Search

This paper proposes a method for analyzing the dialogical functions of metaphors in communicative interactions, and more specifically in the context of medical interviews. The dialogical goals proposed and pursued by the interlocutors are coded using a coding scheme that captures seven mutually exclusive categories of dialogical moves. The functions of the moves, including metaphors, can be identified and correlated with other variables relevant to the type of communication under analysis. The coding scheme is used to analyze a corpus of 39 interactions between healthcare providers and patients affected by Type 2 diabetes. The exploratory quantitative analysis, for the purpose of determining the different distributions of metaphor uses between patients and providers, is combined with qualitative analysis in which the thematic areas of the metaphors are considered. The findings show how patients and providers use metaphors for pursuing different dialogical goals and meeting distinct communicative needs.

Understood as a process of negotiation and co-construction of meaning, shared or mutual understanding is a core issue in healthcare communication. Reaching a shared understanding is indeed important in all phases of medical communication, from diagnosis to treatment, to patient engagement and adherence. Many studies in the field of healthcare communication tackle this issue by explaining it with reference to the asymmetry of knowledge and social roles that characterises medical encounters perceiving asymmetry as one of the primary causes of frequent suboptimal outcomes of professional-patient interactions. While we are not surprised to see insights regarding the same problems being developed differently in different disciplines, we suggest that many issues regarding healthcare communication would probably be more easily analysed if they were considered from the perspective of pragmatics, i.e. the field of research that studies language in use. In this chapter we address the issue of shared understanding in connection with the problem of asymmetry, reframing it as an issue of “knowledge translation”.

Objective: To collect experiences and to identify the main facilitators and barriers for the implementation process of large scale communication training programs. Methods: Using a multiple case study design, data was collected from leaders of the individual programs in Australia, Ireland, Austria and Denmark. The RE-AIM framework was used to evaluate the components: Reach, Effectiveness, Adoption, Implementation, and Maintenance of the programs. Results: The programs, all based on the Calgary-Cambridge Guide, succeeded in reaching the intended target groups corresponding to between 446 and 3000 healthcare workers. New courses are planned and so far the outcome of the intervention has been investigated in two countries. The fact that implementation, including educating trainers, relies on a few individuals was identified as the main challenge. Conclusion: Large scale communication training programs based on the Calgary-Cambridge Guide can be implemented and adopted in multiple different healthcare settings across a national health system culture. The importance of standardized trainer education and adaption of the programs to clinical practice was highlighted. Practice Implications: In order to address the sustainability of the programs and to allow the intervention to scale up, it is important to prioritise and allocate resources at the political and organizational level.

Background: Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians' self-efficacy regarding communication to patients and risk of burnout. Methods: We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models. Results: Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout. Conclusions: Our findings suggest that some physicians' BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.

Purpose: Within the context of a research program on the most relevant discourse types in chronic care medical encounters, this contribution reports on a qualitative study on the role caregivers play within the process of shared understanding occurring between health-care professionals and elderly patients. The purpose of the paper is to highlight one dimension of such complexity, by bringing to light the challenges connected to the achievement of shared understanding between health-care professionals and elderly patients when caregivers are involved in the conversation. Design/methodology/approach: The paper reports on a two-step analysis of a corpus of transcripts of interactions in diabetes and hypertension settings. In the first step, caregivers’ contributions to deliberative sequences have been analyzed. In the second step, the analysis was extended to caregivers’ contributions to the whole encounter. Findings: The results show that professionals’ ability to engage caregivers in deliberations during the encounter and, more generally, to assign a role to caregivers as legitimate participants in the consultation may favor the smooth development of the interaction and an effective process of shared understanding among all participants. Originality/value: The paper further develops original research about the functions of the argumentative component in dialogues occurring in clinical settings.

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.

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.

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.

Background and Aims: Few mobile applications for diabetes care support incorporate educational functions and reminders for adherence to therapy, self-management and healthy lifestyle and fewer are tested for usability. We tested the mobile application ‘‘Active Ageing’’ in a pilot study in seniors (age >63 years) with type 2 diabetes (T2D) andwomen with gestational diabetes (GDM). Method: An application, structured according to cognitiveargumentative model of verbal communication, with empowering text messages was developed by the Catholic University in Milan. Patients were recruited at the San Raffaele Hospital in Milan between 01/01/2017 and 31/08/2017, and invited to use the application to store and share data about glucose (SMBG) and weight and complete the System Usability Scale (SUS). Results: Nineteen out of 116 T2Dpatients (16.4%) (median age 69 (65-73) years) and 12 out of 12 GDMpatients (100%) (median age 37 (34-40) years) accepted to participate. After a median of 11 weeks of use (7-15), 7 T2D and 10 GDM patients completed the SUS (median score 77.5 (75-97.5) and 92.5 (87.5-95) respectively, p = 0.22). T2D patients performed 72% of SMBG measurements and 60% of weight measurements, GDM patients performed 53.5% of SMBG and 29% of weight measurements. Conclusion: The application is usable, although a minority of patients with T2D >63 years are willing to use the App. Younger GDM patients are more likely to use the app, but less compliant to SMBG or weight measurements. Tailoring an App and targeting it to the right patient population may improve the use of technology to empower patients.

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.

Introduction: Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations. Case presentation: Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato. Conclusion: Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosis