Search

Purpose: This study aimed to gather the views and experiences of clinicians and managers on early intervention audiology and speech-language pathology services for culturally and linguistically diverse (CALD) families of children with hearing loss. Method: This qualitative descriptive study involved 27 semistructured interviews with audiologists, speech-language pathologists, and managers working with CALD families of young children with hearing loss. Purposeful sampling was used to recruit participants from three hearing centers working with these families. Interviews were analyzed using thematic analysis. Results: Analysis of the data resulted in five themes: (a) There were perceived added complexities for CALD families in accessing and being involved in services and receiving information; (b) there were perceived family–provider relationship complexities, cultural differences, and service delivery challenges in working with CALD families; (c) clinicians and managers used various strategies for service provision of CALD families; (d) involving interpreters benefited service provision but was challenging at times; and (e) looking to the future and recommendations for clinical practice. Conclusions: Current practices reflect some principles of family-centered care for CALD families of young children with hearing loss. Families and services may benefit from more support regarding family–provider partnerships, information materials and child assessments, working with interpreters, and center support for time and resources. Supplemental Material: https://doi.org/10.23641/asha.20044427

Global health pandemics (such as COVID-19) can result in rapid changes to sanctionable behaviour, impacting society and culture in a multitude of ways. This study examined how pandemic culture and accompanying moral order was produced within and through social interaction during the first and second waves of COVID-19 in Australia. The data consisted of a corpus of 29 video-recorded paediatric palliative care consultations and were analysed using conversation analysis. Analysis showed how adherence to pandemic rules became morally expected, and moral concerns about actual or potential violations to these rules became relevant in and through social interaction during this period. The COVID-19 pandemic provided a natural experiment for how accountable actions and a moral order are negotiated in and through our social interactions when our taken-for-granted ‘natural facts of life’ change in response to a global public health crisis.

This study aimed to explore the experiences of adult clients with hearing loss and their audiologists in using an online tool, the Living Well Tool (LWT), during initial audiology appointments. The LWT is designed to help clients identify when and where it is most important for them to communicate effectively and live well with hearing loss. A total of 24 adult clients with hearing loss and two audiologists participated in this study. Clients were invited to complete the LWT prior to their next audiology appointment, however, most clients chose to use the LWT in-session with their audiologist. Following the appointment, clients and audiologists participated in individual qualitative semi-structured interviews to explore their experiences of using the LWT, and the extent to which the LWT facilitated person-centred care. Qualitative analysis five key themes which reflected participants’ experiences and perceptions of using the LWT: (1) the LWT enhances audiological care; (2) the LWT supports person-centred audiological care; (3) the use of the LWT should be individualised; (4) users value comprehensiveness; and (5) users value accessibility. This study demonstrated that the LWT supported the provision of person-centred audiological care, providing a flexible, comprehensive and accessible means for audiologists to gain an understanding of their clients’ needs and preferences. However, it was also noted that the use of a tool must be individualised and accessible for all.

There is mounting evidence for implementing family-centred care (FCC) in adult audiology services, however FCC is not typically observed in adult clinical practice. This study implemented an intervention to increase family member attendance and involvement within adult audiology appointments.The study involved a mixed method design over three key phases: Standard Care, Intervention I (increasing family member attendance), and Intervention II (increasing family member involvement).Staff from four private audiology clinics within one organisation participated in the intervention. Data was collected from different clients in each phase (Family member attendance increased from 26% of appointments in Standard Care to 40% at Intervention I, and 48% at Intervention II. Family member involvement also showed improvement on some measures (video analysis) although talk time did not significantly increase. Significant improvements in client satisfaction with services were found (Net Promoter Score and Measure of Processes of Care).The implementation of FCC in audiology clinics needs to be an ongoing, whole-of-clinic approach, including staff in all roles. Increasing family member attendance at adult audiology appointments can lead to benefits to client satisfaction with services.

This review synthesized recent qualitative research evidence on language accessibility in early intervention allied health services in the context of providing family-centred care (FCC) for cultura...

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.

