Ellen Barton

Discourse Methods and Critical Practice in Professional Communication The Front-Stage and Back-Stage Discourse of Prognosis in Medicine

A set of discourse-based methods—genre theory, genre analysis, and discourse analysis—can provide a descriptive basis for a critical analysis of the multiple connections between discourse practices and their underlying concepts and categories within professions. To illustrate this theoretical and methodological project, this article analyzes prognosis in the discourse of medicine. Using Goffman’s (1959) distinction between front-stage and back-stage discourse, the author suggests that a back-stage discourse of prognosis points to problems with prognosis in the front-stage discourse of medical encounters between oncologists and patients who have been diagnosed with cancer. The analysis shows that the oral genre of treatment discussion in oncology encounters is organized to allow practitioners to do, appear to do, or avoid doing difficult work like presenting a prognosis. The article suggests that discourse-based methods have the potential to become the basis for productive critical engagement between practitioners and researchers in professional communication.

Design in Observational Research on the Discourse of Medicine: Toward Disciplined Interdisciplinarity:

This article turns to the concept of interdisciplinarity as a framework for the design and development of observational studies investigating the discourse of medicine in language-based fields such as linguistics, rhetoric, composition, and professional communication. It argues that observational studies be designed as disciplined interdisciplinary studies, defined as research that makes an acknowledged contribution to both medicine and language studies. It proposes two guiding principles for the design of observational studies in medicine, both of which focus on issues of prospective design.

A disparity of words: racial differences in oncologist-patient communication about clinical trials.

African Americans are consistently underrepresented in cancer clinical trials. Minority under‐enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients.

Establishing Terminal Status in End-of-Life Discussions

The communicative purpose of an end-of-life discussion is to change the goals of treatment for a terminal patient from therapeutic to comfort care. In this study, the authors present a comparative discourse analysis of end-of-life discussions that reached a consensus to change the goals of treatment and discussions that did not. They found that the presentation of medical information was subtly different across these discussions: Decision-making discussions were based on a consistent accumulation of negative evidence, whereas non—decision-making discussions were inconsistent in this respect, including mention of positive rather than negative outcomes of medical problems, discussion of possible treatment options, and mitigating summary statements. The authors note that end-of-life discussions with these specific features do not progress to a decision to change the goals of treatment to comfort care.

Ethical or Unethical Persuasion? The Rhetoric of Offers to Participate in Clinical Trials

Based on a sample of 22 oncology encounters, this article presents a discourse analysis of positive, neutral, or negative valence in the presentation of three elements of informed consent—purpose, benefits, and risks—in offers to participate in clinical trials. It is found that physicians regularly present these key elements of consent with a positive valence, perhaps blurring the distinction between clinical care and clinical research in trial offers. The authors argue that the rhetoric of trial offers constructs and reflects the complex relationships of two competing ethical frameworks—contemporary bioethics and professional medical ethics—both aimed at governing the discourse of trial offers. The authors consider the status of ethical or unethical persuasion within each framework, proposing what is called the best-option principle as the ethical principle governing trial offers within professional medical ethics.

Interactional Sequences in Shared Book-Reading between Parents and Children with Histories of Language Delay

In this article, we argue against deficit models of early literacy common in the field of speech pathology, proposing instead a competence-based view of early literacy as the concurrent development of language practices develop through social interaction. We look specifically at shared book-reading, developing a discourse analysis of case study data that show how parents do considerable interactional work to position their children with language delays as competent and active co-constructors of meaning in this important early literacy activity.

Researching Telemedicine: Capturing Complex Clinical Interactions with a Simple Interface Design

Telemedicine has been shown to be an effective means of managing follow-up care in chronic diseases such as depression. Exactly why telemedicine calls work, however, remains largely unknown because there are no adequate research tools to describe the complex communicative interactions in these encounters. We report here an ongoing project to investigate the efficacy of telemedicine in depression care, arguing that technical communication specialists have unique contributions to make to this kind of research.

Introduction to the Special Issue The Discourses of Medicine

In the call for papers for this special issue of JBTC, I began with two observations. First, I noted that medicine is a powerful scientific and social institution with a complicated context of history and development, expertise and professionalism, education and training, and communication and practice in a wide variety of settings. Second, I noted that the research literature of medicine is vast, even in the area of medical communication, with work in a wide variety of fields, including history, sociology, anthropology, linguistics, literature, communication studies, and behavioral science. Given this literature, I asked authors for this special issue to answer a series of questions:

A Case of Multiple Professionalisms Service Learning and Control of Communication about Organ Donation

This article offers a retrospective case study of a service learning project in a technical writing class. For this project, students were asked to develop a communication tool with information about consent rates in organ donation to use in an academic medical center. In contrast to the service learning literature, which notes that students often resist the professionalizing move that service learning offers, this study shows that students in this project actually overprofessionalized, constituting themselves as one more party vying for control over the communication of organ donation. This embrace of professionalism via service learning raises as many issues as the resistance to professionalism that is more commonly documented.

Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials

BackgroundCancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients’ decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial.Methods/designData collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients’ understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes.DiscussionPACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers.Trial registrationClinical Trials.gov registration number: NCT02906241 (September 8, 2016).