1
|
Keränen H, Tiitinen S, Juvonen-Posti P, Weiste E, Seppänen S, Ala-Mursula L. Ill persons and capable workers: Constructing work ability in return-to-work negotiations after sickness absence. Health (London) 2024:13634593241290176. [PMID: 39397527 DOI: 10.1177/13634593241290176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
In return-to-work (RTW) negotiations after sickness absence, the work ability of an individual employee becomes a shared interest for the multiple stakeholders representing both the healthcare sector and working life. In practice, the employee, employer and occupational health professionals need to reach a shared understanding of the employee's work ability to enable shared decision-making concerning the plans for sustainable RTW. Drawing on 14 video-recorded RTW negotiations, we used conversation analysis-informed membership categorization analysis to examine how the participants of RTW negotiations discuss the work ability of an employee to pursue a shared understanding of the situation. Work ability was constructed in a very situational way, using illness categories to both explain the work ability of the employee and argue for or against their ability or inability to work. Our study contributes to research on RTW by introducing a new perspective to work ability. We show how work ability is realized during RTW negotiations through interaction, and how participants leverage their cultural understanding of illness and capability when negotiating work ability. We also demonstrate how membership categorization analysis can reveal the situational and consequential aspects of illness and work ability categories.
Collapse
Affiliation(s)
- Hanna Keränen
- University of Oulu, Finland
- Finnish Institute of Occupational Health, Finland
| | | | | | - Elina Weiste
- Finnish Institute of Occupational Health, Finland
| | - Soile Seppänen
- Finnish Institute of Occupational Health, Finland
- University of Oulu, Finland
| | | |
Collapse
|
2
|
Yan T, Yang M. Adult Children as Companions in Geriatric Consultations: An Interpersonal Perspective from China. HEALTH COMMUNICATION 2024:1-14. [PMID: 38862401 DOI: 10.1080/10410236.2024.2364442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Despite the prevalence of accompanied medical visits all over the world, most literature on triadic medical communication shares an Anglo-American background; little is known about non-dyadic medical interactions in Asian societies such as China. This article explores triadic interactions in Chinese geriatric outpatient consultations, focusing on the interpersonal dynamics between doctors, older patients, and the adult children who accompany them throughout the consultation. From an interpersonal pragmatic approach, we conduct a conversation analysis of the transcription of 36 audio-recorded encounters. Our findings demonstrate three patterns of companions' communicative actions during geriatric visits: enhancing rapport, mitigating face threats, and adding tension. These patterns reveal the multi-faceted nature of adult children's participation in geriatric care, highlighting their capacity to simultaneously facilitate a positive interpersonal atmosphere and pose challenges to their older parents' face. Delving into the nuanced mechanisms through which these patterns of engagement are triggered, warranted, and negotiated by all participants in the local contingencies, we further illuminate the institutional and cultural context that informs companions' intervention. Our analysis demonstrates that the influence of Chinese familial values and institutional constraints in Chinese tertiary hospitals, including restricted time and limited privacy within the clinic room, have shaped the interpersonal dynamic in triadic geriatric care. Our research calls for the development of nuanced and targeted interventions and training for healthcare professionals and companions of older patients alike.
Collapse
Affiliation(s)
- Tianxin Yan
- School of Foreign Languages, Renmin University of China
| | - Min Yang
- School of Foreign Languages, Renmin University of China
| |
Collapse
|
3
|
Ford J, Reuber M. Comparing Companion Involvement in Clinical Telephone and Face-To-Face Consultations About Seizures. HEALTH COMMUNICATION 2024; 39:1444-1453. [PMID: 37303167 DOI: 10.1080/10410236.2023.2218143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Companions (i.e., friends, family members, and other accompanying persons) play an important role in seizure clinic consultations, providing information that patients cannot. The COVID-19 pandemic has seen an increase in these consultations being conducted via telephone. Little is known, however, about how this shift might affect companion participation. Using conversation analysis applied to a set of recorded telephone neurologist-patient-companion consultations (n = 9) and comparable moments drawn from a set of face-to-face consultations (n = 37) (both collected in the UK), we aimed to explore this impact and to identify communication methods that clinicians can use to manage companion participation during telephone consultations. We identified four ways in which participation was observably affected by the telephone. Telephone consultations could make it unclear whether a companion was present and make it difficult for the companion to communicate directly with the neurologist. Passing the floor from one speaker to another was more complex remotely, which could also restrict the patient's own participation once the companion had the floor. These issues are rooted in the limitations of the telephone as a communication medium. Based on the issues identified, we conclude our analysis by highlighting some of the ways in which neurologists and other health professionals can manage companion participation in telephone consultations. These include encouraging the use of speakerphone, checking whether a companion is present throughout the call, keeping track of who can hear what throughout the call, and directing questions using given names to avoid ambiguity.