Objective : To examine parents’ questions to clinicians and how clinicians respond in paediatric hearing healthcare appointments with children with hearing loss. Methods : The data consisted of 48 video-recorded hearing habilitation appointments. Participants included 22 clinicians, 41 children, and 48 parents/carers. Data were analysed using conversation analysis. Results : A total of 89 questions from parents were directed to the clinicians in the appointments. Parents’ questions were mostly designed as polar (yes/no) questions. The questions covered several action and topical agendas, and in most instances functioned as something other than merely soliciting information. The most prominent action agenda of parents’ questions involved questions that displayed parental concern. These questions sought reassurance as well as information from the clinician. Conclusion : While parents in this study did not ask a large number of questions during the appointments their questions performed important functions. Parents’ questions cannot be assumed to be only about seeking information. Often parents’ questions are in pursuit of reassurance from the clinician about their child's progress. Practice Implications: Clinicians may need to provide encouragement to parents to ask questions during appointments. As part of delivering family-centred care, clinicians need to be aware that their responses may need to go beyond information provision.

Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video-recorded paediatric palliative care consultations. Detailed turn-by-turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a 'tag question', which follows some statement (e.g. 'he loves that, don't ya'). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.

AIM: Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice. METHODS: A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness. RESULTS: A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness. CONCLUSIONS: The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades.

OBJECTIVES: To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally. DESIGN: Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, "One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to…." The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to "How helpful would this idea be to you?" using a 5-point Likert scale. Hierarchical cluster analysis was applied to the "sorting" data to develop a cluster map using the Concept Systems software. The "rating" data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests. RESULTS: Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the "sorting" data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home). CONCLUSIONS: These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions.

This study describes the development of an intervention to improve family-centred care in adult audiology services.The Behaviour Change Wheel (BCW) was followed to develop the intervention. The BCW involves eight steps across three stages: (1) understanding the behaviour, (2) identifying intervention options, and (3) identifying content and implementation options.The data in Stage 1 comprised of 13 interviews with clinic staff. The research team drew on their own expertise and empirical research to complete Stages 2 and 3.A two-phase, face-to-face intervention was developed to change clinic staff' behaviours to address two problem behaviours: (1) increase family memberThe BCW provided a useful framework for developing a whole-of-clinic intervention to increase family member attendance and involvement in adult audiology appointments. Recent research in social psychology has suggested that this type of family involvement and support in healthcare is a strong predictor of well-being for adult clients and their families.

Background: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. Aim: This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. Design: Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. Setting/participants: Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children’s hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. Results: There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. Conclusions: Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.

For people with hearing impairment (HI), the need to repair hearing-related troubles within conversation is a constant concern that can significantly impact their everyday life and social relationships. This chapter examines repair sequences initiated by people with HI within two corpora, one comprising video-recorded interaction in audiology appointments, the other, audio-recorded interaction between adults with HI and a chosen familiar conversation partner. In particular, the analysis explores the person with HI’s use of meta-comments (“I can’t hear you”, “you’re mumbling”) in the repair sequences to negotiate responsibility for the hearing trouble between the speakers. The findings highlight that the person with HI has an expectation that their communication partners will adapt their talk for the HI recipient to aid the progress of the conversation.

Cognitive Behavioral Therapy (CBT), when applied to mood disorders, is designed to alleviate symptoms of depression and help clients learn more effective ways of dealing with the difficulties that contribute to their suffering. In CBT, therapists are encouraged to engage clients in a highly collaborative process in which there is joint responsibility for decision-making about therapy goals. This chapter explores sequences of interaction that involve decisions about clients’ future actions in a sample of recorded CBT sessions. In particular, the analysis compares sequences in which clients proposed their own ideas for future action with other sequences in which therapists proposed the action themselves. Clients typically resisted therapists’ proposals by indexing their superior epistemic authority in the domain of their experience, thereby invoking their ultimate right to reject the therapist’s proposed course of action. The findings highlight the complexities of implementing joint decision-making practices within therapy interactions.

Objective: This study explored staff perspectives of the barriers and facilitators to improving the implementation of family-centred care (FCC) in audiology practice. Design: Semi-structured interviews, informed by the COM-B (Capability–Opportunity–Motivation–Behaviour) model, were conducted with staff members at a private hearing care company in Australia. Study Sample: Thirteen participants were interviewed including managers, clinicians, and front-of-house staff. Results: Staff with different roles had different perspectives on barriers; however, the main barriers included: (1) insufficient knowledge regarding the principles of FCC and its benefits; (2) insufficient knowledge regarding the reasons why a family member should attend the appointment; (3) inadequate skills in how to ask for family member attendance; (4) experiencing discomfort when asking clients to bring a family member to their appointment; (5) inconsistent training and tools to support the implementation of FCC; (6) organisational culture not supporting FCC; and (7) a lack of confidence in abilities to manage conflict between clients and family members within appointments. Conclusions: The study indicated that there were numerous barriers to be overcome for staff to further implement FCC into their current practice. The interview findings will be used to develop an intervention to improve the implementation of FCC in audiology practice.

