27 February 2019
Marco Pino & Victoria Land - Patient cues about end-of-life concerns: evidence from hospice consultations
Presented By DARG
- B1.14 Brockington Building
About this event
Research and training in healthcare communication has focused on ways in which healthcare practitioners (HPs) can emotionally support patients and their carers. The literature suggests that patients rarely express emotional concerns explicitly; rather, they give away ‘cues’ about the presence of concerns (Zimmermann et al., 2011). Moreover, HPs rarely ‘pick up on’ those cues. Despite cursory approaches to coding patients’ cues and HP responses, no attempts have been made to ground understandings of patient cues in rigorous interactional analyses. Our questions include: do patients use ‘cues’ to initiate talk about emotional concerns (and are they treated as such by recipients)? If so, when do patients produce such cues and what do they look like? How does the talk progress from cues to more explicitly articulated concerns?
We use conversation analysis to study a specific type of patient cue: cues about concerns regarding the end-of-life. Our data consists of 85 recordings of hospice consultations between patients, sometimes accompanied by family or friends, and hospice clinical staff (doctors, occupational therapists and physiotherapists).
We observed that talk about end-of-life is recurrently preceded by a patient’s possible cue. Most frequently these are: (1) ‘Equivocal statements’ (such as “I’ve really had enough” which, in context, indexes the patient suffering severe pain, or wanting to die); and (2) ‘Underspecified troubles reports’ (for example, patients report suffering from panic attacks and subsequently relate that panic to fear of dying).
We seek to identify evidence that these cues can be understood as (possibly) pertaining to end-of-life concerns. We examine three sequential trajectories in which patients produce a cue, and later in the interaction they go on to articulate end-of-life concerns. (1) The patient produces a cue and then expands the same turn-at-talk in a way that disambiguates the cue as being about end-of-life concerns. (2) The patient produces a cue and then produce additional talk, in the same sequence, which disambiguates the cue as being about end-of-life concerns. (3) The patient produces a cue; later in the interaction (that is, not in the same sequence) they go on to articulate an end-of-life concern.
For DARG+ we will be focusing on one of the cases from our collection in more depth.
- Jack Joyce
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