Collapse
Affiliation(s)
- Joseph Ford
- Department of Neuroscience, University of Sheffield
| | | |
Collapse
|
4
|
Downey J, Cooper S, Bassett L, Dubeibe Fong A, Doherty M, Cornwall J. Understanding how volunteer companionship impacts those during the end of life: A realist evaluation. DEATH STUDIES 2024:1-10. [PMID: 38573791 DOI: 10.1080/07481187.2024.2336006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Volunteers are a popular unpaid support role in end of life care yet how accompaniment influences the dying is underdeveloped. This study examined how companionship works, for whom, in what circumstances and why. Initial realist ideas were developed through participant observation (14 months), document analysis, and realist interviews with companionship trainers (n = 6). Theory testing involved volunteer interviews (n = 7), accounts from the dying, proxy accounts for the dying, and written reflections from companionship training. Companionship helps people live well until they die, prepare for death, and experience a good death. Four areas of volunteering explain these outcomes namely a loving friend, a holistic presence, a non-judgmental intermediary, and wrap around care. The four areas activate mechanisms related to reminiscing, preserving dignity/personhood, and easing suffering, contingent on specific contexts. The findings unpack how volunteering exerts its influence and what contextual factors facilitate outcomes, advancing the knowledge in this area.
Collapse
Affiliation(s)
- John Downey
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Susan Cooper
- Institute of Education, Plymouth Marjon University, Plymouth, UK
| | - Lynn Bassett
- The Centre for the Art of Dying Well, St Mary's University, London, UK
| | | | - Margaret Doherty
- The Centre for the Art of Dying Well, St Mary's University, London, UK
| | - Jon Cornwall
- St Vincent De Paul (England and Wales), Membership, UK
| |
Collapse
|
5
|
Zolnoori M, Sridharan S, Zolnour A, Vergez S, McDonald MV, Kostic Z, Bowles KH, Topaz M. Utilizing patient-nurse verbal communication in building risk identification models: the missing critical data stream in home healthcare. J Am Med Inform Assoc 2024; 31:435-444. [PMID: 37847651 PMCID: PMC10797261 DOI: 10.1093/jamia/ocad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In the United States, over 12 000 home healthcare agencies annually serve 6+ million patients, mostly aged 65+ years with chronic conditions. One in three of these patients end up visiting emergency department (ED) or being hospitalized. Existing risk identification models based on electronic health record (EHR) data have suboptimal performance in detecting these high-risk patients. OBJECTIVES To measure the added value of integrating audio-recorded home healthcare patient-nurse verbal communication into a risk identification model built on home healthcare EHR data and clinical notes. METHODS This pilot study was conducted at one of the largest not-for-profit home healthcare agencies in the United States. We audio-recorded 126 patient-nurse encounters for 47 patients, out of which 8 patients experienced ED visits and hospitalization. The risk model was developed and tested iteratively using: (1) structured data from the Outcome and Assessment Information Set, (2) clinical notes, and (3) verbal communication features. We used various natural language processing methods to model the communication between patients and nurses. RESULTS Using a Support Vector Machine classifier, trained on the most informative features from OASIS, clinical notes, and verbal communication, we achieved an AUC-ROC = 99.68 and an F1-score = 94.12. By integrating verbal communication into the risk models, the F-1 score improved by 26%. The analysis revealed patients at high risk tended to interact more with risk-associated cues, exhibit more "sadness" and "anxiety," and have extended periods of silence during conversation. CONCLUSION This innovative study underscores the immense value of incorporating patient-nurse verbal communication in enhancing risk prediction models for hospitalizations and ED visits, suggesting the need for an evolved clinical workflow that integrates routine patient-nurse verbal communication recording into the medical record.
