & Hayes, 2009 ), and four were qualitative studies (Carpiac-Claver & Levy-Storms, 2007 ; Levy-Storms et al., 2011 ; Walters et al., 2012 ; Wanko Keutchafo et al., 2022 ). As shown in Table 3 , most of the studies (n = 4) were conducted in the United States. The following countries produced one study each: Australia, Cameroon, the Netherlands and Hungary. Although all the studies utilised a sample of older patients, the characteristics of the patients differed from one study to another. The studies ranged from primary care settings (Walters et al., 2012 ) and adult medical wards (Wanko Keutchafo et al., 2022 ) to long-term care facilities like nursing homes. Apart from Walters et al. ( 2012 ), the rest of the studies investigated various non-verbal communication strategies with older adults and their impact on various types of patient-centred outcomes, ranging from health-related outcomes (e.g., smoking cessation) to patient-reported outcomes, such as patient satisfaction, self-esteem, and life satisfaction. These outcomes are within the broader umbrella category of patient-centred m outcomes. Further, the studies used different types of communicative strategies that can be used to enhance or promote patient-centred outcomes. In this systematic review, they were categorised into seven, namely (a) touching, (b) smiling, (c) gaze, head nod, and eyebrow movement, (d) active listening, (e) close physical distance, and (f) use of visual aids, and (g) telephone communication. Table 4 summarises the various ways in which each study described its interventions. Table 3 Characteristics of Included Studies Citation Country Research Design Population and setting Type of Communication/ Strategies Outcomes Butts ( 2001 ) United States Experimental 45 female older adults (65–101 years old) in two nursing homes in rural areas Non-verbal (comfort touch) Perceptions of self-esteem, well-being, health status, life satisfaction, social processes, and self-actualisation Walters et al. ( 2012 ) Australia Qualitative 44 COPD patients with a mean age of 65.2 years in primary care settings Verbal (telephone) Physical activity, smoking cessation, psychosocial well-being, symptom management, nutrition, and alcohol Koops van ’t Jagt et al. ( 2016 ) The Netherlands and Hungary Quantitative (but non-specific) (used a formative evaluation approach based on intervention mapping protocols) 13 older adults with limited health literacy Non-verbal (using visual aids like photos and video clips to support communication) Acceptance of the intervention (whether appealing and comprehensible) Gilbert and Hayes ( 2009 ) United States Cross-sectional observational study with a follow-up assessment after four weeks 155 old patients (65 years and above) in nurse practitioners' offices Non-verbal (smile, touch, gaze, eyebrow movement, and nod or shake of the head) Patient satisfaction, intention to adhere to nursing practitioners' recommendations, changes in presenting problems, physical health, and mental health Levy-Storms et al. ( 2011 ) United States Qualitative 15 older patients in nursing homes Non-verbal communication (listening and touching the shoulder) Individualised care (authors hypothesised that it could lead to improve patient satisfaction, autonomy, and independence) Carpiac-Claver and Levy-Storms ( 2007 ) United States Qualitative 17 older patients in nursing homes and assisted living facilities Non-verbal communication (smiling, touching, laughing, eye gazing, shaking hands, head nodding, soft tone, and leaning forward) Affective communication and patient's well-being Wanko Keutchafo et al. ( 2022 ) Cameroon Qualitative Eight older patients in adult wards in two hospitals in Cameroon Non-verbal communication (close physical distance, gentle touch, silence, and active listening) Patient satisfaction and quality of care Table 4 Description of Interventions Used in Studies Communication Strategy Description Touch It can be a skin-to-skin touch for the sole purpose of comfort to foster positive feelings in elderly patients (Butts, 2001 ); interpersonal touches, such as hugs, handshake, pat on the back, touching cheeks, or any other physical contact intended to communicate emotions or establish and maintain social bonds (Carpiac-Claver & LevyStorms, 2007; Gilbert & Hayes, 2009 ; Wanko Keutchafo et al., 2022 ); a pat on the shoulder to show the nurse cares (Levy-Storms et al., 2011 ). Smiling Smiles as a component of the relationship between the patient and the provider (Gilbert & Hayes, 2009 ); smiling when addressing the patient (Carpiac-Claver & LevyStorms, 2007); smiling as a communicative strategy to improve patient satisfaction with the services (Wanko Keutchafo et al., 2022 ). Gaze, head nod, and eyebrow movement Gaze, head nods, and eyebrow movements as relationship components (Gilbert & Hayes, 2009 ) or as nonverbal means of communication to address the patient (Carpiac-Claver & LevyStorms, 2007), often combined with touch and smiling (Carpiac-Claver & LevyStorms, 2007; Gilbert & Hayes, 2009 ). Silence and active listening Listening to patients as a way of showing them respect (combined with touching the shoulder) (Levy-Storms et al., 2011 ); active listening as a channel of effective non-verbal communication (Wanko Keutchafo et al., 2022 ). Close physical distance or leaning forward Close physical distance by sitting on patients' beds and sitting close to patients (Wanko Keutchafo et al., 2022 ); leaning closer to the patient to look in their face (Carpiac-Claver & LevyStorms, 2007). Use of visual aids Using photos and video clips to support communicative exchange between the patient and the provider is helpful, especially when patients have limited health literacy (Koops van 't Jagt et al., 2016). Telephone communication Use of regular phone calls to promote behaviour change in patients using theoretical frameworks of behaviour change (Walters et al., 2012 ) 3.3 Quality Assessment Findings All seven studies were of high quality based on the GRADE Tool-based Assessment. However, Butt (2001) conducted an experimental study, but they did not provide any details indicating whether there was concealment in participant allocation and blinding of participants and outcome assessors. Therefore, it has a high likelihood of risk of bias. However, they scored excellently in the other domains of the GRADE Tool. All four qualitative studies, the cross-sectional observational study, and the quantitative study that did not specify its research design also scored excellently in the domains of the GRADE Tool, apart from the imprecision domain where they could not be scored because none of them reported effect sizes. Table 5 Quality Assessment Using the GRADE TOOL Risk of Bias Inconsistency Indirectness Imprecision Publication Bias Butt (2001) High Risk Low Inconsistency Low Indirectness Low Imprecision Low Risk of Publication Bias Walters et al. ( 2012 ) Low Risk Low Inconsistency Low Indirectness N/A (Qualitative) Low Risk of Publication Bias Koops van’t Jagt et al. ( 2016 ) Low Risk Low Inconsistency Low Indirectness N/A (No effect sizes reported) Low Risk of Publication Bias Gilbert and Hayes ( 2009 ) Low Risk Low Inconsistency Low Indirectness N/A (No effect sizes reported) Low Risk of Publication Bias Levy-Storms et al. ( 2011 ) Low Risk Low Inconsistency Low Indirectness N/A (Qualitative) Low Risk of Publication Bias Carpiac-Claver and LevyStorms (2007) Low Risk Low Inconsistency Low Indirectness N/A (Qualitative) Low Risk of Publication Bias Wanko Keutchafo et al. ( 2022 ) Low Risk Low Inconsistency Low Indirectness N/A (Qualitative) Low Risk of Publication Bias 3.4 Results of Individual Studies Butt (2001) was the only experimental study used in this systematic review investigating the effect of comfort touch on older patients' perceptions of well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. The authors did not report the effect sizes but indicated that comforting touch had a statistically significant effect on each of the five variables. In summary, the authors suggested that comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on the various patient-centred outcomes reported in their study. For each variable, the authors used three groups, the first and second control groups and the third experimental group. After delivering the intervention, they investigated whether the scores of these variables changed between three-time points in each of the three groups. The first time point was the baseline data collected before intervention was initiated; the second was two weeks after baseline data; and the third was four weeks after baseline data. The authors found that in each of the five variables, the scores remained almost the same in the three-time points for the two control groups, but there were significant improvements in the experimental group (the one that received the intervention). For example, the self-esteem variable was measured using Rosenberg's Self-Esteem Scale, with the highest attainable score of 40. In the first control group, the score remained 27.00, 27.27, and 27.13 for Time 1 (baseline), Time 2 (after two weeks), and Time 3 (after four weeks), respectively. The same trend was observed in the second control group. However, in the experimental group, the score improved from 29.17 at baseline to 36.00 at Time 2 and 37.47 at Time 3. These findings suggest that comfort touch was highly effective in improving self-esteem among older patients. The same significant improvements were evident for all the other variables (p.184). While all the other studies focused on nonverbal communication cues, Walters et al. ( 2012 ) focused on telephone communication. They aimed to investigate the effect of a tailored intervention on health behaviour change in older adults delivered through telephone communication. Therefore, the primary rationale for selecting this study for review is that it used a specific communicative strategy (telephone) to deliver the intervention, which is the primary purpose of effective communication in most healthcare settings. The older patients used as participants in this study lived with COPD. The nurses trained to administer the intervention made regular phone calls over 12 months. The intervention was delivered to 90 participants. Of these, 65 were invited for interviews at the end of 12 months. One of the most important outcomes relevant to this systematic review is that the participants reported "being listened to by a caring health professional." It means that regular telephone communication improved the patient's perceptions of the quality of care. Other critical patient-centred outcomes that improved due to this intervention include many participants quitting smoking and increased awareness of COPD effects. Although the intervention might have had an independent impact on the reported outcomes, the effects of the communicative strategy cannot be ignored. However, because the independent effects of the communicative strategy were not reported, the findings of this study remain inconclusive in fully addressing the objectives of this study. Koops van 't Jagt et al. (2016) also conducted a quantitative study but needed to specify the specific research design, which was generally non-experimental. The authors used formative evaluation and a participatory approach to develop a communicative intervention for older adults with limited health literacy. In other words, apart from literature reviews, the authors involved the target population in developing a curated story to improve their health literacy. They developed photo and video-based stories by incorporating narrative and social learning theories. The most important finding of this study was that the authors found the developed communicative strategy appealing and understandable. Such observations imply that the participants' health literacy also likely improved even though the authors did not evaluate it. Thus, the study was considered for inclusion because it provided insights into developing a communicative strategy likely to work for older adults with limited health literacy. It particularly highlighted the potential of a participatory approach in developing communicative strategies intended to address the specific health needs of older adults. Further, using a sample of 155 older patients, Gilbert and Hayes ( 2009 ) investigated the relationship between the communication characteristics between nursing practitioners and the older patients and patients' proximal outcomes, namely patient satisfaction and intention to adhere to the NPs' recommendations, and patients' long-term outcomes, namely presenting problems and physical and mental health. The proximal outcomes (satisfaction and intention to adhere) were measured after visits, whereas the long-term outcomes (presenting problems, mental health, and physical health) were measured at four weeks. The communication and relationship components observed include various non-verbal communication strategies: smile, gaze, touch, eyebrow movement, head nod, and handshakes. The authors recorded videos during patient-provider interactions. These communicative strategies were measured using the Roter Interaction Analysis System (independent variable). In contrast, the other outcomes (dependent variables) outlined above were each measured separately with a validated tool or single-item instruments (Gilbert & Hayes, 2009 ). For example, presenting problems were measured with a single-item instrument, whereas the physical and mental health changes at four weeks were measured using the SF-12 Version 2 Health Survey. The authors found that verbal and nonverbal communication strategies focused on providing patients with biomedical and psychosocial information and positive talk characterised by receptivity and trust were associated with better patient outcomes, such as significant improvements in mental and physical health at four weeks. Therefore, this study was selected for this systematic review because it reported the characteristics and content of the communication that nursing practitioners can use to improve health outcomes among older patients. The study was also included because it indicated that if patients perceived a given communication strategy as patronising (such as higher rates of lifestyle discussion and NPs' rapport building), such a communication strategy was associated with poor outcomes. Although the study did not report effect sizes, the findings agree that effective and quality communication can improve patient-centred outcomes like patient satisfaction. Levy-Storms et al. ( 2011 ) conducted a qualitative study with focus groups (eight focus groups with a range of three to nine participants) of 15 older adults in a nursing home. The study used an ethnographic qualitative design. The nonverbal communication strategies observed in this study included active listening (including verbal responses) and touching. The authors found that the characteristics of the communication strategies that make communication quality and effective include mutual respect, equity, and addressing conflict. The patients perceived that their nursing aides gave them better-individualised care if their relationship and communication were characterised by mutual respect. Portraying mutual respect includes showing the patients that they are being listened to and heard, which can include calling them by their names and showing signs of active listening. Some residents (older patients) complained that some nursing aides had favouritism, whereby they liked some patients and not others. When such a perception emerges, the patients could perceive the treatment as unjust, compromising individualised care quality. Also, nursing aides must equip themselves with communicative strategies to address conflict rather than avoid