Conversation analysis (CA) was used to examine descriptions of pain, the design of questions and answers, and patterns of elaboration. I analysed audio- and video-recorded consultations involving six physicians and one patient in a supportive/palliative care clinic. The physicians enquired about a diversity of aspects of pain (e.g., severity). The patient’s answers aligned with questions indicating that his pain was stable (i.e., no change, no new pain, managed pain), which was consistent with the Clinic’s optimal health outcomes. Questions designed for a ‘no-pain’ answer were relatively infrequent. Whether or not these questions were problematic for the patient depended on when they were asked. The physicians used both single- and multi-unit questioning turns and an assortment of question types (i.e., yes/no interrogatives, yes/no declaratives, alternative questions and WH-questions). The questions were analyzed using four dimensions of question design (agenda, presuppositions, preferences and epistemic stance). While the patient accepted the topic agenda of aspects of pain, he rejected the topic agenda of pain management evaluation. He also rejected presuppositions that implied disease progression. Analysis of the action agenda showed that the physicians relied heavily on yes/no-type polar questions. Some of these encouraged elaboration (e.g., were problem attentive); however, a number of them discouraged elaboration (e.g., were optimized or included a negative polarity item such as any). Some questions that discouraged elaboration allowed the physicians to progress efficiently through a checklist of standardized questions, thus aiding in the progressivity of the talk. Change-implicative talk was pervasive in the physicians’ and patient’s talk; the patient’s answers often rejected the implication that his pain was worse. The characterization of the consultations as “difficult” by some of the physicians is considered in relation to the design of questions that elicited minimal information about the patient’s pain. Study limitations (e.g., the data sample) and directions for future research (e.g., on what constitutes an optimal health outcome) are discussed, and my findings are considered in relation to palliative care practice and training. The study fills some gaps in current palliative care literature regarding the dynamics of physician-patient interactions and contributes to the CA literature on medical interactions.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:OGU.10214/3891 |
| Date | 30 August 2012 |
| Creators | Cunningham, Shannon |
| Contributors | Wood, Linda, MacMartin, Clare |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Rights | http://creativecommons.org/licenses/by-nc-nd/2.5/ca/ |
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