BACKGROUND: Family-centred care (FCC) is recognized as best practice in the delivery of early intervention services for children with hearing loss (HL) and their families. However, there has been little research involving direct observation of family-centred communication practices in paediatric hearing habilitation appointments, which means little is currently known about how family members are involved within appointments, and how FCC is accomplished by health professionals through their interactions with families. AIMS: To examine the interaction between hearing healthcare professionals, children with HL, and their parents within video-recorded paediatric hearing habilitation appointments (including both audiology and speech and language therapy appointments), with a particular focus on how parents were involved in the interaction. METHODS & PROCEDURES: The data for this study involved a corpus of 48 video-recorded paediatric hearing habilitation appointments from three clinical sites (including 33 audiology appointments and 15 speech pathology appointments). Participants included 14 audiologists, 8 speech and language therapists, 41 children with HL (aged 18 months and over) and 48 of their attending family members (e.g., parents/carers). The data were analyzed using conversation analysis. OUTCOMES & RESULTS: Analysis revealed one specific practice that health professionals used to engage parents in the interaction during child-directed assessment and therapy tasks: that of 'parent-directed commentaries', where health professionals shifted their attention to the parent(s) to describe or evaluate what they were observing during appointment tasks. Health professionals were observed to produce two types of parent-directed commentaries: (1) a positive evaluation of the child's just-prior response; and (2) an account for the child's prior behaviour (sometimes also accompanied by a positive evaluation). These commentaries appeared at systematic points in the interaction when the child had been displaying difficulty with their response to the health professional. The parent-directed commentaries accomplished several important functions: they engaged the parent's attention in the interaction; focused the parent's attention on positive responses from the child (while shrouding less positive responses); played down potential negative perceptions of the child's previous missed/incorrect responses; and provided parents with reassurance of their child's progress during the ongoing task. CONCLUSIONS & IMPLICATIONS: The parent-directed commentaries identified in this study provide an example of the practical, interactional resources that health professionals can draw on within paediatric appointments to facilitate FCC with parents.

Highlights - Healthdirect Australia calls are highly structured, involving 8 phases. - Helpline encounters differ in many ways to primary care consultations. - Challenges to interaction can be overcome through specialized call-taker training. - Improved helpline system design could avoid challenges and enhance call flow. Abstract Background Health helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline. Methods Data are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations. Results Through an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks. Conclusions Findings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments.

In spite of increasing gender diversity in employment roles, presumptions persist about the gender of people employed in particular occupations. Focusing on healthcare data collected in Australia and the United Kingdom within the past decade, we use conversation analysis to identify how presumptions about gender are displayed within social interaction through the use of gender-specific pronouns. We show how gender-specific pronouns are asymmetrically selected on the basis of a referent’s occupations, with gender-unspecified members of traditionally male occupations (e.g. doctors) referred to with masculine pronouns and gender-unspecified members of traditionally female occupations (e.g. nurses) referred to with feminine pronouns. We also explore ways people avoid making such presumptions. Our analysis therefore reveals a state of flux in contemporary social life, with instances in which gender presumptions persist as well as attempts to employ person references that reflect contemporary social dynamics.

Background : There are more than 1500 UK health helplines in operation, yet we have scant knowledge about the resources in place to support the seeking and delivering of cancer-related telephone help and support. This research aimed to identify and describe cancer and cancer-related helpline service provision: the number of helplines available, the variety of services provided, and the accessibility of those services. Method : This study used online national questionnaire survey sent to 95 cancer and cancer-related helplines in the United Kingdom. Results : A total of 69 (73%) of 95 surveyed cancer and cancer-related helplines completed the survey. Most helplines/organizations were registered charities, supported by donations; 73.5% of helplines had national coverage. Most helplines served all age-groups, ethnic groups, and men and women. Only 13.4% had a number that was free from landlines and most mobile networks, and 56.6% could only be contacted during working hours. More than 50% of helplines reported no provisions for callers with additional needs, and 55% had no clinical staff available to callers. Ongoing support and training for helpline staff was available but variable. Conclusion : Although cancer helplines in the United Kingdom offer reasonably broad coverage across the country, there are still potential barriers to accessibility. There are also opportunities to optimize the training of staff/volunteers across the sector. There are further prospects for helplines to enhance services and sustain appropriate and realistic quality standards.

