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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”.

Nello studio dei dialoghi in contesti istituzionali emerge spesso la rilevanza delle strutture interrogative, tipicamente trattate come strumento del controllo esercitato dalla persona socialmente più forte nella relazione. Un’analisi attenta di queste strutture, tuttavia, può mostrare una complessità di funzioni strettamente legate al contesto interazionale, ai ruoli discorsivi e agli scopi dialogici. Il presente contributo mira ad approfondire la comprensione del nesso tra strutture linguistiche e contesti interazionali prendendo come ambito di indagine i dialoghi in contesto clinico e analizzando le forme e le funzioni che le strutture interrogative presentano in questi dialoghi.

This volume addresses the issue of pragmatic meaning and interpretation in communication contexts regarding health and does so by combining a series of diverse and complementary approaches, which together highlight the relevance of successfully shared understanding to achieve more accessible, inclusive, and sustainable healthcare systems. The volume is divided into five thematic sections: 1) Analytical approaches to health communication, 2) Intercultural and mediated communication, 3) Negotiation and meaning construction, 4) Expertise and common ground, 5) Uncertainty and evasive answers, bringing together a group of top scholars on the much-debated issue of shared understanding both at the micro-level of dialogues between professionals and patients, and the macro-level of institutional communication. In the variety of its contributions, it represents an ambitious attempt at setting pragmatics at the core of healthcare communication research and practice, by combining conceptual reflections on core topics in the field of pragmatics (among which are speech acts, common ground, ambiguity, implicitness), with discourse and linguistic analysis of real-world examples exploring various problems in health communication.

La riflessione sulla comunicazione pubblica della scienza negli ultimi anni ha posto sempre più l’accento sulle implicazioni della diffusione capillare, a livello globale, delle tecnologie dell’informazione e della comunicazione, e sulla disinformazione. Come ormai noto, concetti quali post-verità, fake news, echo chamber sono entrati prepotentemente sia nel dibattito pubblico sia in quello accademico-scientifico da molteplici prospettive teoriche. Il problema della disinformazione è particolarmente rilevante quando le strategie manipolatorie, la mancanza di cura e responsabilità – deontologica e morale – nella costruzione e diffusione delle notizie e, in generale, i meccanismi della post-verità si riverberano sulla comunicazione che riguarda la scienza e le questioni relative alla salute che coinvolgono le scelte e le opinioni degli individui. Basti pensare a casi esemplari come Stamina o Di Bella in Italia, che hanno indotto a proporre iniziative specifiche tra cui il recente Patto Trasversale per la Scienza (2019). Queste premesse hanno motivato la decisione di organizzare il convegno “Prendersi cura delle parole. Il dibattito pubblico sulla salute da un punto di vista linguistico ed etico”, tenutosi a Roma il 23 maggio 2019 presso il Consiglio Nazionale delle Ricerche e organizzato in collaborazione con l’Università Cattolica del Sacro Cuore di Milano. A partire dallo scambio di idee suscitato dagli interventi al convegno e dal dibattito tra i partecipanti, obiettivo di questo saggio – così come di questo volume – è riflettere sull’impatto di questi fenomeni sulla società del nostro tempo in termini di concreti rischi per la salute dei cittadini, nonché immaginare modi di agire in riferimento ad esso.

Al ritorno da un qualsiasi controllo medico, il commento di molti sembra essere sempre lo stesso: non mi ha neanche lasciato parlare! Sul tema delle competenze comunicative dei clinici si sprecano commenti, sia in contesti divulgativi sia scientifici. Spesso sul banco degli imputati finiscono le domande poste dai clinici stessi che non sempre sembrano essere adeguatamente formulate. A fronte di un’apparente semplicità, l’atto di domanda è in realtà qualcosa di complesso, che non sempre si realizza attraverso una frase interrogativa e che può avere una molteplicità di funzioni: dalla raccolta di informazioni, al coinvolgimento di qualcuno per la realizzazione di uno scopo, fino alle domande retoriche o a quelle che in realtà sono rimproveri o espressioni di incredulità. Nel libro Le strutture interrogative nelle interazioni in contesto clinico Sarah Bigi affronta il tema da una prospettiva linguistica, indagando forme e funzioni delle domande nei colloqui medici, sulla base di una raccolta di consultazioni registrate in un ambulatorio di diabetologia. Dall’analisi emerge come le domande siano uno strumento fondamentale per permettere ai partecipanti il raggiungimento della maggior parte degli obiettivi previsti dal dialogo nel quale sono coinvolti.

Activity types have been described as interactional events that impose constraints on the allowable contributions and on the inferential schemata used by participants to interpret the function of linguistic structures used. In this study, this theoretical framework is applied to the analysis of interrogative structures in clinical dialogues, highlighting their diverse functions in relation to the goal of the activity type, its structure and the roles of the participants. The results of the analysis contribute to ongoing research on questions in dialogues and on the study of communication in medical encounters.

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.

In this paper, argumentation practices will be discussed in view of their potential for favoring effective information sharing and the creation of ‘emergent common ground’, i.e. the common ground that is sought, created and co-constructed in the process of communication. Argumentation is usually tightly knit with information sharing: if the parties have not previously shared a sufficient amount of relevant knowledge, it is difficult for them to produce effective argumentation. Based on these premises, in this paper the argumentation stages of medical encounters will be viewed as opportunities to reveal and integrate insufficient common ground between clinicians and patients. By relying on the analysis of a corpus of real life encounters in a chronic care setting, the interaction between information sharing and argumentation will be shown, along with problematic cases of misunderstandings or ineffective argumentation due to lack of common ground. Implications for the clinical practice will be discussed.

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.