Using mainly quantitative methods of evaluation, as well as patient comment assessment, this study evaluated whether changing the current informed consent process for labor epidural analgesia to a longer, more informational process resulted in a more satisfied patient. Satisfaction with the labor epidural informed consent process was evaluated using a questionnaire that was mailed and also available online. Half of the patient population was given a written labor epidural risk/benefit document at their 36-week obstetric check up. All patients received the standard informed consent. Survey responses were evaluated based on three independent variables dealing with the modality, timing, amount of informed consent information and one dependent variable, whether the patient's expectations of the epidural were met, which is equated with satisfaction. Patients in this study clearly indicated that they want detailed risk/benefit information on epidural analgesia earlier in their pregnancy. A meaningfully larger percentage of patients who received the written risk/benefit document were satisfied with the epidural process as compared to those who did not receive the document.

Successful physician-patient communication is increasingly being acknowledged as a vital aspect of healthcare today. Research in the field has not examined all aspects of patient-centered care and the aspects that have been studied have not been grounded in actual patient action. The research done in the field has largely been studied quantitatively. The present thesis research attempts to contribute to the gap in the field of physician-patient communication by qualitatively examining patient assertiveness. This thesis examines conversations between women in Portland, Oregon recently diagnosed with breast cancer talking to their surgeons about their diagnoses and treatment options. Using grounded qualitative theoretical analysis, this thesis uncovered five major themes of patient assertiveness in breast cancer care.

Abstract not available

Includes bibliography (leaves 249-291). / xxiv, 291, [52] leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Discusses and evaluates the role of intra-operative ultrasound in colorectal surgery ; techniques of laparoscopic surgery and the impact on the incidence of hypothermia during surgery ; advanced prognostic techniques in colorectal cancer ; the impact of ambulatory anorectal surgery ; and, the potential of an information video to decrease the anxiety of patients through imparting essential information to patients. / Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1999

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The most ordinary man or woman has means of knowledge concerning his own feelings and circumstances that immeasurably surpass those that anyone else can have.-John Stuart Mill, On Liberty / One feature that varies within competing conceptions of medical shared decision-making is how a patient's values are to be engaged by a physician. One detail that can be overlooked under "shared" decision-making is whether or not a physician ought (or be allowed) to attempt to persuade the patient to adopt particular health-related values. Some argue that it is incumbent on a physician to share her privileged understanding of medicine so as to help her patient embrace "better" values. This thesis argues that it is dangerous to patient autonomy for a physician to exert moral suasion on her patient to attempt to influence or change those values; the danger lies in the power imbalance between patients and physicians that seems inherent in medical encounters, and is exacerbated by the sick role. Thus, while a physician ought to help her patient articulate his health-related values, she ought not try to change them.

This thesis examines sources of interactional asynchrony and synchrony in intercultural medical consultations between South African English speaking doctors and Zulu-English speaking patients in an urban setting in South Africa. It employs, principally, the theory and methods of Interactional Sociolinguistics to identify and describe sources of asynchrony and synchrony in medical encounters. The thesis provides a review of the South African and international literature relevant to the analysis of doctor-patient interaction. Having noted the significant absence of research that utilizes a model of language use such as Interactional Sociolinguistics, the author reviews South African and international interactional sociolinguistic research literature with a view to identifying an appropriate research framework for the analysis of selected medical consultations. The thesis reports the findings of the fine-grained analyses of three consultations. The societal consequences of the asynchrony evident in two of the consultations are explored drawing, in particular, on insights provided by Critical Language Study. The relative synchrony of the third consultation is traced to the participants' use of positive politeness strategies to generate the "co-membership" of maleness. The significance of this discovery is explored in some depth. Finally, attention is given to further research possibilities arising from the present study. / Thesis (M.A.)-University of Natal, Durban, 1995.

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2003. / Bibliography: p. 397-424. / Introduction -- Models of shared decision-making in medicine -- Framing the study -- The analytic goals of modelling agency -- The context of treatment decision-making in HIV -- Agency and alignment -- Study conclusions and implications. / The quality of doctor-patient communication has been shown to influence treatment uptake, adherence and effectiveness in HIV medicine and elsewhere. Increasingly, it is considered essential that doctors and patients jointly participate in decisions concerning treatment. There is a growing body of literature describing joint decisionmaking and suggesting guidelines for its practice. Few of these studies, however, relate their descriptions of medical decision-making as a social process to the ways in which patterns of verbal interaction realize or foreclose on joint decision-making. -- Dominant models of medical decision-making view shared decision-making as a midpoint between enlightened paternalism and informed choice. Based on a corpus of HIV consultations audio-recorded in Sydney in the late 1990s, this thesis argues that it can be better modelled as a particular type of social process, which differs across a number of dimensions from other styles of medical decision-making, specifiable as contextual parameters of meaning. The thesis then identifies ways in which specific discursive practices realize these contextual parameters. -- A major component of the thesis focuses on agency, and a model is presented in the form of a socio-semantic network, drawing on work by van Leeuwen (1996) and others, which relates a range of grammatical features, not only transitivity patterns, to ways of construing social agency. The thesis then considers the way in which doctors and patients mobilise these and other resources for bringing together potentially conflicting points of view in framing and articulating treatment decisions. Here I draw on notions of mutual alignment (e.g., Goffman 1981) but expand the analysis of what is aligned to account for speakers' implicit discourse orientation, as well as more overt markers. -- Findings emphasise the relationship between representing and enacting agentive roles; the importance of doctors and patients mutually projecting each other's voices; and the variable and iterative character of shared decision-making. The research demonstrates how doctors and patients negotiate a complex, interactionally and symbolically mediated agency, and shows that patients often take the lead in developing more collaborative decision-making practice. There are still institutionally and socially determined limits to the degree of control patients may exercise within the consultation, many of which are of course well founded. / Mode of access: World Wide Web. / xvii, 533, [22] p. ill

Thesis (Master of Science (Hons.) Social Ecology) -- University of Western Sydney, Hawkesbury, 1994. / "A dissertation submitted in fulfilment of the requirements for the degree of Master of Science (Honours) in Social Ecology in the University of Western Sydney - Hawkesbury" Bibliography : leaves 288-300.

Thesis (Ph.D.)--University of Melbourne, Dept. of General Practice and Centre for Health and Society, 2007. / Typescript. Includes bibliographical references (leaves 252-278).