Background : Conversational breakdowns are a persistent concern for older adults with hearing impairment (HI). Previous studies in experimental settings have investigated potential causes of breakdowns in conversations with a person with HI, and effective strategies for repairing these breakdowns. However, little research has explored the causes of hearing-related communication breakdowns, and their repairs, in extended, naturally occurring conversations in a healthcare setting. Aims : To analyse systematically instances of clients’ initiations of repair within video-recorded initial audiology appointments, and to examine the interactional environment in which they occurred. Methods & Procedures : Participants included 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 of the 63 appointments. Conversation analysis (CA) was used to examine the video-recorded audiology appointments with older adults with HI. The corpus was systematically analysed for all instances of ‘other-initiated repair’ by clients (initiation of repair targeting the prior speakers’ turn). A collection of 51 instances of other-initiated repair were identified. These instances were analysed in detail for: (1) the interactional environment in which they occurred; (2) the strategy by which the client initiated repair; and (3) the strategies used by the audiologist to repair the communication breakdown. Outcomes & Results : In 76% (n = 39) of the 51 cases of other-initiated repair from the client, there was a lack of mutual gaze between participants (i.e., either the audiologist or the client were looking away or facing in another direction during the prior turn). More specifically, many of these instances occurred when the audiologist was speaking to the client while multitasking. Audiologists used multiple-repair strategies in their responsive turn in an attempt to repair the communication breakdown efficiently. Conclusions & Implications : These findings, from extended, naturally occurring conversations with older adults with HI in clinic settings, highlight the importance of face-to-face communication even in quiet one-to-one settings. Clinicians should remain aware of their movements and gaze when speaking to clients during appointments. The findings also provide further support for the importance of communication programs in hearing rehabilitation.

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

This paper uses conversation analysis (CA) to examine client resistance in Cognitive Behavioural Therapy (CBT) sessions for clients with depression. Analysis focuses on clients’ responses to therapists’ proposals for behavioural change. Typically, clients displayed active resistance to such proposals by drawing on one of three types of ‘inability to comply’ account: (1) appeals to restrictive situational factors; (2) appeals to fixed physical states; (3) assertions of previous effort to do what the therapist was proposing. Each type of account involved clients utilising knowledge from personal experience as their reason for resisting the proposal. In formulating their accounts, clients’ turns were designed in ways that displayed their epistemic stance in relation to the situation under discussion. By indexing their superior epistemic authority in the domain of their experience, clients were able to invoke their ultimate right to reject the therapist's proposed course of action. The implications for CBT practice are discussed.

Objective: to identify call handlers’ key experiences of providing telephone help on a cancer helpline.Methods: semi‐structured qualitative interviews with 30 call handlers from three UK‐based cancer helplines. Transcribed interview data were analysed thematically.Results: thematic analysis identified three themes: (a) call handlers’ perceptions of their role on the helpline, (b) challenges of working on a helpline and (c) the need for training/keeping up with competencies. Call handlers reported satisfaction with their experience. However, there are tensions: whilst advice is formally not part of the remit of the helpline, in practice the boundary between giving advice and giving information can be blurred. No follow‐up with callers could be difficult and experienced as a lost opportunity to help. Managing patient expectations could be challenging, and interviewees described particular difficulties with distressed callers. Training for the role was commonplace, but there was sometimes a desire for more opportunities.Conclusion: there are challenges faced by helpline staff, and it can be difficult to manage callers’ distress and expectations of what they might get from a call experience. Recognising the skill and complexity of the call handler role is important, as it is meeting call handlers’ support and training needs. Support is important to minimise the risk to their own emotional well‐being.