Collapse
Affiliation(s)
- Maryam Zolnoori
- School of Nursing, Columbia University, New York, NY 10032, United States
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | | | - Ali Zolnour
- School of Electrical and Computer Engineering, University of Tehran, Tehran 14395-515, Iran
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | - Margaret V McDonald
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | - Zoran Kostic
- Electrical Engineering Department, Columbia University, New York, NY 10027, United States
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY 10032, United States
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| |
Collapse
|
6
|
Wu Y, Zhang X. Examining Conversation Analysis in Palliative Care: A Systematic Review. HEALTH COMMUNICATION 2024:1-12. [PMID: 38166606 DOI: 10.1080/10410236.2023.2301202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.
Collapse
Affiliation(s)
- Yijin Wu
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| | - Xin Zhang
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| |
Collapse
|
7
|
Zhang S, Cheng M, Ma W, Liu H, Zhao C. Companion responses to diagnosis in Chinese outpatient clinical interaction. Soc Sci Med 2023; 338:116308. [PMID: 37918227 DOI: 10.1016/j.socscimed.2023.116308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
Patients regularly attend clinical consultations with companions in Chinese outpatient clinics. Despite companions' significant influence on clinical consultations, how companions respond to diagnosis and their contributions to the activity of diagnosis in Chinese outpatient clinical interaction remain under-researched. The present study, by adopting the method of conversation analysis, investigated clinicians' diagnostic deliveries and companions' subsequent responses in Chinese outpatient clinical interaction. The data for this study consisted of 79 video recordings of clinical consultations in the Chinese orthopedic outpatient clinic, approximately lasting 12 h and involving three male clinicians, 79 patients (37 male/42 female), and 91 companions (51 male/40 female). Three basic categories of companion responses to diagnosis were identified: minimal verbal responses, embodied responses, and extended responses. It was demonstrated that these distinct responses allowed companions to challenge clinicians' medical authority in the activity of diagnosis by delivering their own diagnostic judgments, resisting clinicians' diagnoses, and orienting to clinicians' accounts for their diagnostic statements and reasoning, thus displaying companion agency in the Chinese outpatient clinical decision-making and indicating a transition from a paternalistic model to a family-centered model of the doctor-patient relationship in the Chinese orthopedic outpatient interaction. This study furthers current knowledge of companion involvement across healthcare contexts and contributes to raising clinicians' awareness of the significance of companions' contributions in Chinese outpatient clinical interaction.
Collapse
Affiliation(s)
- Shuai Zhang
- School of Foreign Languages, Yantai University, Yantai, Shandong, China
| | - Meili Cheng
- School of Foreign Languages, Yantai Institute of Technology, Yantai, Shandong, China
| | - Wen Ma
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| | - Huashui Liu
- Department of Orthopedics, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chunjuan Zhao
- School of Foreign Languages, Shandong Normal University, Jinan, China.
| |
Collapse
|
8
|
Zolnoori M, Vergez S, Sridharan S, Zolnour A, Bowles K, Kostic Z, Topaz M. Is the patient speaking or the nurse? Automatic speaker type identification in patient-nurse audio recordings. J Am Med Inform Assoc 2023; 30:1673-1683. [PMID: 37478477 PMCID: PMC10531109 DOI: 10.1093/jamia/ocad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVES Patient-clinician communication provides valuable explicit and implicit information that may indicate adverse medical conditions and outcomes. However, practical and analytical approaches for audio-recording and analyzing this data stream remain underexplored. This study aimed to 1) analyze patients' and nurses' speech in audio-recorded verbal communication, and 2) develop machine learning (ML) classifiers to effectively differentiate between patient and nurse language. MATERIALS AND METHODS Pilot studies were conducted at VNS Health, the largest not-for-profit home healthcare agency in the United States, to optimize audio-recording patient-nurse interactions. We recorded and transcribed 46 interactions, resulting in 3494 "utterances" that were annotated to identify the speaker. We employed natural language processing techniques to generate linguistic features and built various ML classifiers to distinguish between patient and nurse language at both individual and encounter levels. RESULTS A support vector machine classifier trained on selected linguistic features from term frequency-inverse document frequency, Linguistic Inquiry and Word Count, Word2Vec, and Medical Concepts in the Unified Medical Language System achieved the highest performance with an AUC-ROC = 99.01 ± 1.97 and an F1-score = 96.82 ± 4.1. The analysis revealed patients' tendency to use informal language and keywords related to "religion," "home," and "money," while nurses utilized more complex sentences focusing on health-related matters and medical issues and were more likely to ask questions. CONCLUSION The methods and analytical approach we developed to differentiate patient and nurse language is an important precursor for downstream tasks that aim to analyze patient speech to identify patients at risk of disease and negative health outcomes.
