Communication and Medicine最新文献

Language brokering refers to the informal interpreting performed by children and young people, typically in migrant families. Hearing heritage signers are typically individuals who grow up using a sign language at home with deaf parents. As most of them are hearing, they often broker between their signing deaf parent(s) and hearing non-signers. Brokering has been found to occur in varied contexts, including healthcare settings. Using semi-structured interviews, this study aimed specifically to explore the experiences of hearing heritage signers brokering between their parents and healthcare professionals using British Sign Language. Hearing heritage signers' experiences of brokering in healthcare settings were found to be varied, as were their attitudes, feelings and views towards brokering. Key themes were identified: pride and pressure; insider and outsider status; conflicting roles; autonomy, dependence and independence; choice and expectation; and perceptions of high- or low-stakes brokering. Based on these findings, recommendations for healthcare providers include increasing awareness of deaf people's rights and access, recognition of children's developmental needs in these contexts and the ability to signpost hearing heritage signers to appropriate support networks.

Previous research has identified that effective and high-quality communication between patients, families and professionals is a key contributing factor to end-of-life (EOL) care and recovery after bereavement. Increasingly, this communication work is being done by non-clinical staff in places such as homes and community settings. These additional care providers offer important pre- and post-bereavement support that can improve the quality of EOL care as well as promote healthy grieving for families, friends and communities. Despite this contribution, though, little is known about how these non-clinical workers use communication in their daily practices. This paper reports on the analysis of a set of nine in-depth interviews conducted in Hong Kong and in one region of Australia that examined in detail relational aspects of communication that shape interactions between non-clinical workers and service users. Data were collected during the COVID-19 health crisis, when the workers experienced exceptional restrictions on communication. The findings of this study highlight the fundamental importance of both verbal and non-verbal communication to the relationships established between non-clinical workers and service users. Specifically, greater support for the development of communication skills in non-clinical EOL workers will promote improvements in the quality of EOL care.

Diabetes self-management is a complex process in which individuals are asked to modify established health behaviors. Healthcare providers are instrumental in enhancing individual self-management and are encouraged to consider the patient perspective, often expressed indirectly. Using multidimensional analysis, this study analyzed talk to compare linguistic features used by adherent and non-adherent individuals with diabetes. In-depth telephone interviews were conducted with 108 individuals. Recruitment was stratified by sex, race and glycated hemoglobin (A1C) score. Interviewer contributions were removed from the transcripts, leaving only the participants' contributions. Using A1C score (<7%, >7%) the texts were divided into adherent and non-adherent datasets. Based on computer-assisted, quantitative analysis, ten linguistic features had a significant difference in frequency of use between the two groups. The participants in the adherent group used a greater frequency of linguistic features related to personal stance than the non-adherent group, and these expressions of personal stance were considered in relation to the participant's sense of agency. A better understanding of the way in which different subsets of individuals talk about diabetes self-management would facilitate greater healthcare provider understanding of the patient's perspective during clinical encounters to improve adherence.

This paper explores how mental health workers construct and categorise the responsibilities allocated to themselves and to their clients, based on how these responsibilities are recorded and located in the handwritten shift reports created during an intensive outpatient rehabilitation course in Finland. The data consist of 27 shift reports, which are first sorted using data-driven inductive analysis that then provides the frame for a more detailed analysis. It is found that the workers see their responsibilities as being to make assessments, and to guide and support their clients to increase their ability to function independently and take responsibility for their everyday lives. Reciprocally, the clients' responsibilities are seen as being to accept the workers' advice and support and to attend to their own everyday tasks. The clients are also regarded as responsible for their own rehabilitation. There are also shared responsibilities, including promoting client recovery together. The aim of all these reported responsibilities is to improve clients' wellbeing and independence.

This article focuses on what can be labelled 'trouble-talk', and in particular how it is initiated and responded to in therapist-resident encounters. It adopts the perspective of an individual with acquired brain injury. The study is based on a video ethnography of interaction, targeted at identifying trouble-talk and its interactional consequences, and it was carried out in a Danish care home facility for residents with this kind of injury. Encounters involving a case resident, an occupational therapist, a social worker (pædagog) and participant researchers were video recorded (totaling 30 hours) during fieldwork over one year, between 2012 and 2013. The dataset has been analyzed through a combination of discourse analysis and ethnomethodological conversation analysis. The findings show that when the resident takes initiatives and/or makes criticisms, this may be heard by the occupational therapist as complaints about institutional life in general and/or as talking gibberish. Such perceived trouble-talk is responded to by the occupational therapist with misalignment and repair work. In general, trouble-talk is co-constructed; however, it is accentuated by the occupational therapist's response, which suggests an undesired institutional ramification. In promoting awareness of the impact of impairments on interaction, I discuss how trouble-talk is emergent in the interaction itself and in what ways it can be resolved or minimized.