Aims and objectives: To explore the accomplishment of physical examination on a health helpline. By focusing on the ways in which callers are asked to examine themselves and report information to nurses, we aim to provide insight into how physical examination at a distance is achieved. Background: Physical examination is a routine feature of healthcare encounters. In face-to-face settings, patients are subject to professional scrutiny through talk, touch and observation. Health professionals working on helplines face challenges in assessing signs of illness when they do not have physical access to patients. Design and Methods: Conversation analysis was used to explore sequences of interaction between nurses and callers that involved physical examination. Analysis: Analysis examined how physical examination was routinely accomplished in a helpline environment. Nurses typically guided callers in self-examination by drawing on gross categorisations that required reporting of large-scale characteristics of symptoms (e.g., whether a body part looked “normal”). Physical examination was also regularly accomplished by nurses through two-component speaking turns: a prefacing component that involved instructions about self-examination; followed by a second component that included an information-soliciting question. These practices resulted in callers successfully accomplishing physical examination, despite their lack of professional medical knowledge. Conclusions: This study identifies the communicative practices used by nurses to accomplish physical examination in helpline calls. Such practices involved asking questions that sought general, rather than specific, information and the prefacing of questions with simple instructions on how to undertake self-examination. Relevance to clinical practice: Previous research indicates that physical examination in telehealth can be challenging, particularly in environments where clinicians need patients to examine themselves. This study identifies how nurses on a helpline manage this challenge. The findings highlight ways in which nurses can recruit patients to undertake tasks that would typically be undertaken by clinicians in physically co-present consultations.

Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p

Family-centred care (FCC) is recognized as best practice in the delivery of early intervention services for children with hearing loss (HL) and their families. However, there has been little research involving direct observation of family-centred communication practices in paediatric hearing habilitation appointments, which means little is currently known about how family members are involved within appointments, and how FCC is accomplished by health professionals through their interactions with families.To examine the interaction between hearing healthcare professionals, children with HL, and their parents within video-recorded paediatric hearing habilitation appointments (including both audiology and speech and language therapy appointments), with a particular focus on how parents were involved in the interaction.The data for this study involved a corpus of 48 video-recorded paediatric hearing habilitation appointments from three clinical sites (including 33 audiology appointments and 15 speech pathology appointments). Participants included 14 audiologists, 8 speech and language therapists, 41 children with HL (aged 18 months and over) and 48 of their attending family members (e.g., parents/carers). The data were analyzed using conversation analysis.Analysis revealed one specific practice that health professionals used to engage parents in the interaction during child-directed assessment and therapy tasks: that of 'parent-directed commentaries', where health professionals shifted their attention to the parent(s) to describe or evaluate what they were observing during appointment tasks. Health professionals were observed to produce two types of parent-directed commentaries: (1) a positive evaluation of the child's just-prior response; and (2) an account for the child's prior behaviour (sometimes also accompanied by a positive evaluation). These commentaries appeared at systematic points in the interaction when the child had been displaying difficulty with their response to the health professional. The parent-directed commentaries accomplished several important functions: they engaged the parent's attention in the interaction; focused the parent's attention on positive responses from the child (while shrouding less positive responses); played down potential negative perceptions of the child's previous missed/incorrect responses; and provided parents with reassurance of their child's progress during the ongoing task.The parent-directed commentaries identified in this study provide an example of the practical, interactional resources that health professionals can draw on within paediatric appointments to facilitate FCC with parents.

Objective: Financial cost is a barrier for many older adults in their decision to obtain hearing aids (HAs). This study aimed to examine conversations about the cost of HAs in detail within initial audiology appointments. Design: Sixty-two initial audiology appointments were video-recorded. The data were analysed using conversation analysis. Study sample: Participants included 26 audiologists, 62 older adults and 17 companions. Results: Audiologists and clients displayed interactional difficulty during conversations about cost. Clients often had emotional responses to the cost of HAs, which were not attended to by audiologists. It was typical for audiologists to present one HA cost option at a time, which led to multiple rejections from clients which made the interactions difficult. Alternatively, when audiologists offered multiple cost options at once this led to a smoother interaction. Conclusions: Audiologists and clients were observed to have difficulty talking about HA costs. Offering clients multiple HA cost options at the same time can engage clients in the decision-making process and lead to a smoother interaction between audiologist and client in the management phase of appointments.

This study aimed to investigate family members' involvement in audiology rehabilitation appointments.Audiology appointments were video-recorded and analysed using quantitative coding and conversation analysis (CA).The study sample included 13 audiologists, 17 older adults with hearing impairment, and 17 family members.Initial coding showed that family members participated in 12% of the total talk time during audiology appointments. The CA results demonstrated that family members were not typically invited to join the conversation. However, family members would self-select to speak by: (1) responding to questions from the audiologist which were directed at the client; (2) self-initiating expansions on clients' turns; and (3) self-initiating questions. When family members did participate in the interaction, audiologists typically responded by shifting the conversation back to the client.While family members currently have minimal participation in audiology appointments, they display a strong interest in being involved and sharing their experiences of the client's hearing impairment. The findings suggest support for implementing family-centred care principles in audiology practice.