Collapse
Affiliation(s)
- Maryam Zolnoori
- School of Nursing, Columbia University, New York, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Ali Zolnour
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Kathryn Bowles
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Zoran Kostic
- Department of Electrical Engineering, Columbia University, New York, New York, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| |
Collapse
|
9
|
Nilsson E, Olaison A. "I See What You Mean"-A Case Study of the Interactional Foundation of Building a Working Alliance in Care Decisions Involving an Older Couple Living with Cognitive Decline. Healthcare (Basel) 2023; 11:2124. [PMID: 37570364 PMCID: PMC10418874 DOI: 10.3390/healthcare11152124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Social workers have a key role in needs assessment meetings with families dealing with dementia, providing information, support, and advocacy, while also assessing needs and making decisions about care services for several parties. These contacts are especially important during the introduction of home care services, where often the person has previously relied on informal support from relatives. The needs assessment process entails the involvement of all present parties, with the aim to reach a mutual agreement, a working alliance, regarding which services to apply for. PURPOSE The aim of this case study is to explore how the participants, by means of different conversational practices, jointly create a working alliance between the different parties in one family. The study provides insights into the process of co-constructing a working alliance in the needs assessment process for elder care services. METHODS This article addresses the process by which social workers build a working alliance in a multi-party conversation with a family living with cognitive decline; a meeting that lasted 50 min. In this case study, we benefit from an inductive and detailed conversation analytic methodology. The theoretical framework of working alliances in institutional interaction has informed the analysis. RESULTS The findings illustrate how the social worker in this case study involves all parties in the decision regarding care services and explores the use of the conversational practices of mitigations, positive framing, adding information, and positioning, as a "we" achieve mutual agreement toward the end of several sequences. CONCLUSIONS Drawing on the results of this case study, we argue that multi-party interaction involving relatives enables diversity in role-taking, where the professional, for instance, can pursue a more empathic role. Also, our results indicate that minimal agreement to a proposal is sufficient in a multi-party interaction involving clients with cognitive decline.
Collapse
Affiliation(s)
- Elin Nilsson
- Division of Social Work, Department of Culture and Society, Linköping University, SE-601 74 Norrköping, Sweden;
| | | |
Collapse
|
10
|
Stewart SJ, Roberts L, Brindle L. Shared decision-making during prostate cancer consultations: Implications of clinician misalignment with patient and partner preferences. Soc Sci Med 2023; 329:115969. [PMID: 37329719 DOI: 10.1016/j.socscimed.2023.115969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
Concepts of patient-centredness and shared decision-making inform expectations that clinicians should display sensitivity to patients' expressed preferences. This study examines the organisation of treatment-related preferences expressed by patients and their partners during clinical consultations for people with localised prostate cancer. A conversation analysis of twenty-eight diagnosis and treatment consultations was conducted with data recorded from four clinical sites across England. When clinicians disaligned from expressions of preference such as directing talk away from expressions, or moving to redress perceived misunderstandings, it caused discordance in the unfolding interaction. This led to couples silencing themselves. Two deviant cases were identified that did not feature the misalignment found in all other collected cases. In these two cases, the interaction remained collaborative. These findings highlight the immediate consequences of expressions of preference being resisted, rejected, and dismissed in a context where clinicians are expected to explore expressed preferences in service of SDM. The deviant case analysis offers an alternative practice to the pattern observed across the collection, offering a comparison between misaligned sequences, and cases where social solidarity was maintained. By acknowledging couple's expressions as valid contributions, rather than acting to inform or correct them, clinicians can create opportunity spaces for discussion around treatment preferences.
