Discourse analysis (DA) has emerged as a valuable method for examining communication between participants in end-of-life (EOL) care. However, there remains a gap in synthesizing the findings of discourse analytic studies focused on communication within EOL care settings. The aim of this study was to synthesize DA studies in EOL care. A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (Prisma) guidelines. An electronic database of Web of Science (WOS), MEDLINE, PubMed, and Embase was performed. 14 peer-reviewed studies published in English before January 10 2024, were included. Thematic analysis identified three overarching themes: (1) caregivers' discursive stances on EOL care, (2) discursive practices of participants in shared decision-making conversations, and (3) discursive resources in talking illness trajectories. Findings suggest that DA has the potential to provide insights into understanding communication practices in EOL care and examining an individual's stance on issues about EOL care, thus informing clinical practice and improving patient-centered care.
This study tested the structural influence model of communication in the context of the 2022 global outbreak of the Mpox virus among young sexual minority men. The primary objective was to understand how distinct social determinants, including education, race/ethnicity, and interpersonal discrimination, influenced exposure to Mpox messages in daily life and affected health anxiety concerning the Mpox virus in the United States. We also explored the significance of LGBTQ+ community connectedness as a crucial form of social capital during the outbreak. We collected a three-wave longitudinal dataset and examined within-person and between-person associations using a random-intercept cross-lagged panel model. Participants (N = 254) reported that internet sources and social media were their primary information sources for Mpox messages during the outbreak. Educational attainment, racial minority status, and LGBTQ+ community connectedness were significantly associated with message exposure. Young sexual minority men who faced greater interpersonal discrimination in their daily lives also reported higher rates of Mpox-related health anxiety. Longitudinal analysis indicated that (at the within-person level) Mpox anxiety was significantly associated with greater Mpox message exposure in the month following the outbreak, but that relationship waned in the subsequent month. The theoretical implications highlight the relevance of minority stress variables in the structural influence model of communication framework and suggest the importance of community connectedness as a distinct form of social capital shaping message exposure and health anxiety during the Mpox outbreak in the United States.
Pain assessment is key in deciding whether amputee patients are fit to receive a prosthesis, but its interactional accomplishment is still underexplored. This study adopts multimodal conversation analysis to investigate how pain assessment is carried out during medical visits at an Italian prosthetic clinic involving 77 patients and 24 health professionals. In the analyzed data, doctors carry out pain assessment by asking patients whether they feel pain during palpation of the stump, and patients respond by elaborating on their sensations and using touch in turn. The analysis focuses on a collection of 10 cases in which patients use response expansions and self-touch to reorient doctors' ongoing inquiry by specifying the type of sensation they experience and its location or to correct doctors' previous inquiry. The analysis illuminates how the patient's body becomes a resource for tactile practices that are shared between doctors and patients in the service of a common understanding of patients' pain. This analysis provides new knowledge of a practice patients use to redirect doctors' attention and understandings.
This study investigates the relationship between media use and breast cancer screening intentions by integrating the celebrity identification model and the theory of reasoned action. It tests an integrative model with survey data from 315 U.S. adult women. The study found that media use for breast cancer information was positively associated with parasocial interaction (PSI) and identification with celebrities who have or have had breast cancer; PSI was positively associated with attitudes, descriptive and injunctive norms in breast cancer screening, while identification with celebrities was positively associated with descriptive norms; attitudes, injunctive norms and descriptive norms were positively associated with breast cancer screening intentions. The study supports the mediating effect of PSI, identification, attitudes, and descriptive and injunctive norms on the association between media use and breast cancer prevention intentions.
Oncology patients face challenges beyond those directly affecting their cancer management. Guided personal narrative programs have been shown to help patients with chronic conditions and life-framing events. Few such narrative programs have been reported for cancer patients or analyzed for their impact on patient experience. We established our Life Story Narrative Program, modeled on the United States Veterans Affairs' "My Life, My Story" for outpatient oncology patients in our hospital's cancer center. Press Ganey™ patient experience scores from program participants were compared retrospectively with scores from patients who were not participants. Over an eight-month period, we invited 30 cancer center outpatients to participate. Twenty-seven individuals accepted, and 18 had their stories edited, approved, and scanned into their electronic health record. Cohort matching yielded a control arm consisting of 255 responses from 48 surveys, while the intervention arm consisted of 68 responses from 12 surveys. 78.4% of responses from the control arm were rated 5 compared with 100% in the intervention arm. The mean Press Ganey™ score response in the control arm was 4.71 compared with 5.00 from the intervention arm. Wilcoxon U value was 10,540 with p < .001. An outpatient narrative medicine program for cancer patients to tell their life stories can easily be organized. Patients were willing to participate, enrollment was brisk, and the use of resources was limited. Although our sample size was small, participation in our Life Story Narrative Pilot Program resulted in a statistically significant improvement in Press Ganey™ scores.
Although addressing cultural and religious practices is important in providing mental health care, little research exists on understanding mental health issues of minority groups such as Muslim immigrant women. We employed an intersectional approach to examine beliefs and attitudes toward mental health issues among Muslim immigrant women in Canada. Four focus groups (21 participants) were conducted, and 101 surveys were collected in Ottawa, Canada. Three core themes emerged from thematic content analysis of focus group data that relate to participants' communication about: 1) stressors, 2) mental health care seeking, and 3) utilizing coping strategies. The survey data were analyzed using independent samples t-test and One-Way ANOVA, the results of which supported the qualitative findings that social stigma was an important obstacle preventing those women from seeking professional mental health services. Muslim women with South and Southeast Asian cultural/ethnic backgrounds were more likely to get help from professionals than those with African cultural/ethnic backgrounds. No group differences were found in age, family income, and employment status. Broadly, the findings underscore the importance of developing knowledge about the intersections among gender, religion, cultural identity, immigration status, and social stigma that influence beliefs and attitudes toward mental health issues. Specifically, the findings point to the need for an intersectional approach that offers a more nuanced understanding for tailoring mental health care to Muslim immigrant women's needs.