Constructing and Communicating Privacy Boundaries: How Family Medicine Physicians Manage Patient Requests for Religious Disclosure in the Clinical Interaction

IRB Problems and Solutions in Health Communication Research

In this article, we contribute to the current literature on the difficulties that social scientists encounter with IRBs, but with a focus on the distinct challenges that health communication scholars face in dealing with IRBs at their own institutions and elsewhere. Although health communication researchers, like other communication researchers, can expect to face many of the same challenges that their social science colleagues face during the IRB process, the researcher narratives we present in this article suggest that health communication research presents some distinct challenges because the communication interactions that we investigate occur in highly protected, private spaces, including the medical exam room, online patient forums, and electronic health records. To that end, we present a series of examples in which health communication researchers were able to find solutions or workarounds to the challenges they faced in gaining IRB approval for their research. In every case that we present, the researcher had to revise her initial study design to get around the constraints imposed by IRB requirements, and in every case, the researcher reports having experienced points of incommensurability similar to those reported by many other social scientists. In some situations, investigators even express frustration that the IRB's needs and demands superseded those of healthcare professionals and the patients whom they serve. Additionally, in some situations, investigators' understandings of human subjects' protection actually go further to protect patients' privacy and confidentiality than the IRB required. But, in all four cases that we present, the health communication research was ultimately successful.

Physicians' Religious Topic Avoidance during Clinical Interactions

Religious and spiritual (R/S) conversations at the end-of-life function to help patients and their families find comfort in difficult circumstances. Physicians who feel uncertain about how to discuss topics related to religious beliefs may seek to avoid R/S conversations with their patients. This study utilized a two-group objective structured clinical examination with a standardized patient to explore differences in physicians’ use of R/S topic avoidance tactics during a clinical interaction. Results indicated that physicians used more topic avoidance tactics in response to patients’ R/S inquiries than patients’ R/S disclosures; however, the use of topic avoidance tactics did not eliminate the need to engage in patient-initiated R/S interactions.