Healthcare That Doesn't Listen: Governance, Communication, and Care in the Experiences of Deaf People

Objective: To map and analyze how the scientific literature describes governance, communication, and healthcare practices in the experiences of deaf people, identifying institutional barriers, mediation strategies, and gaps in ensuring the right to accessible communication.Method: A scoping review conducted in accordance with the recommendations of the Joanna Briggs Institute and reported according to PRISMA-ScR, with searches performed in February 2026 in PubMed/MEDLINE, Scopus, Web of Science, Embase, CINAHL, LILACS, SciELO, and PsycINFO, including studies published between 2000 and 2025 in Portuguese, English, and Spanish. Qualitative, quantitative, mixed-methods studies, and normative analyses addressing communication, service organization, governance, and healthcare from the perspective of deaf individuals were considered.Results: Thirty studies were included. The literature highlights persistent communication barriers throughout the care pathways, associated with the absence of interpreters, the use of improvised strategies, technological limitations, and the weak institutionalization of accessible communication. These barriers negatively impact autonomy, safety of care, the therapeutic relationship, and continuity of care, especially in emergency, mental health, and complex care settings. The mediation strategies described range from informal solutions to institutionalized initiatives, the latter being less frequent but more sustainable.Discussion: The findings indicate that accessible communication constitutes a structural dimension of care governance, rather than an ad hoc adaptation, revealing weaknesses in planning, implementation, and institutional accountability.Conclusion: The governance of accessible communication emerges as a central element in the provision of equitable, safe, and participatory care for deaf people, requiring greater institutionalization and integration into health service routines.