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Qual è la posta in gioco nella comunicazione pubblica su questioni riguardanti la salute? Quali i valori di riferimento per una politica del linguaggio che intenda includere nella dimensione della cura anche il “prendersi cura delle parole” che utilizziamo? Il volume muove dall’esigenza di portare in primo piano il punto di vista delle scienze del linguaggio nel dibattito relativo alla comunicazione pubblica su temi medico-scientifici; una prospettiva che risulta spesso marginale, quando non del tutto assente. I saggi raccolti in questo volume spaziano dalla filosofia del linguaggio, alla linguistica, alla teoria dell’argomentazione, alla retorica, alla pragmatica, alle scienze cognitive e affrontano alcune questioni cruciali per la comunicazione delle conoscenze scientifiche, tra cui: il rapporto tra emozioni e ragione; la questione dell’attendibilità e della fruibilità dei testi; l’intreccio tra le nostre modalità comunicative e la rete dei nostri rapporti sociali; il problema della reputazione e della sfiducia negli esperti; la questione della responsabilità morale nel rapporto con l’uditorio e nella divulgazione della scienza; la realizzazione di concreti progetti applicativi nel settore della comunicazione sulla salute. L’obiettivo ultimo è di consolidare il ruolo delle scienze del linguaggio nella riflessione critica sulle premesse irrinunciabili e sulle indispensabili caratteristiche testuali che lo spazio del discorso sulla salute dovrebbe presentare. Come primo passo per uno sforzo comune verso una reale cura delle parole, prendendo spunto dai contributi presentati nel volume, viene presentato un decalogo di action items per il miglioramento della comunicazione della scienza e della salute.

As discussed in many publications in recent years, researchers in the field of healthcare communication are observing what looks like a paradox. In spite of decades of research and empirical studies providing insights and evidence in support of teaching and using appropriate communication skills for the provision of healthcare, it is still common to find suboptimal and unsatisfactory relational competencies in the professional world (see the special issue of Patient Education and Counseling on “Quality of Communication from the Patient Perspective” [1]). At times, one almost has the impression that all the advancement in knowledge on various topics concerning communication for healthcare delivery has remained confined to the academia, while only bits and pieces have reached the professionals.

The psychoanalytic perspective of this paper suggests the notion of the Resilient Ego as an essential part of military pilots’ job. In order to explore their subjective management of Human Mental Workload, we analysed their resilience based both on structural aspects of their job, and on practical factors of their daily performances and tasks. Moreover, our work presents a qualitative analysis of military pilots’ testimonies about the most significant unexpected events of their career. We analysed their subjective perceptions as well as professional and interpersonal resources they used to face to unforeseen events. In order to describe the mental contents that make up the subjective factor that promotes success in managing the unexpected, we included the analysis of the textual component of pilots’ interviews. We found that in mastering daily job as well as the unexpected, the Resilient Ego is based on realism and cooperative thoughts. On the one hand, technical and non-technical skills – expertise components – are specifically supported by Crew Resource Management (CRM), on the other hand military pilots’ family relationships animate subjective perceptions during flight performances. The Resilient Ego in the sky feeds daily risky tasks with the affective relationships cared for on earth, even when pilots need to manage dangerous conditions. If unforeseen events are an integral part of military pilots’ workload, the analysis of how pilots deal with the unexpected increases our knowledge of the Human Factor and provides information about the subjective factors of resilience.

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of how evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal (making a decision shared by the patient), the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence.

