Ashley Duggan

Understanding Interpersonal Communication Processes Across Health Contexts: Advances in the Last Decade and Challenges for the Next Decade

Interpersonal communication processes are central to the provider–patient interaction and in relationships with someone who is ill or needs care. The last decade of research has documented the ways communication processes predict better outcomes in the provider–patient interaction and key constructs for consideration in close relationships in which a health issue in some way defines the relationship. The current article highlights findings from the previous decade and the ways previous findings serve as a theoretical and methodological foundation for more sophisticated analysis of interpersonal communication processes in health contexts. A relational perspective serves as a link between the provider–patient relationship and close relationships with someone with a health issue. Implications for provider–patient contexts, medical education, and close relationships highlight future directions for theory building, health literacy, health outcomes, family communication, developmental issues, and a life span perspective.

How Do I Ask About Your Disability? An Examination of Interpersonal Communication Processes Between Medical Students and Patients with Disabilities

Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints. Secondary themes related to timing and communication further contextualized the primary themes. Seventy-four percent of students asked about the disability. Analysis of feedback sessions immediately following the interactions revealed that more than half the students who did not ask about disability spontaneously recognized that they avoided disability language. Results suggest that some ways of asking about disability may inhibit patient disclosure and restrict relationship building. In particular, asking about disability, but then avoiding integrating disability disclosure into the treatment plan, or responding to disability-related disclosure with overly positive, infantilizing-type communication, may pose more difficult dilemmas than never asking about the disability. On the contrary, students who ignored disability altogether often also recognized they missed disability cues, thus providing a learning experience of considerable value. Underlying student attitudes and possibilities for integrating biomedical concerns with social–psychological impacts of disability are addressed.

One Down, Two Involved: An Application and Extension of Inconsistent Nurturing as Control Theory to Couples Including One Depressed Individual

About 10% of the US population suffers from depression (NIMH, 2000/2001) affecting both the client and his/her family members. This study applies Inconsistent Nurturing as Control Theory (Le Poire, 1994) to romantic relationships with depressed individuals (N=68 couples) and examines types and patterns of attempts to curtail depression. Results from in-depth interviews of depressed individuals and their partners suggest partners change their communication strategies over time such that they use more negative strategies before they label depression problematic, actively help and encourage depressed individuals more after the labeling, and revert to a less consistent sequence of positive and negative strategies after the initial control strategies have proven unsuccessful. Implications for health challenges in romantic relationships are discussed.

Mutual Influence Processes in Physician-Patient Communication: An Interaction Adaptation Perspective

The current study proposes that physicians and patients become more similar over the course of the interaction in their nonverbal rapport-building behaviors and talk about roles and relationships; and, conversely, that they diverge from one another in their negative nonverbal behaviors and talk about the organization and delivery of care. Physicians and patients in continued-care interactions (N = 34) were videotaped and analyzed. Results provide evidence for physicians and patients becoming more similar in smiling and head nodding; diverging in their negative eye behaviors, sentence disfluencies, and talk about barriers to wellness; and changes in both similarity and divergence in their relationship talk. Implications for relationship-centered care and dyadic analysis of physician-patient interactions are described.

Navigating Ethics of Physician-Patient Confidentiality: A Communication Privacy Management Analysis

The ethics of physician-patient confidentiality is often fraught with contradictions. Privacy boundaries are not always clear, and patients can leave an interaction with their physicians feeling uncomfortable about the security of their private medical information. The best way to meet confidentiality and privacy management expectations that patients have may not be readily apparent. Without realizing it, a physician may communicate a patients information in ways that are inconsistent with that persons perceptions of how his/her medical information should be treated. A proposed model is presented as a tool for physicians to better serve the privacy and confidentiality needs of their patients. This model depends on the communication privacy management (CPM) perspective that emerged from a 35-year research program investigating how people regulate and control information they consider private and confidential. A physicians use of this model enables the ability to establish a confidentiality pledge that can address issues in understanding the best way to communicate about privacy management with patients and more likely overcome potential negative outcomes.

Attention without intention: explicit processing and implicit goal-setting in family medicine residents’ written reflections

Abstract Background: Reflection, a process of self-analysis to promote learning through better understanding of one’s experiences, is often used to assess learners’ metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making. Aim: To identify core components of learning about medicine or medical education from family medicine residents’ written reflections. Design and setting: Family medicine residents’ wrote reflections about their experiences throughout an academic year. Method: Qualitative thematic analysis to identify core components in 767 reflections written by 33 residents. Results: We identified four themes of learning: ‘Elaborated reporting’ and ‘metacognitive monitoring’ represent explicit, purposeful self-analysis that typically would be characterised as reflective learning about medicine. ‘Simple reporting’ and ‘goal setting’ signal an analysis of experience that indicates learning and professional growth but that is overlooked as a component of learning. Conclusion: Identified themes elucidate the explicit and implicit forms of written reflection as sense-making and learning. An expanded theoretical understanding of reflection as inclusive of conscious sense-making as well as implicit discovery better enables the art of physician self-development.

Cultivating the Inner Life of a Physician Through Written Reflection

All of us have an “inner life” that forms the core of who we are. It shapes and is shaped by our actions and experiences. During physician training, attention to residents’ inner life requires a focus on their beliefs and emotions as well as their ethical and spiritual development, topics often considered to be outside the realm of clinical training and practice. We suggest that written reflections, as part of medical residency curriculum, can allow residents to explore their inner lives. The depth and range of residents’ explorations show the value of adding brief, protected time for residents to explore their hopes, joys, struggles, and feelings, and to develop meaning from their experiences with patients.

Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents’ Reflections About Communication

Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients’ illness experiences. This project examines physicians’ written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients’ lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.

A Review of: “D'Cruz, P. (2004). Family Care in HIV/AIDS: Exploring Lived Experience.”

Although health communication scholars have acknowledged the importance of talk about the subjective component of illness for more than 20 years (see, for example, Fisher & Todd, 1983; Hall, Epstein, DeCiantis, & McNeil, 1993; Stewart & Roter, 1989), the role of communication in explaining illness continues to be described (Whaley, 2000). The subjective component of illness includes a patient’s beliefs and emotions about illness and the ways that illness affects the performance of roles and responsibilities (Weston & Brown, 1989) and begins to inform the complexities of communication about illness. Health communication scholars continue to develop sophisticated research integrating theory and practice (e.g., Thompson, Dorsey, Miller, & Parrott, 2003), suggesting implications for the ways in which family relationships are defined by health and illness. In Family Care in HIV=AIDS, Premilla D’Cruz brings life voice to the subjective component of illness and illustrates how family systems are redefined through illness and caretaking. Through provocative narratives, she depicts the voice of the lifeworld, providing language to articulate the meaning of the contextual and familial experience of illness and the private meanings of the caregiver role. D’Cruz brings the realities of the human experience of caring for HIV positive individuals to life and provides stories that challenge the reader to consider explanations for the layers of change in roles and relationships during the progression of the illness. The narratives in the text give meaning and intelligibility to the experience of being either a caregiver or care receiver, and they portray how women caregivers’ lives have been made invisible and their voices silenced.