Clinical yarning and speech pathology terminology

7.8 Speech pathologists should incorporate clinical yarning as a means to build rapport and trust with the Aboriginal and Torres Strait Islander person and their family and to discuss speech pathology terms in a relevant and culturally appropriate way.


Reference: Bessarab & Ng’andu, 2010: Discussion paper; Cochrane et al., 2016: Qualitative study; Ciccone et al., 2019: pre post design; Jones et al., 2020: Systematic review and meta-narrative synthesis of 54 qualitative studies; Lin et al., 2016: Discussion paper 

NHMRC level of Evidence: Qual.

Rationale: Yarning is an Indigenous concept which is about sharing information and stories (Bessarab & Ng’andu, 2010). Clinical yarning is a framework that combines Aboriginal ways of communicating with biomedical knowledge (Lin et al., 2016). Clinical yarning is a person-centred, holistic approach that is relaxed and open-ended, and can be used to build a trusting relationship and as a way to communicate health information (Lin et al., 2016).

Clinical yarning consists of three interrelated parts (Lin et al., 2016):

1. Social yarning is about finding common ground and establishing connection. It is a chance for clinicians to learn about the person and about local Aboriginal culture and to share personal information. Social yarning is holistic, patient-led, values the patient as expert, and values the patient’s story and life knowledge.

2. Diagnostic yarning is about the patient telling their health story, with the clinician interpreting through a biomedical lens. Rather than asking a series of questions, the aim is for the person to tell their story. Open-ended questioning, non-judgemental listening, and allowing conversational silences are key.

3. Management yarning is about the clinician having an honest discussion with their client about their condition and deciding on a management plan together. Information shared with the patient should be clear and medical jargon should be avoided. Stories and metaphors can be used to share information in a meaningful and understandable way, and people should be provided with appropriate resources (such as My Stroke Journey (SF, 2023 – also available in other languages), Our Stroke Journey (SF, 2021), and/or the Aphasia Handbook (SF/AAA, 2023)). The goal of this type of yarn is to come up with an agreed upon plan that is clearly understood by all parties.

A good starting point for learning more about clinical yarning is the Clinical Yarning e-learning module by the Western Australian Centre for Rural Health (Western Australian Centre for Rural Health, n.d.).

Inclusion of (extended) family members should be facilitated if desired by the person with aphasia, considering the importance of (extended) family in many Aboriginal and Torres Strait Islander communities. It is important for speech pathologists and their employers to acknowledge that additional time and flexible approaches may be necessary in order to accommodate yarning (Ciccone et al., 2019; Cochrane et al., 2016; Jones et al., 2020).

References:

1. Bessarab, D. & Ng’andu, B. (2010). Yarning about yarning as a legitimate method in Indigenous research. International Journal of Critical Indigenous Studies, 3(1), 37-50/ DOI: 10.5204/ijcis.v3i1.57
2. Cochrane, F., Brown, L., Siyambalapitiya, S., & Plant, C. (2016). “...Trial and error…”: Speech-language pathologists’ perspectives of working with Indigenous Australian adults with acquired communication disorders. International Journal of Speech-Language Pathology, 18(5), 420-431. DOI: 10.3109/17549507.2015.1101157
3. Ciccone, N., Armstrong, E., Hersh, D., Adams, M., & McAllister, M. (2019). The Wangi (talking) project: A feasibility study of a rehabilitation model for Aboriginal people with acquired communication disorders after stroke. International Journal of Speech-Language Pathology, 21(3), 305-316. DOI: 10.1080/17549507.2019.1595146
4. Jones, B., Heslop, D., & Harrison, R. (2020). Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander people’s healthcare experiences. International Journal for Equity in Health, 19(1), Article 222. DOI: 10.1186/s12939-020-01334-w
5. Lin I, Green C, Bessarab D. (2016). 'Yarn with me': applying clinical yarning to improve clinician-patient communication in Aboriginal health care. Australian Journal of Primary Health, 22(5), 377-382. DOI:  10.1071/PY16051