Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis (2024)

Abstract

Abstract
Objective
Explore how often, when and how care decisions are discussed during consultations at an internal medicine outpatient clinic, and what we can learn from these observations.

Methods
Qualitative analysis of 150 video-taped consultations. Consultations involving a discussion of care decisions were analyzed using conversation analysis.

Results
1) Only 21 of the 150 consultations involved a discussion of care decisions; 2) As there is no destined phase for the introduction of the topic of care decisions, the topic is most often introduced at the end of the phase ‘treatment and course of the disease’; 3) A lot of interactional effort is needed to create common ground and make relevance clear with extensive justification. Hesitation markers, repairs and hypothetical talk show the precariousness of the topic.

Conclusions
Three dilemma’s need to be addressed: 1) a slot has to be created to introduce the topic of care decisions; 2) common ground has to be created, possibly over time; 3) the paradox of framing the topic as relevant ‘in the future’ but ‘needs to be discussed now’ needs to be attended to.

Practice implications
We recommend that physician training should address the three dilemmas. Future research should focus on how to do so.

Original languageEnglish
Pages (from-to)2045-2052
JournalPatient Education and Counseling
Volume105
Issue number7
Early online date1 Dec 2021
DOIs
Publication statusPublished - Jul 2022

Keywords

  • physician-patient communication
  • conversation analysis
  • care decisions
  • treatment limitations
  • outpatient clinic
  • communication training
  • patient education

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  • 1-s2.0-S073839912100776X-mainFinal published version, 1.77 MBLicence: CC BY

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    Briedé, S., Charldorp, T. C., & Kaasjager, H. A. H. (2022). Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis. Patient Education and Counseling, 105(7), 2045-2052. https://doi.org/10.1016/j.pec.2021.11.029

    Briedé, Saskia ; Charldorp, Tessa Cyrina ; Kaasjager, H.A.H. / Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis. In: Patient Education and Counseling. 2022 ; Vol. 105, No. 7. pp. 2045-2052.

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    abstract = "AbstractObjectiveExplore how often, when and how care decisions are discussed during consultations at an internal medicine outpatient clinic, and what we can learn from these observations.MethodsQualitative analysis of 150 video-taped consultations. Consultations involving a discussion of care decisions were analyzed using conversation analysis.Results1) Only 21 of the 150 consultations involved a discussion of care decisions; 2) As there is no destined phase for the introduction of the topic of care decisions, the topic is most often introduced at the end of the phase {\textquoteleft}treatment and course of the disease{\textquoteright}; 3) A lot of interactional effort is needed to create common ground and make relevance clear with extensive justification. Hesitation markers, repairs and hypothetical talk show the precariousness of the topic.ConclusionsThree dilemma{\textquoteright}s need to be addressed: 1) a slot has to be created to introduce the topic of care decisions; 2) common ground has to be created, possibly over time; 3) the paradox of framing the topic as relevant {\textquoteleft}in the future{\textquoteright} but {\textquoteleft}needs to be discussed now{\textquoteright} needs to be attended to.Practice implicationsWe recommend that physician training should address the three dilemmas. Future research should focus on how to do so.",

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    author = "Saskia Bried{\'e} and Charldorp, {Tessa Cyrina} and H.A.H. Kaasjager",

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    Briedé, S, Charldorp, TC & Kaasjager, HAH 2022, 'Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis', Patient Education and Counseling, vol. 105, no. 7, pp. 2045-2052. https://doi.org/10.1016/j.pec.2021.11.029

    Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis. / Briedé, Saskia; Charldorp, Tessa Cyrina; Kaasjager, H.A.H.
    In: Patient Education and Counseling, Vol. 105, No. 7, 07.2022, p. 2045-2052.

    Research output: Contribution to journalArticleAcademicpeer-review

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    T1 - Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis

    AU - Briedé, Saskia

    AU - Charldorp, Tessa Cyrina

    AU - Kaasjager, H.A.H.

    PY - 2022/7

    Y1 - 2022/7

    N2 - AbstractObjectiveExplore how often, when and how care decisions are discussed during consultations at an internal medicine outpatient clinic, and what we can learn from these observations.MethodsQualitative analysis of 150 video-taped consultations. Consultations involving a discussion of care decisions were analyzed using conversation analysis.Results1) Only 21 of the 150 consultations involved a discussion of care decisions; 2) As there is no destined phase for the introduction of the topic of care decisions, the topic is most often introduced at the end of the phase ‘treatment and course of the disease’; 3) A lot of interactional effort is needed to create common ground and make relevance clear with extensive justification. Hesitation markers, repairs and hypothetical talk show the precariousness of the topic.ConclusionsThree dilemma’s need to be addressed: 1) a slot has to be created to introduce the topic of care decisions; 2) common ground has to be created, possibly over time; 3) the paradox of framing the topic as relevant ‘in the future’ but ‘needs to be discussed now’ needs to be attended to.Practice implicationsWe recommend that physician training should address the three dilemmas. Future research should focus on how to do so.

    AB - AbstractObjectiveExplore how often, when and how care decisions are discussed during consultations at an internal medicine outpatient clinic, and what we can learn from these observations.MethodsQualitative analysis of 150 video-taped consultations. Consultations involving a discussion of care decisions were analyzed using conversation analysis.Results1) Only 21 of the 150 consultations involved a discussion of care decisions; 2) As there is no destined phase for the introduction of the topic of care decisions, the topic is most often introduced at the end of the phase ‘treatment and course of the disease’; 3) A lot of interactional effort is needed to create common ground and make relevance clear with extensive justification. Hesitation markers, repairs and hypothetical talk show the precariousness of the topic.ConclusionsThree dilemma’s need to be addressed: 1) a slot has to be created to introduce the topic of care decisions; 2) common ground has to be created, possibly over time; 3) the paradox of framing the topic as relevant ‘in the future’ but ‘needs to be discussed now’ needs to be attended to.Practice implicationsWe recommend that physician training should address the three dilemmas. Future research should focus on how to do so.

    KW - physician-patient communication

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    KW - treatment limitations

    KW - outpatient clinic

    KW - communication training

    KW - patient education

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    DO - 10.1016/j.pec.2021.11.029

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    SN - 0738-3991

    VL - 105

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    EP - 2052

    JO - Patient Education and Counseling

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    Briedé S, Charldorp TC, Kaasjager HAH. Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis. Patient Education and Counseling. 2022 Jul;105(7):2045-2052. Epub 2021 Dec 1. doi: 10.1016/j.pec.2021.11.029

    Discussing care decisions at the internal medicine outpatient clinic: a conversation analysis (2024)
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