Changing geo-political scenarios, especially in Europe, Northern Africa and the Middle East, are displacing populations and reshaping societies. In this context, the provision of health care becomes even more challenging as the cultural and linguistic gaps add challenges to the highly complex interactions taking place within clinical settings. In this contribution, we analyze the main issues regarding effective communication in multilingual medical settings and propose to adopt a theoretical framework that allows to consider mono- and multi-lingual settings on a continuum, thus offering homogeneous tools for the analysis of misunderstandings and ineffective communication. We propose, first, to consider doctor-patient interactions by using the concept of activity type. We argue that, from this perspective, the most challenging aspect of this kind of interaction is not so much the quantitative knowledge disparity between the parties (somewhat foreseen by the preconditions of existence of the activity type itself), but rather the qualitative knowledge disparity. With ‘qualitative knowledge disparity’ we refer to two specific conditions that characterize this activity type: 1. The fact that at least one of the parties involved is defined by having a technical knowledge the other(s) do not share (or share only up to a certain degree); 2. As a consequence of point 1., the fact that the parties often do not share the criteria for the interpretation/assessment of the objective facts (symptoms and clinical parameters), which should constitute the starting point for decisions and actions. The problems that arise in real-life interactions as a consequence of these characteristics have been explored by using theoretical constructs such as ‘asymmetry’, ‘power relations’, ‘medical world vs life world’, ‘voices’, etc. What seems lacking is a dialogical perspective on the issue, allowing the description of the phenomena and of possible solutions that can be tested empirically. In o

Pragmatic presupposition is analyzed as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for presupposing a proposition is represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely they need to be the reasonable conclusions of an underlying presumptive reasoning, which does not or may not contain contradictions with other presumptions. Presumptions are in turn analyzed considering their nature and their hierarchy, namely their subject matter and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between misunderstandings deriving from presuppositional failures and the underlying system of presumptions. This approach is applied to the investigation of communicative issues within the medical context, and more precisely doctor-patient communication in diabetes cases.

mHealth is an expanding field of research and experimentation, concerned with the potentialities of mobile applications as tools to enhance patients’ abilities in the management of chronic conditions. We present a systematic review of mHealth applications available on the Italian market and for the Italian speakers in order to assess their reported usability and functions. The review shows that there are rather few products on offer and the ones that are available display weak educational components, do not seem to be based on solid theoretical models of behavior change or decision making, and do not seem to be intended as devices to be integrated in the ecology of the doctor-patient relationship.

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Medical consultations in chronic care can be described as advice-seeking activity types, in which advice-giving is the main discursive activity that entails an argumentative component. This component appears during deliberative and evaluative sequences. In the first case, participants need to find agreement on a solution to a problem. In the second case, participants need to find agreement on how to assess facts in order to make decisions based on those assessments. We are particularly interested in understanding clinicians’ use of argumentation 1. when deciding for a certain treatment; 2. when patients disagree with them. In order to do this, we propose the analysis of a corpus composed of interviews with chronic care doctors, collected in Italy and in the Chinese region of Inner Mongolia.

Dialogue moves are a pragmatic instrument that captures the most important categories of “dialogical intentions.” This paper adapts this tool to the conversational setting of chronic care communication, characterized by the general goal of making reasoned decisions concerning patients’ conditions, shared by the latter. 7 mutually exclusive and comprehensive categories were identified, whose reliability was tested on an Italian corpus of provider-patient encounters in diabetes care. The application of this method was illustrated through explorative analyses identifying possible correlations between the dialogical structure of medical interviews and one of the indicators of personalized decision-making, namely the specificity of the recommendations given by the provider (“customization”). The statistical analyses show a significant correlation between the exchange of personal information and very specific and customized recommendations for change. It suggests how the creation of common ground, exceeding the boundaries of the paternalistic or patient-centered models, can lead to highly effective communication.

The paper discusses the role of argumentative competencies for the achievement of patient engagement through communication in doctor-patient consultations. The achievement of patient engagement is being proposed by recent studies as a condition that can facilitate in particular patient adherence, which involves behavior change. One obstacle to behavior change that has been observed is reactance, i.e. resistance to persuasive messages when a threat to freedom is perceived. In the medical field, reactance theory has been mostly applied in the field of mental health, less frequently to understand non adherence in general. However, a few studies have revealed that reactance can actually explain in part the motives behind non adherence. These studies propose that the arousal of reactance could be limited or prevented by adopting relational measures aimed at giving patients the feeling that they still hold some control over the process of care and that the ‘impositions’ on their freedoms are acceptable because they have had the opportunity to decide about them. However, they do not discuss how these strategies should be operationalized at the dialogical level. A debated issue in the study of reactance is the role played by knowledge. It seems that pure information regarding an issue is likely to represent a threat in itself. Complementary to this is the finding that quality of argument does not impact on the degree of reactance. These findings pose a problem in view of the goal of patient education, itself considered as a necessary premise for any process of patient engagement and adherence. It seems necessary to move away from a conception of education as mere transmission of information and look for more effective ways of transferring knowledge to patients. With regard to this issue, the paper argues that useful insights can be found in studies on science education, in which it is shown experimentally that argumentative processes favor learning and understanding. Drawin