it. For example, knowing about the patient's history can help nursing aides understand their behaviour in the facility, improving prospects of providing better personalised or individualised care. Thus, this study was also considered for review because it addressed the broader characteristics of effective verbal and nonverbal communication when working with older patients. Carpiac-Claver and LevyStorms (2007) also conducted a qualitative study utilising a sample of 17 older adults in nursing homes and assisted living facilities in the United States. They aimed to identify the types and examples of nurse-aide-initiated communication with long-term care residents during mealtime assistance in the context of the residents' responses. Using a naturalistic approach, the researchers observed communicative interactions between the nurse aides and the residents during mealtime assistance. Videos were recorded and transcribed, and analysed using the grounded theory approach. The authors were careful in identifying elements of affective communication, a strategy to enhance the emotional well-being of the residents, and a patient-centred outcome. Apart from emotional support, nonverbal communication strategies were used by nurse aides to address the residents, initiate and maintain personal conversations, and check-in. Thus, the study was included mainly because it identified specific examples and types of nonverbal communication strategies that can be used to enhance patient well-being by providing emotional support. Although the authors did not provide statistical proof that these communication strategies improved well-being, their findings can inform future studies. Finally, Wanko Keutchafo et al. ( 2022 ) conducted a qualitative, grounded theory study to develop a model for effective non-verbal communication between nurses and older patients, emphasising the importance of effective non-verbal communication in forming effective therapeutic relationships and promoting patient satisfaction and quality of care. The authors conducted overt observations of patient-nurse interactions using a sample of eight older patients. They found that the nature of nonverbal communication to be employed depends on the context or environment, and certain external factors influence it. The factors influencing nonverbal communication include the nurses' intrinsic factors, positive views of older adults, awareness of nonverbal communication, and possession of nonverbal communication skills. Patient factors that can also influence the effectiveness of nonverbal communication include positive moods, financial situations, and non-critical medical conditions. The model developed also emphasised that non-verbal communication, if carried out correctly considering context and environment, can lead to positive outcomes, such as increased adherence to providers' recommendations, improved quality of care, and shorter hospital stays. Hence, this study was selected in this systematic review because the nonverbal communication model developed implied the connection between effective communication and patient-centred outcomes, even though effect sizes were not estimated/reported due to the qualitative nature of the study. 3.5 Results of Syntheses Four themes emerged from the narrative synthesis: nonverbal communication, verbal communication, communication strategies, and patient-centred outcomes. Table 6 summarises the subthemes that emerged under each theme. They are discussed below. 3.5.1 Nonverbal Communication Nonverbal communication was a critical theme that emerged in several studies. Butt (2001) found that nonverbal communication strategies such as comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on patient-centred outcomes, such as well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. Levy-Storms et al. ( 2011 ) identified active listening and touching as important nonverbal communication strategies that make communication quality and effective. Carpiac-Claver and Levy-Storms ( 2007 ) found that nurse-aide-initiated communication during mealtime assistance using nonverbal communication strategies, such as emotional support, was crucial in addressing the residents, initiating (and maintaining) personal conversations, and checking in. Finally, Wanko Keutchafo et al. ( 2022 ) developed a model that emphasised the importance of effective nonverbal communication in forming effective therapeutic relationships, promoting patient satisfaction, and improving the quality of care. An exhaustive list of the nonverbal communication approaches is shown in Table 6 . 3.5.2 Verbal Communication In several studies, verbal communication improved patient-centred outcomes (Gilbert & Hayes, 2009 ; Koops van 't Jagt et al., 2016). Effective and quality verbal communication was found to impact patient satisfaction positively (Gilbert & Hayes, 2009 ), increased awareness of COPD effects (Walters et al., 2012 ), improved health literacy (Koops van 't Jagt et al., 2016), presented problems (Gilbert & Hayes, 2009 ), and mental and physical health (Gilbert & Hayes, 2009 ). However, some communication strategies, such as higher lifestyle discussion and rapport-building rates, were perceived as patronising and associated with poor outcomes (Gilbert & Hayes, 2009 ). Effective verbal communication also requires mutual respect, equity, and addressing conflict (Levy-Storms et al., 2011 ). Unlike nonverbal communication, the studies that highlighted the effect of verbal communication on patient-centred outcomes did not provide rich descriptions of the specific verbal communication strategies that can be used in a face-to-face healthcare setting. The described strategies like using phone calls to regularly communicate with the patient without having to visit a healthcare facility and things to ensure when communicating with the older patient, such as mutual respect and avoiding too many discussions on lifestyle do not offer rich insights into the specific nature of the verbal communication strategies. Table 6 Subthemes Nonverbal communication Verbal communication Communication Strategies Patient-centred Outcomes • Comfort touch (Butt, 2001) • Active listening (Levy-Storms et al., 2011 ) • Touching (Levy-Storms et al., 2011 ) • Smiling (Gilbert and Hayes, 2009 ) • Gaze (Gilbert and Hayes, 2009 ) • Eyebrow movement (Gilbert and Hayes, 2009 ) • Head nod (Gilbert and Hayes, 2009 ) • Handshakes (Gilbert and Hayes, 2009 ) • Nurse-aide-initiated communication (Carpiac-Claver and Levy-Storms, 2007 ) • Emotional support (Carpiac-Claver and Levy-Storms, 2007 ) • Effective nonverbal communication (Wanko Keutchafo et al., 2022 ) • Verbal communication (Walters et al., 2012 ; Gilbert & Hayes, 2009 ; Koops van 't Jagt et al., 2016) • Biomedical and psychosocial information (Gilbert & Hayes, 2009 ) • Positive talk (Gilbert & Hayes, 2009 ) • Lifestyle discussion (Gilbert & Hayes, 2009 ) • Rapport building (Gilbert & Hayes, 2009 ) • Mutual respect (Levy-Storms et al., 2011 ) • Equity (Levy-Storms et al., 2011 ) • Conflict resolution (Levy-Storms et al., 2011 ) • Tailored intervention (Walters et al., 2012 ) • Telephone communication (Walters et al., 2012 ) • Participatory approach (Koops van 't Jagt et al., 2016) • Curated story (Koops van 't Jagt et al., 2016) • Well-being (Butt, 2001) • Self-esteem (Butt, 2001) • Health status (Butt, 2001) • Social processes (Butt, 2001) • Life satisfaction (Butt, 2001) • Self-actualisation (Butt, 2001) • Self-responsibility (Butt, 2001) • Patient satisfaction (Gilbert & Hayes, 2009 ; Walters et al., 2012 ) • Increased awareness of COPD effects (Walters et al., 2012 ) • Improved health literacy (Koops van 't Jagt et al., 2016) • Presenting problems (Gilbert & Hayes, 2009 ) • Mental health (Gilbert & Hayes, 2009 ) • Physical health (Gilbert & Hayes, 2009 ) • Adherence to providers' recommendations (Wanko Keutchafo et al., 2022 ) • Improved quality of care (Wanko Keutchafo et al., 2022 ) • Shorter hospital stays (Wanko Keutchafo et al., 2022 ) 3.5.3 Communication Strategies Communication strategies were also a significant theme that emerged in several studies. Walters et al. ( 2012 ) found that a tailored intervention delivered through telephone communication improved patient perceptions of the quality of care. Koops van 't Jagt et al. (2016) found a participatory approach to developing a curated story that improves health literacy appealing and understandable. In that regard, the studies' findings emphasised the importance of effective communication in delivering or administering clinical interventions to improve patient-centred outcomes. The findings also emphasised the need for participatory approaches when developing communication interventions for patients with varied health and social needs. 3.5.4 Patient-Centered Outcomes All studies reviewed highlighted patient-centred outcomes as the goal of effective communication in older patients. Patient-centred outcomes included well-being (Butt, 2001), self-esteem (Butt, 2001), health status (Butt, 2001), social processes (Butt, 2001), life satisfaction (Butt, 2001), self-actualisation (Butt, 2001), self-responsibility (Butt, 2001), patient satisfaction (Gilbert & Hayes, 2009 ; Walters et al., 2012 ), increased awareness of COPD effects (Walters et al., 2012 ), improved health literacy (Koops van 't Jagt et al., 2016), presenting problems (Gilbert & Hayes, 2009 ), mental health (Gilbert & Hayes, 2009 ), physical health (Gilbert & Hayes, 2009 ), adherence to providers' recommendations (Wanko Keutchafo et al., 2022 ), improved quality of care (Wanko Keutchafo et al., 2022 ), and shorter hospital stays (Wanko Keutchafo et al., 2022 ). All seven studies indicated that the various verbal and nonverbal communication approaches could improve these patient-centred outcomes. 4.0 Discussion and Conclusion 4.1 Summary of Findings In agreement with various studies and reviews conducted in younger populations (Alnaser, 2020 ; Holm et al., 2021 ; Skarbalienė et al., 2019 ), all the seven studies selected in this systematic review supported that effective communication is a cornerstone of improved patient-centred outcomes. Like Chandra et al. ( 2018 ), Choi et al. ( 2016 ), and Świątoniowska-Lonc et al. ( 2020 ), the studies reviewed in this systematic review also supported the idea that effective communication with older adults involves the combination of verbal and nonverbal communication cues. However, this systematic review went a step ahead to identify the specific conditions that must be present for effective verbal and nonverbal communication to take place, such as perceptions of equity, mutual respect, and addressing conflict instead of avoiding it. The qualitative studies used in this systematic review also offered rich descriptions of how providers use nonverbal communication strategies. However, the main shortcoming of the seven studies reviewed is that none aimed to define or describe what constitutes effective communication with older adults, apart from Wanko Keutchafo et al. ( 2022 ), who described a model of nonverbal communication with older adults. The study was qualitative and only formed a theoretical basis of how effective nonverbal communication with older adults could be shaped. The theory developed needs to be tested in an experimental setting so that its effect size in improving patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and emotional and cognitive well-being, can be documented unbiasedly and valid. Therefore, as much as the reviewed studies agreed with younger populations regarding the positive effect of effective and quality communication on patient-centred outcomes (Birkhäuer et al., 2017 ; Chandra et al., 2019 ), the methodological rigour of studies with older patients needs to be improved. Although the individual studies reviewed in this systematic review had low risk of bias apart from Butts ( 2001 ), the screening was based on the judgment of the individual research designs. Otherwise, if the assessment had been done from the perspective of the focus of this systematic review, the risk of bias in studies could have been high in predicting the influence of effective communication on patient-centred outcomes. First, apart from Butts ( 2001 ), none of the studies used a random sample. The qualitative studies used purposively obtained samples, which means the risk of bias from an interventional perspective was high. However, the studies provided in-depth insights into the characteristics and features of verbal and non-verbal communication strategies that can be used to form and maintain provider-patient relationships. Recommendations for Practice and Future Research The main recommendation for practice is that nurses and providers serving older patients must be aware of their verbal and non-verbal communication strategies. Besides, they should engage in continuous professional development to enhance their verbal and non-verbal communication skills. Combining a wide range of nonverbal communication, such as touching the patient on the shoulder or arm or even handshaking can help create strong bonds and relationships, which are key in an effective therapeutic relationship. The qualitative studies reviewed showed that nurses and other providers combine a wide range of nonverbal communication in a single interaction instance, such as eye gazing, nodding, touching, and eyebrow movement. Although studies on verbal communication were rare in this systematic review, some lessons learned from the few studies included (e.g., Walters et al., 2012 ) is that using telephones to communicate with older patients regularly is potentially effective in improving patient-centred outcomes like better self-management. The information shared by the nurse should be tailored to serve the specific health needs of older patients. For example, for COPD patients, a nurse can make regular calls to old patients to educate them about the importance of quitting smoking and alcohol to improve their health condition and better self-management. However, as Gilbert and Hayes ( 2009 ) indicated, the nurse should be cautious about how to present the information to the client and be able to detect patronising discussions quickly. For example, the sample of adults used by Gilbert and Hayes ( 2009 ) found that many lifestyle and rapport-building discussions with the nurse were patronising in ways that may be detrimental to patient-centred outcomes. Some of the strategies providers can employ to ensure that communication is not perceived as patronising by older patients include ensuring mutual respect (e.g., active listening as a sign of mutual respect), creating perceptions of equity rather than favouritism when communicating with multiple patients at a time, and solving conflicts rather than avoiding them, which entails extra efforts, such as understanding the patient's behaviour in the past and present. Overall, although studies have not provided specific estimates of the effect sizes of effective communication on patient-centred outcomes among older adults, there is a general trend and consensus in studies that effective communication, nonverbal and verbal, is the cornerstone of high-quality healthcare. Further, future research needs to address various gaps identified in this study. The first gap is that although Wanko Keutchafo et al. ( 2022 ) tried to develop a model of nonverbal communication with older adults, their study had some drawbacks that limited the comprehensiveness of the model. First, the authors used a sample of only eight older adults in two medical wards in Cameroon. Besides the small sample, the study was conducted in medical wards, which means its findings may not be generalisable to long-term care settings like nursing homes. More older adults who encounter healthcare professionals are admitted in long-term care facilities, calling for developing a more robust communication strategy. Second, Wanko Keutchafo et al. ( 2022 ) only focused on nonverbal communication, thereby providing limited practical applicability of the model since verbal and nonverbal communication co-exists in a single interactional instance. Therefore, there is a need to develop a model that provides a complete picture into what effective communication is like with older adults. After developing a valid, reliable, and generalisable model for effective communication with older adults in various healthcare settings, future research should also focus on investigating the impact of such a model on patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and physical and mental health. More particularly, the developed model can be used to derive communication interventions, which can be applied and tested in various healthcare settings with older adults. That way, research on this subject matter will mature as more and more studies test the effectiveness of such a communication model in various settings and countries. All that is known in the literature is that effective verbal and nonverbal communication can help promote patient-centred outcomes among older adults. Conclusion This systematic review selected seven studies whose narrative synthesis demonstrated that effective verbal and non-verbal communication could improve patient-centred outcomes. However, the studies were mostly qualitative, and hence they only provided rich descriptions of how nurses and older patients communicate in various clinical settings. It is only one study (Butts, 2001 ) that was experimental. Still, its risk of bias was high since patients were not concealed to allocation, and participants and outcome assessors were not blinded. Future research needs to focus on deriving a valid, reliable, and generalisable communication model with older adults using a larger and more representative sample size of older patients. Such a model should encompass both verbal and nonverbal communication. After developing a robust model, the next phase of future studies is to derive interventions based on the model and then, through experimental research, test their effectiveness. In that way, a standard approach to communicating effectively and in quality will be achieved, which is yet to be achieved in the current studies. Declarations Ethics approval and consent to participate 'Not applicable' for that section. The article is a systematic review type. Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests The author declares that he has no competing interests Funding None Authors’ contributions I am the primary and sole author of this article. My contribution to this article is a full contribution. Acknowledgment I thank my wife and children for their patience and the great opportunity to devote a lot of time to doing the article in the best possible way. References Al khalaf MM, Thalib L, Doi SAR. Combining heterogenous studies using the random-effects model is a mistake and leads to inconclusive meta-analyses. J Clin Epidemiol. 2011;64(2):119–23. https://doi.org/10.1016/j.jclinepi.2010.01.009 . Alnaser F. Effective communication skills and patient’s health. CPQ Neurol Psychol. 2020;3(4):1–11. Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, Gerger H. Trust in the health care professional and health outcome: A meta-analysis. PLoS ONE. 2017;12(2):e0170988. https://doi.org/10.1371/journal.pone.0170988 . Bramer WM, De Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: An efficient and complete method to develop literature searches. J Med Libr Association. 2018;106(4). https://doi.org/10.5195/jmla.2018.283 . Butts JB. Outcomes of comfort touch in institutionalized elderly female residents. Geriatr Nurs. 2001;22(4):180–4. https://doi.org/10.1067/mgn.2001.117914 . Calcagno KM. Listen up ??? Someone important is talking. Home Healthc Nurse: J Home Care Hospice Prof. 2008;26(6):333–6. https://doi.org/10.1097/01.NHH.0000324304.63835.0b . Campbell M, Thomson H, Katikireddi SV, Sowden A. Reporting of narrative synthesis in systematic reviews of public health interventions: A methodological assessment. The Lancet. 2016;388:34. https://doi.org/10.1016/S0140-6736(16)32270-X . Carpiac-Claver ML, Levy-Storms L. In a manner of speaking: Communication between nurse aides and older adults in long-term care settings. Health Commun. 2007;22(1):59–67. https://doi.org/10.1080/10410230701310307 . Chandra S, Mohammadnezhad M. Doctor–patient communication in primary health care: A mixed-method study in Fiji. Int J Environ Res Public Health. 2021;18(14):7548. https://doi.org/10.3390/ijerph18147548 . Chandra S, Mohammadnezhad M, Ward P. Trust and communication in a doctor- patient relationship: A literature review. J Healthc Commun. 2018;03(03). https://doi.org/10.4172/2472-1654.100146 . Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva Sub-divisional Health Center, Fiji, 2018: A mixed method study. Front Public Health. 2019;7:183. https://doi.org/10.3389/fpubh.2019.00183 . Chichirez CM, Purcărea VL. Interpersonal communication in healthcare. J Med Life. 2018;11(2):119–22. Choi E, Chentsova-Dutton Y, Parrott WG. The effectiveness of somatization in communicating distress in Korean and American cultural contexts. Front Psychol. 2016;7. https://doi.org/10.3389/fpsyg.2016.00383 . Cuffy C, Hagiwara N, Vrana S, McInnes BT. Measuring the quality of patient–physician communication. J Biomed Inform. 2020;112:103589. https://doi.org/10.1016/j.jbi.2020.103589 . Daly L. Effective communication with older adults. Nurs Standard. 2017;31(41):55–63. https://doi.org/10.7748/ns.2017.e10832 . Freudenberger DC, Baker EA, Siljander MP, Rohde RS. Factors driving patient perception of quality care after primary total hip and total knee athroplasty. JAAOS: Global Research and Reviews. 2018;2(11):e061. https://doi.org/10.5435/JAAOSGlobal-D-18-00061 . Ghosh AK, Joshi S, Ghosh A. Effective patient-physician communication—A concise review. J Assoc Phys India. 2020;68(6):53–7. Gilbert DA, Hayes E. Communication and outcomes of visits between older patients and nurse practitioners. Nurs Res. 2009;58(4):283–93. https://doi.org/10.1097/NNR.0b013e3181ac1413 . Hausler M, Strecker C, Huber A, Brenner M, Höge T, Höfer S. Distinguishing relational aspects of character strengths with subjective and psychological well-being. Front Psychol. 2017;8:1159. https://doi.org/10.3389/fpsyg.2017.01159 . Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. pp. 205–28. https://doi.org/10.1002/9781119536604.ch8 . Holm A, Karlsson V, Dreyer P. Nurses’ experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit. Int J Qualitative Stud Health Well-Being. 2021;16(1):1971598. https://doi.org/10.1080/17482631.2021.1971598 . van ’t Jagt K, de Winter R, Reijneveld AF, Hoeks SA, J. C. J., Jansen CJM. Development of a communication intervention for older adults with limited health literacy: Photo stories to support doctor–patient communication. J Health Communication. 2016;21(sup2):69–82. https://doi.org/10.1080/10810730.2016.1193918 . Levy-Storms L, Claver M, Gutierrez VF, Curry L. Individualized care in practice: Communication strategies of nursing aides and residents in nursing homes. J Appl Communication Res. 2011;39(3):271–89. https://doi.org/10.1080/00909882.2011.585400 . Long HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences. 2020;1(1):31–42. https://doi.org/10.1177/2632084320947559 . Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, …, Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;71. https://doi.org/10.1136/bmj.n71 . Peimani M, Nasli-Esfahani E, Sadeghi R. Patients’ perceptions of patient–provider communication and diabetes care: A systematic review of quantitative and qualitative studies. Chronic Illn. 2020;16(1):3–22. https://doi.org/10.1177/1742395318782378 . Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme . Lancaster University. https://doi.org/10.13140/2.1.1018.4643 . Ratna H. The importance of effective communication in healthcare practice. HPHR J. 2019;23. https://doi.org/10.54111/0001/W4 . Ruggeri K, Garcia-Garzon E, Maguire Á, Matz S, Huppert FA. Well-being is more than happiness and life satisfaction: A multidimensional analysis of 21 countries. Health Qual Life Outcomes. 2020;18(1):192. https://doi.org/10.1186/s12955-020-01423-y . Skarbalienė A, Skarbalius E, Gedrime L. Effective communication in the healthcare settings: Are the graduates ready for it? Management. 2019;24:137–47. https://doi.org/10.30924/mjcmi.24.si.9 . Sterne JA, Hernán MA, McAleenan A, Reeves BC, Higgins JP. Assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. pp. 621–41. https://doi.org/10.1002/9781119536604.ch25 . Surbakti F, Sari K. The relationship between consultation length and patient satisfaction: A systematic review. KnE Life Sciences. 2018;4(9):41. https://doi.org/10.18502/kls.v4i9.3556 . Świątoniowska-Lonc N, Polański J, Tański W, Jankowska-Polańska B. Impact of satisfaction with physician–patient communication on self-care and adherence in patients with hypertension: Cross-sectional study. BMC Health Serv Res. 2020;20(1):1046. https://doi.org/10.1186/s12913-020-05912-0 . TOV W. (2018). Well-being concepts and components. In Handbook of subjective well-being (pp. 1–15). van de Schoot R, de Bruin J, Schram R, Zahedi P, de Boer J, Weijdema F, Kramer B, Huijts M, Hoogerwerf M, Ferdinands G, Harkema A, Willemsen J, Ma Y, Fang Q, Hindriks S, Tummers L, Oberski DL. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell. 2021;3(2):125–33. https://doi.org/10.1038/s42256-020-00287-7 . Walters JAE, Cameron-Tucker H, Courtney-Pratt H, Nelson M, Robinson A, Scott J, Turner P, Walters EH, Wood-Baker R. Supporting health behaviour change in chronic obstructive pulmonary disease with telephone health-mentoring: Insights from a qualitative study. BMC Fam Pract. 2012;13(1):55. https://doi.org/10.1186/1471-2296-13-55 . Wanko Keutchafo EL, Kerr J, Baloyi OB. A model for effective nonverbal communication between nurses and older patients: A grounded theory inquiry. Healthcare. 2022;10(11):2119. https://doi.org/10.3390/healthcare10112119 . Williams K. Evidence-based strategies for communicating with older adults in long-term care. J Clin Outcomes Manage. 2013;20(11):507–12. Zhang Y, Alonso-Coello P, Guyatt GH, Yepes-Nuñez JJ, Akl EA, Hazlewood G, Pardo-Hernandez H, Etxeandia-Ikobaltzeta I, Qaseem A, Williams JW, Tugwell P, Flottorp S, Chang Y, Zhang Y, Mustafa RA, Rojas MX, Schünemann HJ. GRADE Guidelines: 19. Assessing the certainty of evidence in the importance of outcomes or values and preferences—Risk of bias and indirectness. J Clin Epidemiol. 2019;111:94–104. https://doi.org/10.1016/j.jclinepi.2018.01.013 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Aug, 2023 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Major revision 27 Jun, 2023 Reviews received at journal 23 Jun, 2023 Reviews received at journal 16 Jun, 2023 Reviewers agreed at journal 13 Jun, 2023 Reviewers agreed at journal 05 Jun, 2023 Reviewers agreed at journal 02 May, 2023 Reviewers invited by journal 02 May, 2023 Editor assigned by journal 02 May, 2023 Editor invited by journal 02 May, 2023 Submission checks completed at journal 02 May, 2023 First submitted to journal 07 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2789752","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":196805599,"identity":"26227fba-7f39-4af0-98e3-9442a58b0989","order_by":0,"name":"Samer Sharkiya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYNACGxs5EHXgAfFa0tKMwVoSSNByKLEBRBOlRb79dOLjioQD6fPDDj8E2mInp9tAQIvBmdzNhmcS7uRuvJ1mANSSbGx2gJAWhtxtko0/nuVunJ0A0nIgcRshLfL9b7f/bEg4nG44O/0DcVoYbuRuYwRqSZCXziHSFoMbbzdLNiSkGW6Qzik4kGBAhF/k+3M3fmxIsJGXn52++cOHCjs5gloQ1oFVGhCrHGxdAymqR8EoGAWjYEQBABmWSzuBSla7AAAAAElFTkSuQmCC","orcid":"","institution":"Arab American University","correspondingAuthor":true,"prefix":"","firstName":"Samer","middleName":"","lastName":"Sharkiya","suffix":""}],"badges":[],"createdAt":"2023-04-07 11:44:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2789752/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2789752/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-023-09869-8","type":"published","date":"2023-08-22T15:00:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36648763,"identity":"28c1e58a-a7b8-4663-a8bd-207e0edbd171","added_by":"auto","created_at":"2023-05-05 14:20:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62456,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flowchart summarising the study selection process.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2789752/v1/03e660df55e01d52c663c698.png"},{"id":42780929,"identity":"ff0c0b92-9629-4748-b113-ffce5d7b2d4e","added_by":"auto","created_at":"2023-09-07 15:03:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":605522,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2789752/v1/e508ac4e-a0c0-4acb-b9f6-9b610663582f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Type of article:Quality Communication Can Improve Patient-Centred Health Outcomes Among Older Patients: A Systematic Review","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eExcellent communication is critical for all health professionals. Medical practice heavily relies on communication to share ideas (Skarbalienė et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Without effective communication, the entire health system would not operate efficiently, leading to all stakeholders experiencing adverse outcomes (Alnaser, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Communication is critical because it affects the quality of healthcare output, impacts the patient's health and satisfaction, and benefits both patients and providers (Holm et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Chichirez and Purcărea (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) argue that communication is a critical clinical competence because it establishes trust between providers and patients, creating a therapeutic relationship. Quality communication in clinical settings should be bi-directional because patients must inform providers about their health complaints. Providers must understand and interpret this information to address health issues correctly and convey sufficient information to individuals to enable them to take preventive interventions to maintain health (Ratna, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Physician-patient communication plays several functions, including making decisions, exchanging information, improving the physician-patient relationship, managing the patient's doubts, addressing emotions, and enhancing self-management (Świątoniowska-Lonc et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). What matters in the communication process for patients is being a partner in the communication process and a sense of having their needs acknowledged by healthcare professionals. According to Świątoniowska-Lonc et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), features of effective or quality communication are involving patients in decisions, allowing patients to speak without interruptions, encouraging a patient to ask questions and answering the questions, using a language that the patient understands, paying attention to the patient and discussing the next steps. This communication also includes listening, developing a good interpersonal relationship, and making patient-centred management plans.