Collapse
Affiliation(s)
- Simon John Stewart
- Department of Psychology, Faculty of Health, Science, and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
| | - Lisa Roberts
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
| | - Lucy Brindle
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
| |
Collapse
|
11
|
Pino M, Land V. How companions speak on patients' behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:395-415. [PMID: 35157323 PMCID: PMC9306617 DOI: 10.1111/1467-9566.13427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 05/06/2023]
Abstract
Companions are individuals who support patients and attend health-care appointments with them. Several studies characterised companions' participation in broad terms, glossing over the details of how they time and design their actions, and how patients and health-care practitioners (HCPs) respond to them. This article aims to examine these aspects in detail by using conversation analysis, focusing on actions whereby companions speak on patients' behalf-mentioning delicate aspects of patients' experience (specifically, by alluding to patients' thoughts or feelings about dying). Some studies suggested that these actions undermine patients' autonomy. By contrast, through examination of palliative care consultations in a UK hospice, we found that these interventions are warranted by contextual circumstances: they are either invited by patients or HCPs (through questions or gaze) or volunteered to help with the progression of an activity (e.g. when a patient does not answer an HCP's question). Additionally, all parties collaborate in constructing these companion interventions as temporary departures from an otherwise prevailing normative orientation to patients' right to speak for themselves. The study contributes to the sociology of health and illness by characterising how companions contribute to the ways in which participants coordinate their relative rights and responsibilities, and ultimately their relationships, within health-care interactions.
Collapse
Affiliation(s)
- Marco Pino
- School of Social Sciences and HumanitiesLoughborough UniversityLoughboroughUK
| | - Victoria Land
- School of Social Sciences and HumanitiesLoughborough UniversityLoughboroughUK
| |
Collapse
|
12
|
Fatigante M, Zucchermaglio C, Alby F. Being in Place: A Multimodal Analysis of the Contribution of the Patient's Companion to "First Time" Oncological Visits. Front Psychol 2021; 12:664747. [PMID: 34149558 PMCID: PMC8209470 DOI: 10.3389/fpsyg.2021.664747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Companions to medical visits have been alternatively viewed as members who “support” or “inhibit” and “interfere” with the doctor-patient interaction. One way of looking at the companions' contribution to medical visits is by coding roles or functions of their communicative behavior. Our paper aims at reconsidering these findings and analyzing how the companion participation is a local and sequential accomplishment, changing from time to time in the consultation. The paper relies upon an overall collection of 58 videorecordings of first oncological visits. Visits were conducted in two different hospitals, one of which a University hospital, and by different oncologists, including both senior professionals and (in the second setting) medical students in oncology. Visits were fully transcribed according to the Jeffersonian conventions and authors examined the transcripts and video according to the methodology of Conversation Analysis. The aim of the paper focused on how patient's companions orient and contribute to the accomplishment of the different aims and activities at different stages of the visit as an institutional speech event. The multimodal analysis of turns and actions (such as, gaze shifts, prosodic modulation, bodily arrangements), and the close examination of the sequential and temporal arrangements of companions' and their co-participants' turns revealed that companions finely attune to the multiparty framework of the encounter and the institutional constraints that govern the oncological first visit. Overall, results show two relevant features: that companions act as to preserve the doctor-patient interaction and to maintain the patient as the most responsible and legitimate agent in the interaction; that companions' contributions are relevant to the activities that sequentially unfold at different stages in the consultation (e.g., history taking, problem presentation, treatment recommendation etc.). The study complements earlier findings on the companion's roles, showing how these are highly mobile, multimodal and multiparty accomplishments, and they are tied to the specific contingencies of the visit. The results solicit to consider the value of multimodal analysis in understanding the complexity of multiparty communication in medical setting, and make it usable also in medical education.
Collapse
Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Alby
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|