Communication and Medicine最新文献

'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.

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.

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.

Due to the urgent, time-sensitive nature of interactions in emergency ambulance phone calls, dealing with repairs (communication trouble) can be challenging. We investigate a critical medical emergency known as out-of-hospital cardiac arrest (OHCA) and focus on how ambulance call-takers handle repairs during an interactive sequence concerning the retrieval of automatic external defibrillators (AED). Clear communication about AEDs is vital, because the device can deliver a life-saving shock to an OHCA patient's heart. We examined repair initiations, and their subsequent trajectories, during the defibrillator sequences in 58 OHCA emergency calls. We found evidence of competing influences in resolving such repairs: (1) providing a repair solution (including ensuring caller comprehension of what a defibrillator is) to achieve intersubjectivity that could resolve the question of defibrillator availability; or (2) progressing the call as swiftly as possible to an immediately applicable life-saving intervention such as cardiopulmonary resuscitation. The findings suggest that in certain institutional contexts, such as emergency medical service dispatch, the resolution of repairs in communication can take varying trajectories in order to achieve the most feasible goal in immediate time. We suggest that emergency medical services consider these trajectories in helping ambulance call-takers anticipate repairs in OHCA calls.

This study deals with assessment as an interactional practice in assisted eating activities involving people with late-stage dementia (here Alzheimer's disease) in an elderly care home. The dataset for the study consists of video recordings of 26 occasions of eating activities. We investigate the use of embodied, vocal and verbal assessments (e.g., headshakes, nods and gustatory 'mmm') together with evaluative terms (e.g., 'good' or 'great') in three consecutive phases in these activities: 'introducing the mealtime activity', 'offering the food' and 'receiving the food'. Drawing on multimodal analysis of interaction, we analyze three mealtime events, in which we show how assessments are issued by caregivers more often in interaction with a person with dementia who appears less engaged in the activity compared to a more engaged resident. Moreover, the analysis explicates how assessments fit in with the overall organization of the activity and are issued in a timely fashion when the food is introduced and brought close to the lips of the person with dementia, and when it is accepted. The findings show that assessments are used not only to share an evaluation of e.g., food or the action of the person with dementia, but also to manage the assisted eating activity. Assessments seem to be used distinctively (1) to build joint attention in the eating activity and (2) to encourage the assisted person to submit to/continue the activity of eating.

I think it is fair to say that the thoughtful comments on my paper were less 'rejoinders' than additions and elaborations. In that spirit, what follows is a summary of the arguments made and the critical questions that remain, also drawing on some personal communications I have received.