\u003c/p\u003e \u003cp\u003eTOV (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) defines well-being as how individuals positively experience and evaluate their lives. Experiencing life positively would involve feeling good, having control over one's life, functioning well, having positive emotions, a sense of purpose, experiencing positive relationships, and developing potential (Ruggeri et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Well-being constitutes subjective and psychological well-being. Subjective well-being comprises the cognitive component of satisfaction with life as a whole and having positive emotions and not having negative emotions (Hausler et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Subjective well-being encompasses psychological well-being, personal growth, self-acceptance, environmental mastery, purpose in life, personal relationships, and autonomy. The two forms of well-being are related by significantly distinct.\u003c/p\u003e \u003cp\u003eCuffy et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) argue that the quality of patient-physician communication influences several aspects of the patient-provider relationship and patient-reported outcomes. For instance, effective communication is associated with enhanced patient satisfaction, regulating emotions, and increasing compliance, leading to improved health and better outcomes (Ghosh et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Surbakti \u0026amp; Sari, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). According to Birkh\u0026auml;uer et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), quality communication enhances patients' trust in their providers, making patients more satisfied with the treatment and better quality of life. A trusting provider-patient relationship causes individuals to believe they receive better care (Chandra et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This perception enhances a patient's perceived well-being. Freudenberger et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) posit that the degree and quality of providers' communication with each other and patients affect how individuals appraise their care experience. For instance, productive communication between healthcare professionals and patients makes patients rate their overall care more highly.\u003c/p\u003e \u003cp\u003eEffective provider-patient communication influences several aspects related to patient well-being. For instance, Choi et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) report that effective provider-patient communication improves social, somatic, and psychological health. During communication, the provider may enhance positive motivations and involve the individual in treatment decisions. Communication helps patients to acknowledge their illnesses, the associated risks, and the advantages of consistent treatment. Świątoniowska-Lonc et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) note that mutual communication between providers and patients stimulates or strengthens patients' perception of control over their health, the knowledge to discern symptoms and self-care and identify changes in their condition. Effective communication leads to improved perceived quality of health care. Chandra et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) report that physician-patient communication influences the perceived quality of healthcare services.\u003c/p\u003e \u003cp\u003eSimilarly, Chandra and Mohammadnezhad (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) argue that effective communication is a blueprint to ensure that providers provide high-quality care. Patients perceive effective communication to equate to high-quality care because they obtain sufficient information regarding their health and care plan, empowering them to enhance their health and contribute to care decisions. Patient-centred communication enhances patients' perception of the quality of care by creating positive relationships between professionals and patients and shifting from authoritarian interactions to more participatory ones. Research has found that how patients perceive their communication with healthcare professionals is significantly better at predicting patient outcomes (Peimani et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Improved patient outcomes create positive perceptions of the quality of care and personal health.\u003c/p\u003e \u003cp\u003eThis systematic review aims to review studies that have previously investigated the influence of quality communication on patient-centred outcomes among older adults, such as well-being, physical/emotional/psychological health, patient satisfaction, self-esteem, adherence to providers' recommendations, and independence/autonomy. The specific objectives include (a) exploring the strategies used to ensure quality and effective communication with older patients in various healthcare settings, (b) exploring the patient-centred health outcomes reported by previous studies investigating quality communication between providers and older patients, and (c) to link quality communication strategies with older patients to patient-centred health outcomes among older patients. The primary rationale for conducting this systematic review is that although many studies have examined the relationship between quality communication and various patient-centred outcomes, few studies have used older patients as their participants. As a result, more is needed about the specific quality communication strategies that could improve patient-centred outcomes among older adults. No systematic review has focused on this topic. Therefore, this is the first systematic review to explore quality communication and its impact on patient-centred health outcomes among older patients in various healthcare settings. This systematic review's findings could inform practitioners of the quality communication strategies they can use to improve patient-reported outcomes. Besides, the systematic review evaluates the quality of studies investigating this matter and makes informed recommendations for future research to advance knowledge on this subject.\u003c/p\u003e"},{"header":"2.0 Methods","content":"\u003cp\u003eThis systematic review was conducted in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). After providing the review's background, rationale, and objectives, the next step is defining the eligibility criteria.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Eligibility Criteria\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below summarises the inclusion and exclusion criteria used to guide study selection in this systematic review.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eInclusion and Exclusion Criteria\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJustification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies using a sample of older adults/patients (defined as 65 years and above) under the care of healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies using a sample of older adults with communication impairment (e.g., aphasia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe systematic review focused on the quality of communication in older adults without hearing or speaking impairment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies focusing on effective communication interventions, both verbal and non-verbal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies focusing on communicative interventions for patients with communication impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis systematic review focused on older patients without any hearing or speaking impairment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies focusing on patient-centred outcomes, such as well-being, patient satisfaction, quality of care, emotional and cognitive well-being, health status, life satisfaction, autonomy, independence, intervention acceptance, life satisfaction, social processes, self-esteem, and self-actualisation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo outcome reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFocusing on a particular outcome like patient well-being would not have yielded any studies enough for review to address the review objectives due to the scarcity of research on this subject matter\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies published between 2000 and 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOlder studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore recent studies (within the past five years) would have been preferred, but unfortunately, researchers have recently given attention to this topic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies published in the English language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe researcher is an English speaker, which means studies published in non-English languages could have resulted in translational errors and costs undermining the study's credibility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary studies using both qualitative and quantitative research designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary studies, like other literature reviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe inclusion of secondary studies would have introduced bias into this systematic review.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies conducted in any country in the world\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies conducted in sanctioned countries for violating international law norms and traditions, such as human rights violations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConsidering the lack of research on this subject, focusing on a single country would not have yielded studies for review.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Information Sources\u003c/h2\u003e \u003cp\u003eFour academic databases were searched: PubMed, Scopus, CINAHL, and PsycINFO. These databases were used as sources of information because they publish studies in healthcare sciences on a wide range of topics, including communication and the health outcomes of various interventions. Additionally, Google Scholar was searched to supplement the databases because it indexes academic journal articles in all disciplines, including healthcare. Combining Google Scholar with these databases has been recommended for an optimal search strategy (Bramer et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Search Strategy\u003c/h2\u003e \u003cp\u003eVarious search terms related to the critical variables of this systematic review, namely quality communication, patient-centred health outcomes, and older patients, were combined using Boolean connectors (AND \u0026amp; OR). Regarding quality communication, some of the keywords that were used include \"quality communication,\" \"effective communication,\" \"doctor-patient communication,\" and \"patient-centred communication.\" The keywords that were used for patient-centred outcomes included \"well-being,\" \"patient satisfaction,\" \"quality of care,\" \"health status,\" and \"quality of life.\" The search terms related to older patients included \"nursing home residents,\" \"older,\" and \"elderly.\" Additionally, since most older patients are institutionalised, search terms like \"nursing homes\" and \"assisted living facilities\" were used in the search strategy. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below presents a sample search strategy executed on Google Scholar and PubMed between September 2022 and January 2023.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSearch Strategy\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoolean Connector\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSearch Terms\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"quality communication\") OR (\"effective communication\") OR (\"doctor-patient communication\") OR (\"patient-provider communication\") OR (\"affective communication\") OR (\"emotional support\") OR (\"non-verbal communication\") OR (\"facial expressions\") OR (\"comfort touch\") OR (\"therapeutic touch\") OR (\"patient-centred communication\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"elderly\") OR (\"older\") OR (\"geriatric\") OR (\"nursing home residents\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"nursing homes\") OR (\"long-term care facilities\") OR (\"skilled nursing facilities\") OR (\"assisted living facilities\") OR (\"geriatric centres\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"well-being\") OR (\"quality of care\") OR (\"emotional well-being\") OR (\"cognitive well-being\") OR (\"individualised care\") OR (\"health status\") OR (\"patient satisfaction\") OR (\"quality of life\") OR (\"individualised care\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Study Selection Process\u003c/h2\u003e \u003cp\u003eOnly one reviewer (the author) was involved in screening the studies. The reviewer screened each record at least twice for confirmation purposes. Afterwards, an automation tool called ASReview which relies on machine learning to screen textual data was used as a second confirmation (van de Schoot et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The software was trained on the eligibility criteria and the broader context of this study before it was used to screen the studies and confirm the reviewer's decision. Therefore, if a record were retrieved, the author would screen for its eligibility the first time and confirm it the second time. For the third time confirmation, ASReview was employed. In case of disagreement between the author's first and second attempts, a third attempt could be made to resolve it. In case of disagreement between the author's first/second/third attempts and ASReview, a fourth attempt was made to resolve it.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Collection Process\u003c/h2\u003e \u003cp\u003eOne reviewer (the author) extracted data from the qualifying records. The reviewer could collect data from a given study in the first round, record them, and confirm them in the second round. In case of disagreement between the first and second rounds, the author would extract data from the record for the third time to resolve it. The data points on which data extraction was based include the country where the study was conducted, the study's research design (if reported), the population and setting of the study, the characteristics of the intervention (communication), and outcomes. Also, the author remained keen to identify ways the studies defined quality or effective communication in the context of older patient care. Regarding the characteristics of the intervention, some of the data sought included the type of communication (e.g., verbal or non-verbal) and the specific communicative strategies, such as touch and active listening.\u003c/p\u003e \u003cp\u003eRegarding outcomes, 'patient-centred outcomes' was used as an umbrella term for several variables that relate to the patient's subjective well-being. Such variables include perceptions of quality of care, quality of life, symptom management, physical health, mental health, health literacy, patient satisfaction, individualised care, and overall well-being, including social processes, self-actualisation, self-esteem, life satisfaction, and psychosocial well-being. If studies reported on the acceptance and usability of communicative strategies, it was also included as a patient-centred outcome because the patient accepts a specific intervention and acknowledges its usability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Study Quality Assessment\u003c/h2\u003e \u003cp\u003e The study quality assessment in this systematic review entailed the risk of bias and certainty assessments. Risk of bias assessment formed an essential aspect of certainty assessment. The risk of bias in qualitative studies was evaluated using the Critical Appraisal Skills Program (CASP) Qualitative Checklist (Long et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); the Cochrane Risk of Bias (RoB) tool was used for randomised studies (Higgins et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e); and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) was used for cross-sectional observational studies (Sterne et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The Grading for Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for all study designs (Zhang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The risk of bias in each study design and its corresponding assessment tool was calculated as a percentage of the total points possible. For example, the CASP Qualitative Checklist has ten items; each awarded one point. If a study scored seven out of 10 possible points, its risk of bias would be rated as 70%. The GRADE Tool has five domains, namely risk of bias, inconsistency, indirectness, imprecision, and publication bias. The first domain, risk of bias, was populated using the findings of risk of bias assessment using the stated tools. The overall quality of a study was based upon all five domains of the GRADE Tool.