Hearing problems are the most common communication disability in older people. The wide-ranging impact of hearing impairment means that not only does the person with hearing impairment experience the consequences, but also his or her family members. This impact on family members is referred to as a “third-party disability” (World Health Organization, 2001). Health professionals and researchers worldwide suggest that professionals can increase effectiveness of health care if they take into account the needs of the person with hearing impairment and the needs of family members (Dunst, 2002). This article discusses the important role of family-centered care in audiologic rehabilitation for adults with hearing impairment. Strategies for increased inclusion of family members in the rehabilitation process are proposed, with concepts from the field of psychology applied to audiologic rehabilitation.

This article uses conversation analysis to examine Cognitive Behavioural Therapy (CBT) interactions with clients diagnosed with depression. The analysis explicates some routine conversational practices used by therapists in CBT to involve or co-implicate clients in the decision-making process regarding behavioural change. The article illustrates how the co-implication of clients in plans for behavioural change involves complex, therapist-guided sequences of interaction. Instances of co-implication are compared to those where therapists propose their own suggestions for change, resulting in different interactional consequences. The demonstration of therapists' use of systematic turn structures to co-implicate clients in the therapeutic process offers an interactional specification of the therapeutic relationship of collaborative empiricism that is encouraged in CBT practice and also shows how this relationship unfolds in the moment-to-moment interaction of therapy.

Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists’ proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed.

Objective Helplines are a key service used for information and support by people affected by cancer. Little is known about the process of delivering and seeking cancer related telephone help. Methods Using conversation analysis 52 calls between callers and specialist nurses on a major UK cancer helpline are analysed; focusing on the openings of helpline calls by specialist nurses. The helpline involves a triage system from a frontline call-taker to a specialist nurse. Results The triage system introduces challenges to the interactions for nurses and callers. This paper demonstrates how calls commence, and outlines implications for how they progress. Four key elements to the nurse's initial opening of the call were identified, which together contribute to managing an effective transition from the frontline call-taker to the current call with the specialist cancer nurse. Conclusion The smooth exchange of information and provision of support in a trusted call environment is a critical goal of the cancer helpline; an effective call opening in a triage environment may significantly optimise the possibility of this goal being realised. Practice implications A simple strategy is recommended to avoid the difficulties identified, a script for how the triaged call openings may be optimally formulated.

Hearing impairment is highly prevalent in the older population, and it impacts communication and quality of life for both the people with the hearing difficulties and their significant others. In this article, typical audiological assessment and management of an older adult is contrasted with a best practice approach wherein the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework is applied. The aim of the comparison is to demonstrate how the ICF expands our focus: rather than merely focusing on impairment, we also consider the activities, participation, and contextual factors for both the person with the hearing impairment and his or her family. A case example of an older patient and her spouse is provided, and their shared experience of the patient's hearing impairment is mapped onto the ICF framework. Family-centered hearing care is recommended for individualizing care and improving outcomes for older patients and their families.

The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment.Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment.The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments.Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined).The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.

Purpose The study aimed (a) to profile audiologists' language during the diagnosis and management planning phase of hearing assessment appointments and (b) to explore associations between audiologists' language and patients' decisions to obtain hearing aids. Method Sixty-two audiologist–patient dyads participated. Patient participants were aged 55 years or older. Hearing assessment appointments were audiovisually recorded and transcribed for analysis. Audiologists' language was profiled using two measures: general language complexity and use of jargon. A binomial, multivariate logistic regression analysis was conducted to investigate the associations between these language measures and hearing aid uptake. Results The logistic regression model revealed that the Flesch–Kincaid reading grade level of audiologists' language was significantly associated with hearing aid uptake. Patients were less likely to obtain hearing aids when audiologists' language was at a higher reading grade level. No associations were found between audiologists' use of jargon and hearing aid uptake. Conclusions Audiologists' use of complex language may present a barrier for patients to understand hearing rehabilitation recommendations. Reduced understanding may limit patient participation in the decision-making process and result in patients being less willing to trial hearing aids. Clear, concise language is recommended to facilitate shared decision making.

