Marco Pino

Acceptability and design of video-based research on healthcare communication: Evidence and recommendations

OBJECTIVES To contribute to understandings about acceptability and risks entailed in video-based research on healthcare communication. To generate recommendations for non-covert video-based research on healthcare communication - with a focus on maximising its acceptability to participants, and managing and reducing its risks. METHODS A literature review and synthesis of (a) empirical research on participant acceptability and risks of video recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific). RESULTS 36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication: CONCLUSION AND PRACTICE IMPLICATIONS The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available.

Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying

Objective To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design Conversation analysis of video- and audio-recorded consultations. Participants Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce–then later further articulate–EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions Through communicating–via open elaboration solicitations–in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.

I-Challenges: Influencing Others’ Perspectives by Mentioning Personal Experiences in Therapeutic Community Group Meetings:

In this article, I examine the communicative practice of mentioning a personal experience as a vehicle for challenging a peer’s perspective. I study this in the context of therapeutic community (TC) group meetings for clients recovering from drug misuse. Using conversation analysis, I demonstrate that TC clients use this practice, which I call an I-challenge, to influence how their peers make sense of their own experiences and to do so without commenting on those peers’ experiences and perspectives. This study highlights the power of talking in the first person as a means of influencing others—a notion previously made popular by Thomas Gordon’s work on “I-messages.” Additionally, this study illustrates a novel way of studying social influence. Whereas previous research in social psychology has focused on the cognitive constraints behind phenomena of social influence and persuasion, here I contribute to understandings of the interactional norms underlying the organization of influence as a structured and coordinated domain of social action.

Sharing knowledge and shaping identities in healthcare interactions

This paper was accepted for publication in the journal Patient Education and Counseling and the definitive published version is available at http://dx.doi.org/10.1016/j.pec.2016.04.008

Delivering criticism through anecdotes in interaction

Criticising someone’s conduct is a disaffiliative action that can attract recipient objections, particularly in the form of defensive detailing by which the recipient volunteers extenuating circumstances that undermine the criticism. In Therapeutic Community (TC) meetings for clients with drug addiction, support staff regularly criticise clients’ behaviours that violate therapeutic principles or norms of conduct. This study examines cases where, rather than criticising a client’s behaviour directly, TC staff members do so indirectly through an anecdote: a case illustrating the inappropriateness of the type of conduct of which the client’s behaviour is an instantiation. TC staff members design the anecdote to convey a principle or norm of conduct which the client has putatively violated, and they systematically pursue endorsement of that principle by the client. By constructing the anecdote as an exemplary case, distanced from the individual client’s personal experience, TC staff members make it an empirically unverifiable, self-evident, and therefore hard to challenge, illustration of a norm.

“Oh” + Apology + Solution: A Practice for Managing the Concomitant Presence of a Possible Offense and a Problem-to-be-Solved

In this article we examine a turn construction (“oh”+apology+solution) that speakers use to deal with the concomitant presence of a possible offense and a problem-to-be-solved in the immediately preceding interactional environment. We show that speakers collaborate in differentiating the offense aspect and the problem aspect of an emerging circumstance by treating the apology component as preliminary to and in the service of the primary function of the turn: treating the circumstance as a problem-to-be-solved and providing a solution for it. The “oh” prefacing, which treats the circumstance as something of which the speaker had not been previously aware, and the turn-medial positioning of the apology contribute to treating the matter at hand as a minor shortcoming or imposition rather than a major wrongdoing.

Invoking the complainer's past transgressions: a practice for undermining complaints in therapeutic community meetings

ABSTRACT This article examines how a person who is the target of a complaint can undermine the moral entitlement of the complainer to issue that complaint. They do so by invoking the complainer’s own past transgressions. By pointing out an incongruence between the complainer’s current moral stance, as reflected in the complaint, and their status, as evidenced in their past conduct, speakers orient to an expectation of moral status/stance congruence as a basis for the validity of a complaint. My data consist of complaints and rebuttals collected from recorded group meetings within therapeutic communities for the treatment of people recovering from drug misuse. Data are in Italian with English translation.

21 Real talk – a novel evidence-based, video-based communication skills training resource.

Background Much palliative care communication training draws on sparse evidence about practice. Yet training’s effectiveness depends on the strength of its underpinning evidence. An empirical, observational science of language and social interaction – ‘Conversation Analysis’ holds great promise because: it is generating copious evidence on communication, and healthcare–communication specifically; shows role–played interactions differ from authentic ones in fundamentally important ways; recent quantitative evaluations of interventions based on conversation analytic findings have shown effectiveness. Within a research and training development programme, we designed novel training resources – ‘Real Talk’ incorporating research findings and clips from video-recorded hospice consultations. We designed Real Talk to complement rather than replace existing resources. We report a preliminary evaluation of Real Talk’s strengths and weaknesses. Method Mixed-methods, qualitative evaluation entailing observations, interviews, and participant-completed feedback questionnaires. Results We collected data from 11 events, 10 trainers across England, and 150 trainees. Conclusions Trainees and trainers alike appreciated the video clips and their authentic nature. Observations and reports indicated Real Talk was particularly effective for encouraging participants to both emotionally engage with the nature of palliative care, and actively engage in discussion and overall learning about communication practices. Trainers used the video clips more than they did the research findings components; with a similar pattern seen in most trainees’ feedback. Our decision to design Real Talk for trainers to use without initial intensive training meant we could rapidly and widely distribute the resources and evaluate their use. However, this also meant heavy reliance on trainers’ existing facilitation skills, and on their allocation of adequate time to familiarise themselves with the materials. We argue that this is also why the research findings-based components were not put to full use by trainers. We are revising Real Talk and its delivery on the basis of our evaluation.

Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff

Background: Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. Aim: To explore views of hospice patients, carers and clinical staff about whether videoing patient–doctor consultations is acceptable for research and training purposes. Design: We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark’s thematic analysis. Setting/participants: Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). Results: Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. Conclusion: Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent.

Schoolwide prevention models: lessons learned in elementary schools

In Part 3, the association between comprehension impairment and neurological damage/sensory impairment is analysed. Specifically, comprehension difficulty is studied in children with spina bifida myelomeningocele (Chapter 7) and those who have suffered paediatric traumatic brain injury (Chapter 8). Chapter 9 analyses the role of word recognition in children with hearing impairment. In the last section, common themes of educational and research implications are discussed. In my opinion, the chapter devoted to children with autism spectrum disorder (ADS) is particularly interesting. In these children, we find a ‘triad of impairment’ in language and communication – both verbal and nonverbal, in social interaction and in the behaviour that is often repetitive and associated with impaired imagination. Many of these children show no verbal language at all and a poor use of nonverbal communication. When verbal speech is present, the children often speak in a ‘strange’ way, with a loud voice, with flat or high intonation and repetitive speech. When these individuals grow up, they tend to develop a good comprehension of vocabulary and grammar, but they often continue to have difficulties comprehending discourse and extensive difficulties with pragmatic issues. Three-quarters of children with ADS have cognitive abilities below the normal range. There are several theories about language comprehension impairment in autism. For some authors, cognitive deficit is seen as the core issue, while for others it is the social aspect. Recent research suggests that for highly verbal children, intervention in syntactic aspects of language can be effective. Kate Cain and Jane Oakhill conclude their contribution by saying that the intent of their work is manifold: to offer a simple summary, to assess the theoretical implications arising from this body of work, to consider educational practices and also to find new instruments to help children with comprehension. Finally, they hope to stimulate future research about language comprehension difficulties and find a better way to remedy them.