'Health Data' is a term that is used in many different contexts, but understandings of what it encompasses are at best vague. Without an agreed definition, effective law making, ethical discussions and the development of solutions that relate to Health Data are hindered, and decisions about how and when it can be utilized will be distorted and inconsistent, meaning that the potential value of this important resource for society will not be realized. This study contributes to the healthcare literature by offering an empirical characterization of Health Data, enabling a more rigorous and informed discussion through an exploration of its characteristics and how these can support the formulation of a definition which is functional at an interdisciplinary level. Qualitative interviews with 30 Danish stakeholders working with data and health indicate that a proper definition of Health Data should acknowledge a distinction between when the focus is on the source of the data and when it is on how data is used. Further, it needs to incorporate information relating both to clinical data involving patients and to a population's health status and behaviors more generally. Lastly, it needs to encompass structural data, pertaining to the health system and to wider societal and environmental factors.

Healthcare today increasingly involves patients using various devices to engage in different care activities and often doing so without the aid of trained healthcare professionals. This situation means patients must often use health and medical information (i.e., content) in various contexts with different dynamics. As a result, usability - or how effectively individuals can use items - becomes central to effective medical communication. Usability expectations affecting such communication dynamics are often guided by psychological processes reflecting prior healthcare experiences. Meeting these expectations involves identifying the cognitive factors influencing how individuals use materials. This conceptual paper examines how the psychological concept of 'cognitive scripts' can help address such situations. The paper also presents an approach for identifying the cognitive scripts affecting usability expectations and applying this information to create usable communication materials for healthcare contexts.

Patients sharing their illness experiences can help members of the general population to adopt measures to prevent contracting similar diseases and also improve the treatment and management outcomes of those who are sick. In this study, experiences shared by cancer patients and survivors were used to establish the appropriateness of narratives in promoting cancer literacy, as well as in describing adherence to set policies on cancer treatment and management. Anchored on the Health Belief Model, this study analysed sampled Daily Nation newspaper articles sharing the experiences of cancer patients and survivors in Kenya. The data was analysed using content analysis and compared with guidelines in national policies on cancer and the Setting Perception Invitation or Information Knowledge Empathy Summarize or Strategize (SPIKES) protocol for breaking bad news. The key findings suggest that the narratives effectively captured critical aspects on cancer literacy including detection of symptoms, diagnosis, communication of results, palliative care and treatment and management. A lack of counselling before disclosing the results of cancer diagnosis and instances of absence of shared decision making in the treatment process indicated non-adherence to national policies on cancer treatment as well as the SPIKES protocol.

Research has identified the tasks associated with effective patient-centered communication (PCC), but less is known about the contexts that can enable or hinder its implementation. This study explores East Slavic doctors' perspectives and experiences of intercultural PCC with Western patients. Semi-structured interviews informed by the principles of PCC were carried out with 15 doctors from two private clinics in Ukraine. The interviews were analyzed both for content and themes, informed by the dimensions of culture approach developed by Geert Hofstede and co-authors. The findings suggest disparities between the Ukrainian doctors' perspectives and experiences of PCC and those encountered in the West, with those of the former seeming to be influenced by socio-historical and educational barriers, and by dimensions of national culture in Ukraine. In conceptualizing PCC, the societal context needs to be taken into account, lest some important functions of medical communication be placed at risk.

Developing strategies to provide effective supportive messages for people with dementia that also promote the wellbeing of active listeners is essential for healthy caregiver-care-recipient relationships. We work to identify, critique and explore the pragmatics of language patterns between caregiving listeners and care-recipient listeners who experience dementia, with a focus on cultivating a more inclusive conceptualization of active listening verbal behaviors. Through content analysis of 66 conversations in the Alzheimer's and dementia context utilizing an adapted Active Listening Observation Scale (ALOS), our findings create a baseline from which to explore listening behaviors and the wellbeing of both caregivers and care-recipients. The results point to caregivers exhibiting higher active listening behaviors than care-recipients on every measure, and that across the duration of the conversation caregivers' active listening on a global level decreases and care-recipients' active listening increases. Ultimately, we hope that this research will decrease negative impacts on caregivers of the caregiving role, by addressing communication challenges; increase the agency and voice of care-recipients as listeners who contribute to communication events; create more inclusive conceptualizations of active listening verbal processes; and improve the quality of active listening in Alzheimer's and dementia caregiving contexts.