Conversational breakdowns are a persistent concern for older adults with hearing impairment (HI). Previous studies in experimental settings have investigated potential causes of breakdowns in conversations with a person with HI, and effective strategies for repairing these breakdowns. However, little research has explored the causes of hearing-related communication breakdowns, and their repairs, in extended, naturally occurring conversations in a healthcare setting.To analyse systematically instances of clients' initiations of repair within video-recorded initial audiology appointments, and to examine the interactional environment in which they occurred.Participants included 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 of the 63 appointments. Conversation analysis (CA) was used to examine the video-recorded audiology appointments with older adults with HI. The corpus was systematically analysed for all instances of 'other-initiated repair' by clients (initiation of repair targeting the prior speakers' turn). A collection of 51 instances of other-initiated repair were identified. These instances were analysed in detail for: (1) the interactional environment in which they occurred; (2) the strategy by which the client initiated repair; and (3) the strategies used by the audiologist to repair the communication breakdown.In 76% (n = 39) of the 51 cases of other-initiated repair from the client, there was a lack of mutual gaze between participants (i.e., either the audiologist or the client were looking away or facing in another direction during the prior turn). More specifically, many of these instances occurred when the audiologist was speaking to the client while multitasking. Audiologists used multiple-repair strategies in their responsive turn in an attempt to repair the communication breakdown efficiently.These findings, from extended, naturally occurring conversations with older adults with HI in clinic settings, highlight the importance of face-to-face communication even in quiet one-to-one settings. Clinicians should remain aware of their movements and gaze when speaking to clients during appointments. The findings also provide further support for the importance of communication programs in hearing rehabilitation.

Family members are significantly affected by the consequences of hearing impairment and can potentially play an important role in a client’s hearing rehabilitation. This paper uses two types of interaction analysis (Roter Interaction Analysis System (RIAS) and Conversation Analysis (CA)) to examine family member participation in a corpus of 17 video-recorded initial audiology appointments. RIAS results demonstrated that family members’ primary active communication role in consultations involved information provision. The CA findings supported this, and additionally identified that when family members provided additional information,it was often in disaffiliation with clients’ descriptions. In particular, disaffiliation arose concerning the extent of the client’s hearing difficulties and the client’s hearing rehabilitation needs. These ‘disagreements’ between clients and family members are analysed in detail, including how they were typically responded to by the audiologist. The implications of these disagreements are discussed in relation to family-centred care and effective rehabilitation in audiology.

Helplines are core feature of the contemporary U.K. health care system, however little is known about callers' experiences of seeking cancer-related telephone help. Qualitative interviews were conducted with 32 cancer helpline callers. The findings suggest cancer helplines offer callers (1) time to discuss their issues, (2) anonymity, (3) convenience, and (4) an open outlet for anyone affected by cancer including family/friends. Further, the findings highlighted that callers' help-seeking behavior was multifaceted, with their psychosocial needs being intrinsically intertwined with their information or advice-seeking needs. The implications are discussed in relation to the role of cancer helplines in the healthcare system.

Objectives: Medical and healthcare organisations— including the national cancer support and helpline organisation that is the subject of this study—are expected to collect and monitor information about the ethnicity of their client populations. Information about ethnicity is important for a variety of reasons, including monitoring need and targeting healthcare services appropriately. Previous survey and interview research has suggested that collecting ethnicity data from service users can be incomplete and of variable quality —pointing to a need for an improved understanding of the (interactional) difficulties involved when call-handlers ask callers about their ethnicity. Design: This study analyses a corpus of real-life audio-recorded calls to a national cancer helpline in the UK, focusing on the way that call-handlers collect the ethnic monitoring data. Setting: A major national cancer helpline in the UK. Participants: A sample of 273 recorded calls were recorded, of which 267 were frontline calls in which call-handlers are expected to ask the ethnicity monitoring question. Results: Findings suggest that caller uncertainty about how to answer the question, resistance to answering and call-handler presumption can compromise the effectiveness of ethnic monitoring. It is likely to be improved by changing how the ethnicity monitoring question is asked. Changes include avoiding open question formats to ease caller uncertainty; offering callers a rationale (account) for the question to minimise resistance and confirming the accuracy of the ethnic category recorded. Conclusions: We recommend that telephone-based healthcare personnel avoid asking the ethnicity monitoring question in an ‘open’ format; instead, a question containing a (short) standardised list can assist callers in responding. A training tool has been developed that applies this and other findings, with a view to improving ethnic monitoring.