Knowledge displays: Soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction

Inviting the Patient to Talk About a Conversation They Had with Another Healthcare Practitioner: A Way of Promoting Discussion About Disease Progression and End of Life in Palliative Care Interactions

Discussing disease progression is a core task in palliative care. This is especially important when there are indications that a patient considers their death as less imminent than the clinical team does. This article examines a communicative action that palliative medicine doctors use to address such discrepancies in knowledge and understanding of the patient's prognosis: inviting the patient to talk about the contents of a conversation they had with another healthcare practitioner. The study used conversation analysis to examine five consultations in which this action was identified. These were part of a larger data set of 37 consultations recorded in a large UK hospice and involving patients with palliative care needs, sometimes accompanied by family or friends, and palliative medicine doctors. Findings are that the action of inviting the patient to talk about a previous conversation creates an opportunity for patients to articulate what they know and understand about their disease progression - but without requiring them to do so. Discussing such sensitive matters is thus made a matter of 'opting in' (rather than 'opting out'). Doctors thereby avoid being interactionally accountable for directly initiating a potentially distressing topic. The article shows how the task of discussing disease progression and end of life is intertwined with the delicate management of patients' displayed states of awareness regarding their disease progression. The study thus has practical implications by documenting ways in which clinicians can help patients realign their expectations about such delicate matters.

Stories of Change: Comparative Time-Framed Experience Telling in Health Promotion Group Discussions

In this article, we examine comparative time-framed experience telling: episodes of interaction in health promotion group discussions in which one of the participants tells their experience and, in response, another participant tells their own experiences from separate moments or periods of their life and compares them. In so doing, group members reinforce and encourage the previous speaker's positive stance or challenge the negative stance toward contextually relevant objects: behavior change and suggested solutions. This practice allows group members to demonstrate their independent access to experiences that are similar to those of the other, present evidence of similarities and differences between the experiences, and show their epistemic independence regarding their claims. By recontextualizing the experience of the other in this way, it becomes possible for the group members to interpret and even oppose it while maintaining a level of understanding of the differences between the experiences in question and respecting them.

It Does Take Two to Tango: An Applied Conversation Analysis of Interactions between a Psychiatrist and Service-Users Discussing Medication

Decisions concerning psychiatric medication are complex and often involve a protracted process of trial and error. We examine three recorded meetings for power-sharing and power-taking discourse strategies employed by both the psychiatrist and mental health service-user, when discussing psychiatric medication. We identify examples of good practice, as well as missed opportunities to engage service-users in co-constructed dialogue, and highlight that participation and active involvement in decisions is not best seen as a fixed pattern, but is a complex interplay that changes both between and within interactions.

How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice

OBJECTIVE

To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so.

METHODS

Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists.

RESULTS

Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work.

CONCLUSION

Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates.

PRACTICE IMPLICATIONS

Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.

I-Challenges: Influencing Others’ Perspectives by Mentioning Personal Experiences in Therapeutic Community Group Meetings

In this article, I examine the communicative practice of mentioning a personal experience as a vehicle for challenging a peer’s perspective. I study this in the context of therapeutic community (TC) group meetings for clients recovering from drug misuse. Using conversation analysis, I demonstrate that TC clients use this practice, which I call an I-challenge, to influence how their peers make sense of their own experiences and to do so without commenting on those peers’ experiences and perspectives. This study highlights the power of talking in the first person as a means of influencing others—a notion previously made popular by Thomas Gordon’s work on “I-messages.” Additionally, this study illustrates a novel way of studying social influence. Whereas previous research in social psychology has focused on the cognitive constraints behind phenomena of social influence and persuasion, here I contribute to understandings of the interactional norms underlying the organization of influence as a structured and coordinated domain of social action.

Asking 'What about' questions in chronic illness self-management meetings

OBJECTIVES

This study investigates 'What about' questions asked by patients in the course of diabetes self-management groups led by nurses, and explores their functions in these empowerment-informed settings.

METHODS

Conversation Analysis of 24 video-recorded sessions of a Start Insulin Group Programme for patients with type 2 diabetes, in a diabetes centre in the South of England. The groups included 2-7 patients and were led by 5 nurses, all of whom had received training in the empowerment approach.

RESULTS

The analysis revealed a prevalence of single-unit 'Whatabout X' questions and found that they were used to embed requests for information in current or just closed activities. The nurses always provided the information, but could ask patients to specify the content of the question and collaborate to the answer.

CONCLUSION

The analysis suggests that the short form of the question may be adapting to the nurses' restraint in giving recommendations or immediate responses to information seeking-questions.

PRACTICE IMPLICATIONS

When healthcare communication practices are shaped in observance to a theoretical approach, such as empowerment, it is recommendable that practitioners monitor not only what they do, but also how patients change their habitual forms of speech in response.