Communication and Medicine最新文献

In many countries, including Belgium and the Netherlands, dependence on benzodiazepines (BZDs) is a medical and social issue, and, for long-term users who want to taper off, doing so remains a personal challenge. For these users, online contexts such as forums can be a place to discuss this experience and look for practical and moral support among former users and fellow users trying to reduce or stop BZD use. This paper aims to shed light on the discourses of a Dutch-language benzodiazepine withdrawal forum, examining 133 forum threads (41,516 words). We take a corpus-based approach that combines frequency analyses with qualitative discourse analysis. We explore how the users extensively share lived, experiential knowledge of using and reducing medication and, in doing so, engage with domain-specific biomedical jargon. As such they discursively construct specialised expertise and a medical(ised), health professional-like expert identity, both in relation to their own situation, but also in interaction with other forum members, as advisors to each other. The forum thus not only serves as a site for emotional peer support, but also as a site for detailed informational support on tapering, which is traditionally offered by health professionals. This is especially pervasive, as many forum users also express indignation about the medical establishment and its lack of institutional knowledge support in the process of tapering off.

New developments in cancer research provide opportunities to reduce the amount or intensity of chemotherapy for patients with early-stage breast cancer (EBC), with the goal of achieving recurrence-free survival rates equivalent to the current standard of care while reducing the short- and long-term toxicities that are associated with more aggressive chemotherapy regimens. Clinical trials are necessary to determine the lowest effective dosage of chemotherapy, and there is interest from patients and providers to enroll eligible patients in these trials. Currently, the word being used to describe these trials is 'de-escalation'. This paper considers the reactions of EBC patients and patient advocates to the word 'de-escalation' and how best to describe this approach and its anticipated benefits. Based on a patient survey and on interviews that were coded with the assistance of a content analysis program, we found that the participants tended to react negatively to 'de-escalation', with many associating this word with giving up in the war against cancer. Instead, the participants prefer positive, patient-centered language. This information will be useful to providers in considering how best to describe de-escalation clinical trials to eligible patients in ways that avoid therapeutic misconception and facilitate the shared decision-making process regarding treatment.

This article interrogates the linguistic construction of agency in accounts of endometriosis pain in English and Spanish. Endometriosis is a reproductive condition causing incapacitating pain which is often dismissed or normalised, leading to delayed diagnosis. We take a patient-centred qualitative approach and analyse data gathered from 10 semi-structured interviews with women with endometriosis in British English and Argentine Spanish, using the transitivity and social actor representation frameworks. The findings indicate that the women across the two settings represent pain as an agentive overpowering actor and themselves with varying degrees of decreased agency. However, pain is more closely related to mental representations of the patients' experiences in Spanish than in English, where it is construed as an actor performing physical actions. The findings of the study have implications for pain communication practices and cross-language healthcare communication and should inform local pain assessment measures.

People living with dementia (PWDs) often experience stigma that is reinforced by negative representations of the condition in discourse. This paper addresses the lack of research into this stigma by analyzing the representation of the condition in naturally occurring texts of people in direct contact with PWDs. Two blogs from Flemish family caregivers and one blog from a Flemish health professional were selected based on word count and keyword relevance, and studied both quantitatively and qualitatively. For the quantitative analysis keywords, n-grams, and collocations were identified in 225 blog posts, using Sketch Engine. For the qualitative analysis, 26 blog posts were analyzed by categorizing conceptual metaphors according to their conceptual mappings. The quantitative analysis indicates that the health professional employs a different approach in reporting, compared to the family caregivers. The qualitative analysis results in five conceptual mappings: PWDs as living dead, PWDs as trees, dementia as concealment, dementia as an acting entity and dementia as an attack. The frequency of these mappings shows that the condition is being dissociated from the PWDs, and described with more negative metaphors than the PWDs themselves.

Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians' perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the under-pinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician-patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.

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 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.

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.