In this article we discuss how commercials about food contribute to the construction of the concepts of ‘healthy, natural and genuine food’. We analyze a corpus of interviews by identifying all the passages in which consumers speak about products providing reasons for considering them ‘natural’ or ‘healthy’. By analyzing the argumentation schemes and by relating them to the multimodality in the commercials, we describe the reasoning underlying consumers’ motivations.

The concept of patient engagement is attracting growing attention from scholars working on doctor-patient interactions. It refers to the condition in which patients are fully aware of their medical condition and willing to be active both in the relationship with their caregivers and towards the health care institutions. However, the operative steps necessary to achieve patient engagement have not yet been fully described. This chapter focuses on the communicative dimension of engagement. Communication is shown to be a pivotal means to improve patient self-efficacy and commitment, both fundamental components of engagement. In particular, the authors take a closer look at the process of decision making in chronic care settings, and propose a normative model to analyze and evaluate the quality of decision making in consultations. It is argued that the model can also be used as a blueprint to create training materials for clinicians.

At the start of studies on health communication, scholars were primarily concerned with showing the ethical implications of a new approach to care and with collecting evidence to demonstrate its greater effectiveness as opposed to the paternalistic and mechanistic paradigms. Well into the second decade of the 21st century, different issues need to be addressed. Aging populations and the spread of chronic diseases are challenging the sustainability of health care systems worldwide; increased awareness of health issues among the population and greater citizen participation seem to threaten clinicians’ authority. In this new scenario, it is acknowledged that the quality of verbal communication plays a crucial role, but it is still not clear how it impacts on the outcomes of care, which are its constitutive components and how it interacts with the institutional, cultural and social context of interactions. This book suggests that the time is ripe for a fresh start in health communication studies. As Debra Roter points out in her foreword, this proposal “is ambitious in attempting to integrate perspectives derived from pragmatics and argumentation theory with those derived from quantitative methods of medical interaction analysis and its prediction of outcomes”. On the other hand, as Giovanni Gobber explains in his foreword, “health communication can profit from an application of a performance-oriented linguistic analysis that pays attention to the role of the various relevant context factors in speech events related to specific activity types”. In this way, the open questions regarding communication in medical encounters are considered under a new light. The answers provided open up novel lines of research and provide an original perspective to face the new challenges in medical care.

The study of medical argumentation typically draws on empirical data. This poses a challenge, as in medical practice, utterances that serve an argumentative purpose are intertwined with utterances that serve different dialogical – as well as clinical – goals. Comprehensive understanding of the communicative context is thus imperative. This contribution seeks to provide a blueprint for the analysis of medical argumentation in context. Doing so, chronic care consultation is used as a particular example of doctor-patient interaction.

mHealth is an expanding field of research and experimentation, concerned with the potentialities of mobile applications as tools to enhance patients’ abilities in the management of chronic conditions. In general, patient education seems to be an effective trigger for a better management of chronic conditions. However, most of the apps available on the market do not seem to have very developed educational functionalities. Moreover, most of them have not been tested through rigorous studies and it is not clear if they are based on solid theoretical models of behavior change or decision making. The present contribution is the first output of a research project aimed at designing and testing an app for diabetes patients.