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Synthesis Methods\u003c/h2\u003e \u003cp\u003eBoth qualitative and quantitative studies were included in this review. The studies were highly heterogeneous in their research designs hence statistical methods like a meta-analysis synthesis were impossible (Al khalaf et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Besides, the studies also had substantial heterogeneity in the study settings (some were conducted in primary care settings, but a majority were conducted in long-term care facilities/nursing homes) and outcomes. The studies measured different outcomes under the umbrella variable of patient-centred outcomes. As such, a narrative synthesis approach was considered the most suitable (Campbell et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The narrative synthesis guidance by Popay et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) was used. The first step based on the guidelines should be developing a theoretical model of how the interventions work, why, and for whom.\u003c/p\u003e \u003cp\u003e The introduction (of this systematic review) indicated that research conducted in other healthcare settings using younger populations has shown that quality and effective communication is critical in healthcare to improve patient outcomes. It works by helping the provider and the patient to exchange meaningful information that can aid in decision-making. More particularly, effective communication helps the provider establish an effective therapeutic relationship with the patient, creating a safe and effective medium through which helpful information will be exchanged. If valuable information is exchanged between the provider and the patient, better health outcomes will be reported because the patient will feel heard and understood. The information that flows from the provider to the patient can help the patient to improve health attitudes, leading to better health behaviours, including effective symptom management. Also, the information that flows from the patient to the provider will help the provider to make better medical and nursing decisions about the patient, including better symptom management. This systematic review's explanation of how effective or quality communication leads to improved patient-centred outcomes formed the theoretical basis. The second step of a narrative synthesis entails organising findings from the included studies to describe patterns across the studies based on the direction of the effect size or effects (Popay et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The third step is to explore the relationship in the data by identifying the reasons for the direction of effects or effect size. This systematic review's reasons were based on the theoretical notions outlined above in this paragraph. The final step is to provide insights into the generalizability of the findings to other populations, which, in the process, further research gaps can be outlined. The results are stated below.\u003c/p\u003e \u003c/div\u003e"},{"header":"3.0 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Selection\u003c/h2\u003e \u003cp\u003eAfter running the search strategy, 40 articles were identified from PubMed, 13 from Google Scholar, 24 from Scopus, 18 from CINHAL, and 10 from PsycINFO based on the relevance of the titles. It was discovered that 26 were duplicated records between databases, which reduced the number of identified records to 79. Further, the automation tool (ASReview) marked five records as ineligible based on their title in light of the inclusion and exclusion criteria. These articles were excluded because the author confirmed in the fourth round that they were ineligible. After realising they did not focus on older adults, the author excluded three more records. Therefore, 71 records were screened using their abstracts with the help of ASReview, whereby 44 were excluded for various reasons, such as being expert opinions and professional development based on field experiences (e.g., Daly, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and did not have a methodology. The remaining 27 records were sought for retrieval, whereby one was excluded because its full text was inaccessible. The remaining 26 articles were assessed for eligibility with the help of ASReview, whereby eight records were excluded because they did not report their research designs, contexts, and target population (e.g., Calcagno, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), another eight were secondary studies (e.g., Williams, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and three were non-peer-reviewed preprints. Therefore, seven studies met the eligibility criteria for this systematic review.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Study Characteristics\u003c/h2\u003e \u003cp\u003eOut of the seven studies, one was an experimental study (Butt, 2001), one was a quantitative study without a specific research design (Koops van 't Jagt et al., 2016), one was a cross-sectional observational study (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), and four were qualitative studies (Carpiac-Claver \u0026amp; Levy-Storms, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, most of the studies (n\u0026thinsp;=\u0026thinsp;4) were conducted in the United States. The following countries produced one study each: Australia, Cameroon, the Netherlands and Hungary. Although all the studies utilised a sample of older patients, the characteristics of the patients differed from one study to another. The studies ranged from primary care settings (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) and adult medical wards (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) to long-term care facilities like nursing homes. Apart from Walters et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), the rest of the studies investigated various non-verbal communication strategies with older adults and their impact on various types of patient-centred outcomes, ranging from health-related outcomes (e.g., smoking cessation) to patient-reported outcomes, such as patient satisfaction, self-esteem, and life satisfaction. These outcomes are within the broader umbrella category of patient-centred m outcomes.\u003c/p\u003e \u003cp\u003eFurther, the studies used different types of communicative strategies that can be used to enhance or promote patient-centred outcomes. In this systematic review, they were categorised into seven, namely (a) touching, (b) smiling, (c) gaze, head nod, and eyebrow movement, (d) active listening, (e) close physical distance, and (f) use of visual aids, and (g) telephone communication. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarises the various ways in which each study described its interventions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCharacteristics of Included Studies\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCitation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResearch Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePopulation and setting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of Communication/ Strategies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eButts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 female older adults (65\u0026ndash;101 years old) in two nursing homes in rural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal (comfort touch)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePerceptions of self-esteem, well-being, health status, life satisfaction, social processes, and self-actualisation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalters et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 COPD patients with a mean age of 65.2 years in primary care settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVerbal (telephone)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhysical activity, smoking cessation, psychosocial well-being, symptom management, nutrition, and alcohol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKoops van \u0026rsquo;t Jagt et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe Netherlands and Hungary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative (but non-specific) (used a formative evaluation approach based on intervention mapping protocols)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 older adults with limited health literacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal (using visual aids like photos and video clips to support communication)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAcceptance of the intervention (whether appealing and comprehensible)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGilbert and Hayes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional observational study with a follow-up assessment after four weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155 old patients (65 years and above) in nurse practitioners' offices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal (smile, touch, gaze, eyebrow movement, and nod or shake of the head)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient satisfaction, intention to adhere to nursing practitioners' recommendations, changes in presenting problems, physical health, and mental health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevy-Storms et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 older patients in nursing homes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal communication (listening and touching the shoulder)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndividualised care (authors hypothesised that it could lead to improve patient satisfaction, autonomy, and independence)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarpiac-Claver and Levy-Storms (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 older patients in nursing homes and assisted living facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal communication (smiling, touching, laughing, eye gazing, shaking hands, head nodding, soft tone, and leaning forward)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAffective communication and patient's well-being\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEight older patients in adult wards in two hospitals in Cameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-verbal communication (close physical distance, gentle touch, silence, and active listening)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient satisfaction and quality of care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDescription of Interventions Used in Studies\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication Strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTouch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt can be a skin-to-skin touch for the sole purpose of comfort to foster positive feelings in elderly patients (Butts, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e); interpersonal touches, such as hugs, handshake, pat on the back, touching cheeks, or any other physical contact intended to communicate emotions or establish and maintain social bonds (Carpiac-Claver \u0026amp; LevyStorms, 2007; Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); a pat on the shoulder to show the nurse cares (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmiles as a component of the relationship between the patient and the provider (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e); smiling when addressing the patient (Carpiac-Claver \u0026amp; LevyStorms, 2007); smiling as a communicative strategy to improve patient satisfaction with the services (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGaze, head nod, and eyebrow movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGaze, head nods, and eyebrow movements as relationship components (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) or as nonverbal means of communication to address the patient (Carpiac-Claver \u0026amp; LevyStorms, 2007), often combined with touch and smiling (Carpiac-Claver \u0026amp; LevyStorms, 2007; Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilence and active listening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eListening to patients as a way of showing them respect (combined with touching the shoulder) (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e); active listening as a channel of effective non-verbal communication (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClose physical distance or leaning forward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClose physical distance by sitting on patients' beds and sitting close to patients (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); leaning closer to the patient to look in their face (Carpiac-Claver \u0026amp; LevyStorms, 2007).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of visual aids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing photos and video clips to support communicative exchange between the patient and the provider is helpful, especially when patients have limited health literacy (Koops van 't Jagt et al., 2016).