The up-to-date treatment of diabetes often includes the adoption of technology (eHealth) to support patients’ self-management. This contribution features first data on patients’ usage of ActiveAgeing, a mobile app supporting daily self-management. Over 6 months, 15 elderly patients with type 2 diabetes (T2D) and 11 young women with gestational diabetes mellitus (GDM) received daily reminders to perform treatment activities, registered capillary glucose within the app, and added personal notes to explain abnormal values. While no differences emerged between the groups’ glucose registrations, T2D patients were more likely to add notes. Sentiment analysis with the software Watson on T2D patients’ notes and some selected notes are reported. Discussion highlights that notes may be used not only to explain abnormal data, but also to express emotions and confide personal information. eHealth presents opportunities not only for self-management, but also to empower and enrich trust between patients and health providers.

The purpose of this chapter is twofold. On the one hand, our goal is theoretical, as we aim at providing an instrument for detecting, analyzing, and solving ambiguities based on the reasoning mechanism underlying interpretation. To this purpose, combining the insights from pragmatics and argumentation theory, we represent the background assumptions driving an interpretation as presumptions. Presumptions are then investigated as the backbone of the argumentative reasoning that is used to assess and solve ambiguities and drive (theoretically) interpretive mechanisms. On the other hand, our goal is practical. By analyzing ambiguities as stemming from different presumptions concerning language or, more importantly, expected communicative roles and goals, we can use communicative misunderstandings as the signal of deeper disagreements concerning mutual expectations or cultural differences. This argumentation-based interpretive mechanism will be applied to the analysis of medical interviews in the area of diabetes care, and will be used to bring to light the sources of misunderstanding and the different presumptions that define distinct cultures. We will consequently illustrate the analytical tools by identifying and distinguishing the various types of ambiguity underlying misunderstandings, and we will address them by describing the communicative intentions ascribed to the ambiguous utterances.

In health care, information and communication technologies (ICTs) are being used more and more frequently as a way of improving the provision of care. The devices that are marketed for this purpose include web and mobile applications, telephone, decision-making aids, and telemedicine tools (Wootton 2012; Nicolini 2011; Ekeland et al. 2012). However, their uses in many cases are limited to data transfer and information exchange between physicians and patients. Moreover, the technological instruments marketed to patients as aids for a better management of their health have usually been designed to be used at home and are not meant to be integrated within the program proposed to patients by the health care system. This makes it difficult for clinicians to exploit the potential of these instruments for better care or integrate them in their daily practice. Positive Technology, a recent field of research developed in the area of Positive Psychology, focuses on technological tools aimed at individuals’ increased wellness, strength and resilience (Riva 2014; Wiederhold et al. 2013). Existing Positive Technologies are classified according to their objectives: hedonic (mood-altering devices); eudaimonic (systems designed to support individuals in reaching engaging and self-actualizing experiences); and social/interpersonal (technologies that seek to improve the connectedness between individuals, groups, and organizations) (Botella et al. 2012). In our contribution, we focus on the eudaimonic dimension, discussing in particular ICT applications aimed at supporting chronic patients’ engagement and self-management of their disease. More specifically, we present the design of an application for the enhancement of diabetes patients’ critical decision making and motivation. On a theoretical level, the application is based on the notion of dialogue types, which has been developed within the field of Argumentation Theory (Walton, Toniolo and Norman 2014; Bigi 2014a). A preliminary a

The paper describes results from an observational study on argumentation in the medical setting, which show how and why argumentation skills can become a useful therapeutic tool in chronic care. The results of the study show that the therapeutic goals of chronic care are strongly linked to dialogical activities such as argumentation, explanation, decision making and information giving. The article discusses how doctors’ argumentation skills can be improved, especially in the crucial phase of shared decision making.

Collaborative goal setting in patient–provider communication with chronic patients is the phase in which – after collecting the data regarding the patient’s health – it is necessary to make a decision regarding the best therapy and behaviors the patient should adopt until the next encounter. Although it is considered a pivotal phase of shared decision making, there remain a few open questions regarding its components and its efficacy: What are the factors that improve or impede agreement on treatment goals and strategies?; What are the ‘success conditions’ of collaborative goal setting?; How can physicians effectively help patients make their preferences explicit and then co-construct with them informed preferences to help them reach their therapeutic goals? Using the theoretical framework of dialogue types, an approach developed in the field of Argumentation Theory, it will be possible to formulate hypotheses on the ‘success conditions’ and effects on patient commitment of collaborative goal setting.