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelephone communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of regular phone calls to promote behaviour change in patients using theoretical frameworks of behaviour change (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Quality Assessment Findings\u003c/h2\u003e \u003cp\u003eAll seven studies were of high quality based on the GRADE Tool-based Assessment. However, Butt (2001) conducted an experimental study, but they did not provide any details indicating whether there was concealment in participant allocation and blinding of participants and outcome assessors. Therefore, it has a high likelihood of risk of bias. However, they scored excellently in the other domains of the GRADE Tool. All four qualitative studies, the cross-sectional observational study, and the quantitative study that did not specify its research design also scored excellently in the domains of the GRADE Tool, apart from the imprecision domain where they could not be scored because none of them reported effect sizes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eQuality Assessment Using the GRADE TOOL\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRisk of Bias\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInconsistency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndirectness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImprecision\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePublication Bias\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eButt (2001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow Imprecision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalters et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (Qualitative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKoops van\u0026rsquo;t Jagt et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (No effect sizes reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGilbert and Hayes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (No effect sizes reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevy-Storms et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (Qualitative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarpiac-Claver and LevyStorms (2007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (Qualitative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow Inconsistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow Indirectness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A (Qualitative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow Risk of Publication Bias\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Results of Individual Studies\u003c/h2\u003e \u003cp\u003eButt (2001) was the only experimental study used in this systematic review investigating the effect of comfort touch on older patients' perceptions of well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. The authors did not report the effect sizes but indicated that comforting touch had a statistically significant effect on each of the five variables. In summary, the authors suggested that comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on the various patient-centred outcomes reported in their study. For each variable, the authors used three groups, the first and second control groups and the third experimental group. After delivering the intervention, they investigated whether the scores of these variables changed between three-time points in each of the three groups. The first time point was the baseline data collected before intervention was initiated; the second was two weeks after baseline data; and the third was four weeks after baseline data. The authors found that in each of the five variables, the scores remained almost the same in the three-time points for the two control groups, but there were significant improvements in the experimental group (the one that received the intervention). For example, the self-esteem variable was measured using Rosenberg's Self-Esteem Scale, with the highest attainable score of 40. In the first control group, the score remained 27.00, 27.27, and 27.13 for Time 1 (baseline), Time 2 (after two weeks), and Time 3 (after four weeks), respectively. The same trend was observed in the second control group. However, in the experimental group, the score improved from 29.17 at baseline to 36.00 at Time 2 and 37.47 at Time 3. These findings suggest that comfort touch was highly effective in improving self-esteem among older patients. The same significant improvements were evident for all the other variables (p.184).\u003c/p\u003e \u003cp\u003eWhile all the other studies focused on nonverbal communication cues, Walters et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) focused on telephone communication. They aimed to investigate the effect of a tailored intervention on health behaviour change in older adults delivered through telephone communication. Therefore, the primary rationale for selecting this study for review is that it used a specific communicative strategy (telephone) to deliver the intervention, which is the primary purpose of effective communication in most healthcare settings. The older patients used as participants in this study lived with COPD. The nurses trained to administer the intervention made regular phone calls over 12 months. The intervention was delivered to 90 participants. Of these, 65 were invited for interviews at the end of 12 months. One of the most important outcomes relevant to this systematic review is that the participants reported \"being listened to by a caring health professional.\" It means that regular telephone communication improved the patient's perceptions of the quality of care. Other critical patient-centred outcomes that improved due to this intervention include many participants quitting smoking and increased awareness of COPD effects. Although the intervention might have had an independent impact on the reported outcomes, the effects of the communicative strategy cannot be ignored. However, because the independent effects of the communicative strategy were not reported, the findings of this study remain inconclusive in fully addressing the objectives of this study.\u003c/p\u003e \u003cp\u003eKoops van 't Jagt et al. (2016) also conducted a quantitative study but needed to specify the specific research design, which was generally non-experimental. The authors used formative evaluation and a participatory approach to develop a communicative intervention for older adults with limited health literacy. In other words, apart from literature reviews, the authors involved the target population in developing a curated story to improve their health literacy. They developed photo and video-based stories by incorporating narrative and social learning theories. The most important finding of this study was that the authors found the developed communicative strategy appealing and understandable. Such observations imply that the participants' health literacy also likely improved even though the authors did not evaluate it. Thus, the study was considered for inclusion because it provided insights into developing a communicative strategy likely to work for older adults with limited health literacy. It particularly highlighted the potential of a participatory approach in developing communicative strategies intended to address the specific health needs of older adults.\u003c/p\u003e \u003cp\u003eFurther, using a sample of 155 older patients, Gilbert and Hayes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) investigated the relationship between the communication characteristics between nursing practitioners and the older patients and patients' proximal outcomes, namely patient satisfaction and intention to adhere to the NPs' recommendations, and patients' long-term outcomes, namely presenting problems and physical and mental health. The proximal outcomes (satisfaction and intention to adhere) were measured after visits, whereas the long-term outcomes (presenting problems, mental health, and physical health) were measured at four weeks. The communication and relationship components observed include various non-verbal communication strategies: smile, gaze, touch, eyebrow movement, head nod, and handshakes. The authors recorded videos during patient-provider interactions. These communicative strategies were measured using the Roter Interaction Analysis System (independent variable).\u003c/p\u003e \u003cp\u003eIn contrast, the other outcomes (dependent variables) outlined above were each measured separately with a validated tool or single-item instruments (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). For example, presenting problems were measured with a single-item instrument, whereas the physical and mental health changes at four weeks were measured using the SF-12 Version 2 Health Survey. The authors found that verbal and nonverbal communication strategies focused on providing patients with biomedical and psychosocial information and positive talk characterised by receptivity and trust were associated with better patient outcomes, such as significant improvements in mental and physical health at four weeks. Therefore, this study was selected for this systematic review because it reported the characteristics and content of the communication that nursing practitioners can use to improve health outcomes among older patients. The study was also included because it indicated that if patients perceived a given communication strategy as patronising (such as higher rates of lifestyle discussion and NPs' rapport building), such a communication strategy was associated with poor outcomes. Although the study did not report effect sizes, the findings agree that effective and quality communication can improve patient-centred outcomes like patient satisfaction.\u003c/p\u003e \u003cp\u003eLevy-Storms et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) conducted a qualitative study with focus groups (eight focus groups with a range of three to nine participants) of 15 older adults in a nursing home. The study used an ethnographic qualitative design. The nonverbal communication strategies observed in this study included active listening (including verbal responses) and touching. The authors found that the characteristics of the communication strategies that make communication quality and effective include mutual respect, equity, and addressing conflict. The patients perceived that their nursing aides gave them better-individualised care if their relationship and communication were characterised by mutual respect. Portraying mutual respect includes showing the patients that they are being listened to and heard, which can include calling them by their names and showing signs of active listening. Some residents (older patients) complained that some nursing aides had favouritism, whereby they liked some patients and not others. When such a perception emerges, the patients could perceive the treatment as unjust, compromising individualised care quality. Also, nursing aides must equip themselves with communicative strategies to address conflict rather than avoid it. For example, knowing about the patient's history can help nursing aides understand their behaviour in the facility, improving prospects of providing better personalised or individualised care. Thus, this study was also considered for review because it addressed the broader characteristics of effective verbal and nonverbal communication when working with older patients.\u003c/p\u003e \u003cp\u003eCarpiac-Claver and LevyStorms (2007) also conducted a qualitative study utilising a sample of 17 older adults in nursing homes and assisted living facilities in the United States. They aimed to identify the types and examples of nurse-aide-initiated communication with long-term care residents during mealtime assistance in the context of the residents' responses. Using a naturalistic approach, the researchers observed communicative interactions between the nurse aides and the residents during mealtime assistance. Videos were recorded and transcribed, and analysed using the grounded theory approach. The authors were careful in identifying elements of affective communication, a strategy to enhance the emotional well-being of the residents, and a patient-centred outcome. Apart from emotional support, nonverbal communication strategies were used by nurse aides to address the residents, initiate and maintain personal conversations, and check-in. Thus, the study was included mainly because it identified specific examples and types of nonverbal communication strategies that can be used to enhance patient well-being by providing emotional support. Although the authors did not provide statistical proof that these communication strategies improved well-being, their findings can inform future studies.\u003c/p\u003e \u003cp\u003eFinally, Wanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) conducted a qualitative, grounded theory study to develop a model for effective non-verbal communication between nurses and older patients, emphasising the importance of effective non-verbal communication in forming effective therapeutic relationships and promoting patient satisfaction and quality of care. The authors conducted overt observations of patient-nurse interactions using a sample of eight older patients. They found that the nature of nonverbal communication to be employed depends on the context or environment, and certain external factors influence it. The factors influencing nonverbal communication include the nurses' intrinsic factors, positive views of older adults, awareness of nonverbal communication, and possession of nonverbal communication skills. Patient factors that can also influence the effectiveness of nonverbal communication include positive moods, financial situations, and non-critical medical conditions. The model developed also emphasised that non-verbal communication, if carried out correctly considering context and environment, can lead to positive outcomes, such as increased adherence to providers' recommendations, improved quality of care, and shorter hospital stays. Hence, this study was selected in this systematic review because the nonverbal communication model developed implied the connection between effective communication and patient-centred outcomes, even though effect sizes were not estimated/reported due to the qualitative nature of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Results of Syntheses\u003c/h2\u003e \u003cp\u003eFour themes emerged from the narrative synthesis: nonverbal communication, verbal communication, communication strategies, and patient-centred outcomes. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e summarises the subthemes that emerged under each theme. They are discussed below.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1 Nonverbal Communication\u003c/h2\u003e \u003cp\u003eNonverbal communication was a critical theme that emerged in several studies. Butt (2001) found that nonverbal communication strategies such as comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on patient-centred outcomes, such as well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. Levy-Storms et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) identified active listening and touching as important nonverbal communication strategies that make communication quality and effective. Carpiac-Claver and Levy-Storms (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) found that nurse-aide-initiated communication during mealtime assistance using nonverbal communication strategies, such as emotional support, was crucial in addressing the residents, initiating (and maintaining) personal conversations, and checking in. Finally, Wanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) developed a model that emphasised the importance of effective nonverbal communication in forming effective therapeutic relationships, promoting patient satisfaction, and improving the quality of care. An exhaustive list of the nonverbal communication approaches is shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2 Verbal Communication\u003c/h2\u003e \u003cp\u003eIn several studies, verbal communication improved patient-centred outcomes (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Koops van 't Jagt et al., 2016). Effective and quality verbal communication was found to impact patient satisfaction positively (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), increased awareness of COPD effects (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), improved health literacy (Koops van 't Jagt et al., 2016), presented problems (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), and mental and physical health (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). However, some communication strategies, such as higher lifestyle discussion and rapport-building rates, were perceived as patronising and associated with poor outcomes (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Effective verbal communication also requires mutual respect, equity, and addressing conflict (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Unlike nonverbal communication, the studies that highlighted the effect of verbal communication on patient-centred outcomes did not provide rich descriptions of the specific verbal communication strategies that can be used in a face-to-face healthcare setting. The described strategies