One of the biggest challenges for doctors working in chronic care is the correct management of the argumentation phases during the encounters with their patients. During these phases doctors should provide patients with acceptable reasons for being adherent to treatment and for changing certain unhealthy behaviors and lifestyles, something which is particularly difficult for elderly patients, for whom changing life long habits can be extremely hard. However, the medical literature on the subject of communication in the chronic care encounter shows lack of theoretical models and methodological approaches that can highlight which specific linguistic structures or elements in different communication styles favor or impede patient commitment, trust in the relationship and adherence to treatment. The contribution describes ongoing research on argumentative strategies in the encounter with diabetes patients. I describe one recently concluded research project on the argumentation phases of medical encounters in diabetes care, which highlighted critical areas in need of improvement. I also describe the design and aims of a new research project, aimed at testing the effectiveness and usability of certain argumentation schemes in the medical encounter.

By proposing a case study analysis from the context of Assisted Reproductive Technology (ART), we argue that non-neutrality may paradoxically have – if it is properly managed – a higher degree of ethical convenience (§3). In summary, we show the relevance for the context of health communication of recent issues discussed in cognitive pragmatics and linguistics (§ 2); having in mind the idea that patients’ autonomy and freedom is guaranteed by understanding within shared decision-making, we then introduce the argumentative theory of reasoning and we discuss the significant role of argumentative instruments within patient-provider interactions. Finally, we propose a case study analysis of a medical consultation within ART and show how an ethical management of non-neutrality requires an appropriate use of communicative instruments and, more specifically, of argumentative instruments (§3). Finally, we discuss some preliminary results and sketch further lines of research (§4).

The relevance of context has been acknowledged also recently as a fundamental element for the correct evaluation of argumentative moves within institutional fields of interaction. Indeed, not considering the larger culture-specific and social features of the context within which the interactions take place poses problems of interpretation of the data and comparability of results. Starting from these considerations, the paper aims at discussing a model for the description of the social context of interaction that may allow for a better interpretation and evaluation of argumentative moves within medical consultations. The efficacy of the model is shown by applying it to the description and analysis of examples of real-life consultations recorded in the Italian region of Lombardy. In the first section, the model for the description of the social context of interaction is presented and discussed. In the second section, examples of argumentative passages from a selection of consultations are presented and commented on by relying on the model. Some concluding remarks and further developments of the research are proposed in the final section.

This article is set within the general frame of the discussion on the reconstruction of implicit premises in argumentation. On the backdrop of the theoretical framework provided by the Argumentum Model of Topics (AMT), we set out to propose a hypothesis on how the endoxa of a given argument scheme are derived from certain cognitive frames activated by the use of linguistic units, which we call keywords. Implicit premises in argumentation are described according to the distinction between procedural and material starting points: the former refer to the inferential component of the argument scheme; the latter, to the premises of a contextual nature, which allow the argument scheme to become relevant for the interlocutors in a specific dialogical context. Our proposal is focused on the reconstruction of the endoxical part of the material starting points. The proposed hypothesis on the linguistic activation of endoxa is illustrated through the analysis of a case of political debate. The theoretical hypothesis proposed in the article, set at the crossroads between the study of argumentation theory and linguistic semantics, is a first step towards the understanding of the connection between the linguistic and the inferential level in the structure of argument schemes.

The paper presents partial results from an ongoing research on communication in the medical setting. The aim of the paper is to show how the institutional context can affect argumentation by focusing on the activity type of consultations. In order to achieve this goal, the paper is structured in four sections. The first one offers a description of the institutional dimension of the medical consultation set within the cultural domain of the Italian National Health Service. In the second section, this description is completed by outlining also the interpersonal dimension of the context. The third section presents partial results obtained through the analysis of a collection of medical consultations. The analysis was conducted by selecting the argumentative extracts from the consultations and by describing the argument schemes used both by doctors and patients. In the concluding section further lines of research are proposed.