like using phone calls to regularly communicate with the patient without having to visit a healthcare facility and things to ensure when communicating with the older patient, such as mutual respect and avoiding too many discussions on lifestyle do not offer rich insights into the specific nature of the verbal communication strategies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSubthemes\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonverbal communication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal communication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunication Strategies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient-centred Outcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Comfort touch (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Active listening (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Touching (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Smiling (Gilbert and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Gaze (Gilbert and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Eyebrow movement (Gilbert and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Head nod (Gilbert and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Handshakes (Gilbert and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Nurse-aide-initiated communication (Carpiac-Claver and Levy-Storms, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Emotional support (Carpiac-Claver and Levy-Storms, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Effective nonverbal communication (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Verbal communication (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Koops van 't Jagt et al., 2016)\u003c/p\u003e \u003cp\u003e\u0026bull; Biomedical and psychosocial information (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Positive talk (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Lifestyle discussion (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Rapport building (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Mutual respect (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Equity (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Conflict resolution (Levy-Storms et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Tailored intervention (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Telephone communication (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Participatory approach (Koops van 't Jagt et al., 2016)\u003c/p\u003e \u003cp\u003e\u0026bull; Curated story (Koops van 't Jagt et al., 2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Well-being (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Self-esteem (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Health status (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Social processes (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Life satisfaction (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Self-actualisation (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Self-responsibility (Butt, 2001)\u003c/p\u003e \u003cp\u003e\u0026bull; Patient satisfaction (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Increased awareness of COPD effects (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Improved health literacy (Koops van 't Jagt et al., 2016)\u003c/p\u003e \u003cp\u003e\u0026bull; Presenting problems (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Mental health (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Physical health (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Adherence to providers' recommendations (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Improved quality of care (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u0026bull; Shorter hospital stays (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.5.3 Communication Strategies\u003c/h2\u003e \u003cp\u003eCommunication strategies were also a significant theme that emerged in several studies. Walters et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) found that a tailored intervention delivered through telephone communication improved patient perceptions of the quality of care. Koops van 't Jagt et al. (2016) found a participatory approach to developing a curated story that improves health literacy appealing and understandable. In that regard, the studies' findings emphasised the importance of effective communication in delivering or administering clinical interventions to improve patient-centred outcomes. The findings also emphasised the need for participatory approaches when developing communication interventions for patients with varied health and social needs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.5.4 Patient-Centered Outcomes\u003c/h2\u003e \u003cp\u003eAll studies reviewed highlighted patient-centred outcomes as the goal of effective communication in older patients. Patient-centred outcomes included well-being (Butt, 2001), self-esteem (Butt, 2001), health status (Butt, 2001), social processes (Butt, 2001), life satisfaction (Butt, 2001), self-actualisation (Butt, 2001), self-responsibility (Butt, 2001), patient satisfaction (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), increased awareness of COPD effects (Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), improved health literacy (Koops van 't Jagt et al., 2016), presenting problems (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), mental health (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), physical health (Gilbert \u0026amp; Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), adherence to providers' recommendations (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), improved quality of care (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and shorter hospital stays (Wanko Keutchafo et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). All seven studies indicated that the various verbal and nonverbal communication approaches could improve these patient-centred outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4.0 Discussion and Conclusion","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Summary of Findings\u003c/h2\u003e \u003cp\u003eIn agreement with various studies and reviews conducted in younger populations (Alnaser, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Holm et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Skarbalienė et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), all the seven studies selected in this systematic review supported that effective communication is a cornerstone of improved patient-centred outcomes. Like Chandra et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Choi et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and Świątoniowska-Lonc et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), the studies reviewed in this systematic review also supported the idea that effective communication with older adults involves the combination of verbal and nonverbal communication cues. However, this systematic review went a step ahead to identify the specific conditions that must be present for effective verbal and nonverbal communication to take place, such as perceptions of equity, mutual respect, and addressing conflict instead of avoiding it. The qualitative studies used in this systematic review also offered rich descriptions of how providers use nonverbal communication strategies.\u003c/p\u003e \u003cp\u003eHowever, the main shortcoming of the seven studies reviewed is that none aimed to define or describe what constitutes effective communication with older adults, apart from Wanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), who described a model of nonverbal communication with older adults. The study was qualitative and only formed a theoretical basis of how effective nonverbal communication with older adults could be shaped. The theory developed needs to be tested in an experimental setting so that its effect size in improving patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and emotional and cognitive well-being, can be documented unbiasedly and valid. Therefore, as much as the reviewed studies agreed with younger populations regarding the positive effect of effective and quality communication on patient-centred outcomes (Birkh\u0026auml;uer et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Chandra et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), the methodological rigour of studies with older patients needs to be improved.\u003c/p\u003e \u003cp\u003eAlthough the individual studies reviewed in this systematic review had low risk of bias apart from Butts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), the screening was based on the judgment of the individual research designs. Otherwise, if the assessment had been done from the perspective of the focus of this systematic review, the risk of bias in studies could have been high in predicting the influence of effective communication on patient-centred outcomes. First, apart from Butts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), none of the studies used a random sample. The qualitative studies used purposively obtained samples, which means the risk of bias from an interventional perspective was high. However, the studies provided in-depth insights into the characteristics and features of verbal and non-verbal communication strategies that can be used to form and maintain provider-patient relationships.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations for Practice and Future Research\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The main recommendation for practice is that nurses and providers serving older patients must be aware of their verbal and non-verbal communication strategies. Besides, they should engage in continuous professional development to enhance their verbal and non-verbal communication skills. Combining a wide range of nonverbal communication, such as touching the patient on the shoulder or arm or even handshaking can help create strong bonds and relationships, which are key in an effective therapeutic relationship. The qualitative studies reviewed showed that nurses and other providers combine a wide range of nonverbal communication in a single interaction instance, such as eye gazing, nodding, touching, and eyebrow movement. Although studies on verbal communication were rare in this systematic review, some lessons learned from the few studies included (e.g., Walters et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) is that using telephones to communicate with older patients regularly is potentially effective in improving patient-centred outcomes like better self-management. The information shared by the nurse should be tailored to serve the specific health needs of older patients. For example, for COPD patients, a nurse can make regular calls to old patients to educate them about the importance of quitting smoking and alcohol to improve their health condition and better self-management. However, as Gilbert and Hayes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) indicated, the nurse should be cautious about how to present the information to the client and be able to detect patronising discussions quickly. For example, the sample of adults used by Gilbert and Hayes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) found that many lifestyle and rapport-building discussions with the nurse were patronising in ways that may be detrimental to patient-centred outcomes. Some of the strategies providers can employ to ensure that communication is not perceived as patronising by older patients include ensuring mutual respect (e.g., active listening as a sign of mutual respect), creating perceptions of equity rather than favouritism when communicating with multiple patients at a time, and solving conflicts rather than avoiding them, which entails extra efforts, such as understanding the patient's behaviour in the past and present. Overall, although studies have not provided specific estimates of the effect sizes of effective communication on patient-centred outcomes among older adults, there is a general trend and consensus in studies that effective communication, nonverbal and verbal, is the cornerstone of high-quality healthcare.\u003c/p\u003e \u003cp\u003eFurther, future research needs to address various gaps identified in this study. The first gap is that although Wanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) tried to develop a model of nonverbal communication with older adults, their study had some drawbacks that limited the comprehensiveness of the model. First, the authors used a sample of only eight older adults in two medical wards in Cameroon. Besides the small sample, the study was conducted in medical wards, which means its findings may not be generalisable to long-term care settings like nursing homes. More older adults who encounter healthcare professionals are admitted in long-term care facilities, calling for developing a more robust communication strategy. Second, Wanko Keutchafo et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) only focused on nonverbal communication, thereby providing limited practical applicability of the model since verbal and nonverbal communication co-exists in a single interactional instance. Therefore, there is a need to develop a model that provides a complete picture into what effective communication is like with older adults.\u003c/p\u003e \u003cp\u003eAfter developing a valid, reliable, and generalisable model for effective communication with older adults in various healthcare settings, future research should also focus on investigating the impact of such a model on patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and physical and mental health. More particularly, the developed model can be used to derive communication interventions, which can be applied and tested in various healthcare settings with older adults. That way, research on this subject matter will mature as more and more studies test the effectiveness of such a communication model in various settings and countries. All that is known in the literature is that effective verbal and nonverbal communication can help promote patient-centred outcomes among older adults.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e \u003c/p\u003e \u003cp\u003e This systematic review selected seven studies whose narrative synthesis demonstrated that effective verbal and non-verbal communication could improve patient-centred outcomes. However, the studies were mostly qualitative, and hence they only provided rich descriptions of how nurses and older patients communicate in various clinical settings. It is only one study (Butts, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) that was experimental. Still, its risk of bias was high since patients were not concealed to allocation, and participants and outcome assessors were not blinded. Future research needs to focus on deriving a valid, reliable, and generalisable communication model with older adults using a larger and more representative sample size of older patients. Such a model should encompass both verbal and nonverbal communication. After developing a robust model, the next phase of future studies is to derive interventions based on the model and then, through experimental research, test their effectiveness. In that way, a standard approach to communicating effectively and in quality will be achieved, which is yet to be achieved in the current studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e'Not applicable' for that section.\u003c/p\u003e\n\u003cp\u003eThe article is a systematic review type.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that he has no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI am the primary and sole author of this article.\u003c/p\u003e\n\u003cp\u003eMy contribution to this article is a full contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI thank my wife and children for their patience and the great opportunity to devote a lot of time to doing the article in the best possible way.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl khalaf MM, Thalib L, Doi SAR. Combining heterogenous studies using the random-effects model is a mistake and leads to inconclusive meta-analyses. J Clin Epidemiol. 2011;64(2):119\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinepi.2010.01.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2010.01.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlnaser F. Effective communication skills and patient\u0026rsquo;s health. CPQ Neurol Psychol. 2020;3(4):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirkh\u0026auml;uer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, Gerger H. Trust in the health care professional and health outcome: A meta-analysis. PLoS ONE. 2017;12(2):e0170988. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0170988\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0170988\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBramer WM, De Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: An efficient and complete method to develop literature searches. J Med Libr Association. 2018;106(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5195/jmla.2018.283\u003c/span\u003e\u003cspan address=\"10.5195/jmla.2018.283\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButts JB. Outcomes of comfort touch in institutionalized elderly female residents. Geriatr Nurs. 2001;22(4):180\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1067/mgn.2001.117914\u003c/span\u003e\u003cspan address=\"10.1067/mgn.2001.117914\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalcagno KM. Listen up ??? Someone important is talking. Home Healthc Nurse: J Home Care Hospice Prof. 2008;26(6):333\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.NHH.0000324304.63835.0b\u003c/span\u003e\u003cspan address=\"10.1097/01.NHH.0000324304.63835.0b\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell M, Thomson H, Katikireddi SV, Sowden A. Reporting of narrative synthesis in systematic reviews of public health interventions: A methodological assessment. The Lancet. 2016;388:34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(16)32270-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(16)32270-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarpiac-Claver ML, Levy-Storms L. In a manner of speaking: Communication between nurse aides and older adults in long-term care settings. Health Commun. 2007;22(1):59\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10410230701310307\u003c/span\u003e\u003cspan address=\"10.1080/10410230701310307\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra S, Mohammadnezhad M. Doctor\u0026ndash;patient communication in primary health care: A mixed-method study in Fiji. Int J Environ Res Public Health. 2021;18(14):7548. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18147548\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18147548\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra S, Mohammadnezhad M, Ward P. Trust and communication in a doctor- patient relationship: A literature review. J Healthc Commun. 2018;03(03). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4172/2472-1654.100146\u003c/span\u003e\u003cspan address=\"10.4172/2472-1654.100146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva Sub-divisional Health Center, Fiji, 2018: A mixed method study. Front Public Health. 2019;7:183. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2019.00183\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2019.00183\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChichirez CM, Purcărea VL. Interpersonal communication in healthcare. J Med Life. 2018;11(2):119\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi E, Chentsova-Dutton Y, Parrott WG. The effectiveness of somatization in communicating distress in Korean and American cultural contexts. Front Psychol. 2016;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2016.00383\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2016.00383\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCuffy C, Hagiwara N, Vrana S, McInnes BT. Measuring the quality of patient\u0026ndash;physician communication. J Biomed Inform. 2020;112:103589. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jbi.2020.103589\u003c/span\u003e\u003cspan address=\"10.1016/j.jbi.2020.103589\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaly L. Effective communication with older adults. Nurs Standard. 2017;31(41):55\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7748/ns.2017.e10832\u003c/span\u003e\u003cspan address=\"10.7748/ns.2017.e10832\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreudenberger DC, Baker EA, Siljander MP, Rohde RS. Factors driving patient perception of quality care after primary total hip and total knee athroplasty. JAAOS: Global Research and Reviews. 2018;2(11):e061. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5435/JAAOSGlobal-D-18-00061\u003c/span\u003e\u003cspan address=\"10.5435/JAAOSGlobal-D-18-00061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhosh AK, Joshi S, Ghosh A. Effective patient-physician communication\u0026mdash;A concise review. J Assoc Phys India. 2020;68(6):53\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilbert DA, Hayes E. Communication and outcomes of visits between older patients and nurse practitioners. Nurs Res. 2009;58(4):283\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/NNR.0b013e3181ac1413\u003c/span\u003e\u003cspan address=\"10.1097/NNR.0b013e3181ac1413\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHausler M, Strecker C, Huber A, Brenner M, H\u0026ouml;ge T, H\u0026ouml;fer S. Distinguishing relational aspects of character strengths with subjective and psychological well-being. Front Psychol. 2017;8:1159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2017.01159\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2017.01159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiggins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. pp. 205\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/9781119536604.ch8\u003c/span\u003e\u003cspan address=\"10.1002/9781119536604.ch8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolm A, Karlsson V, Dreyer P. Nurses\u0026rsquo; experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit. Int J Qualitative Stud Health Well-Being. 2021;16(1):1971598. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17482631.2021.1971598\u003c/span\u003e\u003cspan address=\"10.1080/17482631.2021.1971598\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan \u0026rsquo;t Jagt K, de Winter R, Reijneveld AF, Hoeks SA, J. C. J., Jansen CJM. Development of a communication intervention for older adults with limited health literacy: Photo stories to support doctor\u0026ndash;patient communication. J Health Communication. 2016;21(sup2):69\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10810730.2016.1193918\u003c/span\u003e\u003cspan address=\"10.1080/10810730.2016.1193918\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevy-Storms L, Claver M, Gutierrez VF, Curry L. Individualized care in practice: Communication strategies of nursing aides and residents in nursing homes. J Appl Communication Res. 2011;39(3):271\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00909882.2011.585400\u003c/span\u003e\u003cspan address=\"10.1080/00909882.2011.585400\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLong HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine \u0026amp; Health Sciences. 2020;1(1):31\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/2632084320947559\u003c/span\u003e\u003cspan address=\"10.1177/2632084320947559\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hr\u0026oacute;bjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, \u0026hellip;, Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.n71\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n71\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeimani M, Nasli-Esfahani E, Sadeghi R. Patients\u0026rsquo; perceptions of patient\u0026ndash;provider communication and diabetes care: A systematic review of quantitative and qualitative studies. Chronic Illn. 2020;16(1):3\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1742395318782378\u003c/span\u003e\u003cspan address=\"10.1177/1742395318782378\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S. (2006). \u003cem\u003eGuidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme\u003c/em\u003e. Lancaster University. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13140/2.1.1018.4643\u003c/span\u003e\u003cspan address=\"10.13140/2.1.1018.4643\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRatna H. The importance of effective communication in healthcare practice. HPHR J. 2019;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.54111/0001/W4\u003c/span\u003e\u003cspan address=\"10.54111/0001/W4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuggeri K, Garcia-Garzon E, Maguire \u0026Aacute;, Matz S, Huppert FA. Well-being is more than happiness and life satisfaction: A multidimensional analysis of 21 countries. Health Qual Life Outcomes. 2020;18(1):192. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12955-020-01423-y\u003c/span\u003e\u003cspan address=\"10.1186/s12955-020-01423-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkarbalienė A, Skarbalius E, Gedrime L. Effective communication in the healthcare settings: Are the graduates ready for it? Management. 2019;24:137\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.30924/mjcmi.24.si.9\u003c/span\u003e\u003cspan address=\"10.30924/mjcmi.24.si.9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSterne JA, Hern\u0026aacute;n MA, McAleenan A, Reeves BC, Higgins JP. Assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. pp. 621\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/9781119536604.ch25\u003c/span\u003e\u003cspan address=\"10.1002/9781119536604.ch25\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSurbakti F, Sari K. The relationship between consultation length and patient satisfaction: A systematic review. KnE Life Sciences. 2018;4(9):41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18502/kls.v4i9.3556\u003c/span\u003e\u003cspan address=\"10.18502/kls.v4i9.3556\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŚwiątoniowska-Lonc N, Polański J, Tański W, Jankowska-Polańska B. Impact of satisfaction with physician\u0026ndash;patient communication on self-care and adherence in patients with hypertension: Cross-sectional study. BMC Health Serv Res. 2020;20(1):1046. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-020-05912-0\u003c/span\u003e\u003cspan address=\"10.1186/s12913-020-05912-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTOV W. (2018). Well-being concepts and components. In \u003cem\u003eHandbook of subjective well-being\u003c/em\u003e (pp.\u0026nbsp;1\u0026ndash;15).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan de Schoot R, de Bruin J, Schram R, Zahedi P, de Boer J, Weijdema F, Kramer B, Huijts M, Hoogerwerf M, Ferdinands G, Harkema A, Willemsen J, Ma Y, Fang Q, Hindriks S, Tummers L, Oberski DL. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell. 2021;3(2):125\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s42256-020-00287-7\u003c/span\u003e\u003cspan address=\"10.1038/s42256-020-00287-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalters JAE, Cameron-Tucker H, Courtney-Pratt H, Nelson M, Robinson A, Scott J, Turner P, Walters EH, Wood-Baker R. Supporting health behaviour change in chronic obstructive pulmonary disease with telephone health-mentoring: Insights from a qualitative study. BMC Fam Pract. 2012;13(1):55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2296-13-55\u003c/span\u003e\u003cspan address=\"10.1186/1471-2296-13-55\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWanko Keutchafo EL, Kerr J, Baloyi OB. A model for effective nonverbal communication between nurses and older patients: A grounded theory inquiry. Healthcare. 2022;10(11):2119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/healthcare10112119\u003c/span\u003e\u003cspan address=\"10.3390/healthcare10112119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams K. Evidence-based strategies for communicating with older adults in long-term care. J Clin Outcomes Manage. 2013;20(11):507\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Alonso-Coello P, Guyatt GH, Yepes-Nu\u0026ntilde;ez JJ, Akl EA, Hazlewood G, Pardo-Hernandez H, Etxeandia-Ikobaltzeta I, Qaseem A, Williams JW, Tugwell P, Flottorp S, Chang Y, Zhang Y, Mustafa RA, Rojas MX, Sch\u0026uuml;nemann HJ. GRADE Guidelines: 19. Assessing the certainty of evidence in the importance of outcomes or values and preferences\u0026mdash;Risk of bias and indirectness. J Clin Epidemiol. 2019;111:94\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinepi.2018.01.013\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2018.01.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"effective communication, elderly, well-being.","lastPublishedDoi":"10.21203/rs.3.rs-2789752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2789752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This systematic review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like \"effective communication,\" \"elderly,\" and \"well-being.\" Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The search strategy yielded seven studies. Four studies were qualitative (one phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, one was an experimental study, and the final was a quantitative study (unclear design). The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.\u003c/p\u003e","manuscriptTitle":"Type of article:Quality Communication Can Improve Patient-Centred Health Outcomes Among Older Patients: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-05 14:20:10","doi":"10.21203/rs.3.rs-2789752/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-06-27T06:52:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-06-23T15:26:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-06-16T15:20:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2c2175f6-198e-4b9a-995e-8ea8bd52e2b5","date":"2023-06-13T09:24:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"da80e862-b464-4040-9ef4-f338c363971d","date":"2023-06-05T06:46:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1b3fe34a-fc40-4410-8499-e38087ee7f3c","date":"2023-05-02T11:15:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-05-02T10:19:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-05-02T10:10:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-05-02T09:49:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-05-02T09:43:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2023-04-07T11:42:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9f4b468f-18dd-44a9-821f-0b0d393ceef8","owner":[],"postedDate":"May 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:02:45+00:00","versionOfRecord":{"articleIdentity":"rs-2789752","link":"https://doi.org/10.1186/s12913-023-09869-8","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2023-08-22 15:00:36","publishedOnDateReadable":"August 22nd, 2023"},"versionCreatedAt":"2023-05-05 14:20:10","video":"","vorDoi":"10.1186/s12913-023-09869-8","vorDoiUrl":"https://doi.org/10.1186/s12913-023-09869-8","workflowStages":[]},"version":"v1","identity":"rs-2789752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2789752","identity":"rs-2789752","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}