Wayne A. Beach

Between dad and son: initiating, delivering, and assimilating bad cancer news.

The opening moments of a phone call reveal how a father informs his son, for the 1st time, that his moms tumor is malignant. An extended phone opening reveals how delaying talk about the moms condition allows for important interactional work: Displaying resistance to announce the bad news directly, projecting and anticipating the valence of forthcoming news prior to its announcement, and delicately sharing ownership of a serious health condition at the outset of a family cancer journey. Enacting a biomedical demeanor, replete with technical language and withholdings of emotional and personal reactions, subsequent delivery and reception of the bad news is managed stoically-a normalized resource employed by consequential figures when managing and coping with dreaded news events. By closely examining how family members talk through cancer on the telephone, the scope of health communication research is extended beyond clinical settings into home environments, progress is made on the noticeable absence of interactional studies in psycho-oncology, and diverse implications arise for understanding how lay persons diagnose and manage illness dilemmas.

Orienting to the Phenomenon

A central concern of this chapter is to articulate relationships among researchers’ and interactants’methods for orienting to naturally occurring social activities. Basic questions are raised as central to the future course of research on social interaction. Following an overview of research commitments of conversation analysis, a discussion of “coding” is offered as a practical achievement enacted by all researchers as they orient Id interaction. A transcribed segment of courtroom interaction is offered so as to examine, in turn-by-tum detail, the nature of participants’ achieved orientations to a civil hearing. It is argued that by examining actual sequences of interaction as displays of social order, priority is given to the talk itself. This position is in contrast to accounting for the detailed work of speakers and hearers by invoking “macroconcepts” such as power, status, identity, institution, or related forces in any way “external” to the interaction.

Uncertain Family Trajectories: Interactional Consequences of Cancer Diagnosis, Treatment, and Prognosis

Analysis of a corpus of family phone calls reveals how family members routinely address uncertain issues when attempting to understand cancer diagnosis, treatment, and prognosis. A large collection of moments are overviewed and organized into three prominent social activities: biomedical reportings about anonymous medical staff; references to doctors in anticipation of explanations; and assessing the care provided by doctors and medical staff. Specific attention is drawn to how reportings include lay depictions about lack of knowledge, ambiguities associated with the passage of time, and emergent troubles with pain and medication. These instances make clear how family cancer journeys are interactionally organized events, comprised of distinct communication practices for raising and resolving illness dilemmas.

TEMPORAL DENSITY IN COURTROOM INTERACTION: CONSTRAINTS ON THE RECOVERY OF PAST EVENTS IN LEGAL DISCOURSE

Data for the present study were drawn from an ongoing investigation of a murder trial, naturalistically observed throughout a six‐month period, including pretrial hearings, and grounded in the microanalytic, turn‐by‐turn analysis of a courtroom transcript exceeding 1,000 pages. Attention is given to how courtroom interaction may be understood as a temporally organized and constrained social activity. Guided by formal legal procedures, lawyers and witnesses collaborate by time‐traveling into past times and places, through present interrogation and testimony, for future deliberation and sentencing. These temporal and spatial shifts are similar to more casual conversations, yet also unique due to the restrictions imposed on questioning and storifying practices. An examination of these comparisons leads not only to an enhanced understanding of the communicative functions and language devices used to time‐travel within the judicial system, but also reveals the inherent tensions involved as the temporally dense...

Searching for universal features of conversation

(1990). Searching for universal features of conversation. Research on Language and Social Interaction: Vol. 24, No. 1-4, pp. 351-368.

Making the Case for Airline Compassion Fares: The Serial Organization of Problem Narratives During a Family Crisis

Faced with the need to make last minute and thus unexpected travel plans to visit his dying mother, a son searches for discounted and timely airline reservations. His search for compassion fares involves a series of interactions with family members before and after calls to major airlines. We identify specific devices for delicately initiating phone openings with airline agents, making a persuasive case for urgent and affordable assistance and soliciting special understandings regarding the legitimacy of his troubling circumstances. Attention is drawn to the serial organization and cumulative impact of calls over time, one advantage of working with longitudinal data. It is shown how an initial call with the sons mom and dad forms the basis for subsequent problem narratives, the contingent enactment of narratives as progressively built for agents, and a retrospective summary to an aunt whose advice about compassion fares was misinformed. Numerous ironies are identified: unavoidable disjunctures between institutional representatives and lay persons, how the son streamlines his actions as an upshot of learning about the airline system, and ways predictions about imminent death give rise to interactional trajectories susceptible to modification and change.

Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews

New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients’ reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients’ fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.

Introduction: Diagnosing ‘lay diagnosis’

Abstract The studies herein offer previously unarticulated insights about physician–patient–family relationships. Primary attention is drawn to interactions comprising medical interviews, though conversations among family members are also addressed: i. How do patients initiate and solicit social actions during clinical encounters? ii. Outside of the clinic (e.g., in home environments), how do patients and family members deliver and update news about an illness?

Opening up gift-openings: Birthday parties as situated activity systems

Abstract We analyze the interactional organization and embodied actions of children and adults involved in gift-opening activities. Attention is drawn to gift-opening as a situated activity system, comprised of gift-opening activities occurring within shifting participation frameworks and intense focus clusters. Talk and embodied actions (the use of objects, body orientations, and the structure of the environment) are revealed as seamlessly conjoined in the midst of a routine birthday party. Attention is further drawn to an extended summons–answer sequence involving initiation of a gift-opening, enthusiastic response cries, positive assessments of the gifts, the offering and prompting of thanks, and related actions. It is revealed that children at the party are not just playing games and opening gifts, but involved in a complex social system where adults model and facilitate the construction and integration of past, present, and future relationships. Implications are raised for understanding how gift-opening activities provide opportunities for examining how language development and childhood socialization are enacted as interactional achievements.

The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play.

Basic communication research has identified a major social problem: communicating about cancer from diagnosis through death of a loved one. Over the past decade, an award-winning investigation into how family members talk through cancer on the telephone, based on a corpus of 61 phone calls over a period of 13 months, has been transformed into a theatrical production entitled The Cancer Play. All dialogue in the play is drawn from naturally occurring (transcribed) interactions between family members as they navigate their way through the trials, tribulations, hopes, and triumphs of a cancer journey. This dramatic performance explicitly acknowledges the power of the arts as an exceptional learning tool for extending empirical research, exploring ordinary family life, and exposing the often taken-for-granted conceptions of health and illness. In this study, a Phase I STTR project funded by the National Cancer Institute (NCI), we assess the feasibility of educating and impacting cancer patients, family members, and medical professionals who viewed the play as a live performance and through DVD screenings. Pre- and postperformance questionnaires were administered to solicit audience feedback. Pre–post change scores demonstrate overwhelming and positive impacts for changing opinions about the perceived importance, and attributed significance, of family communication in the midst of cancer. Paired-sample t-tests were conducted on five factor-analyzed indices/indicators—two indices of opinions about cancer and family communication, two indices measuring the importance of key communication activities, and the self-efficacy indicator—and all factors improved significantly (<.001). Informal talkback sessions were also held following the viewings, and selected audience members participated in focus groups. Talkback and focus-group sessions generated equally strong, support responses. Implications of the Phase I study are being applied in Phase II, a currently funded effort to disseminate the play nationally and to more rigorously test its impact on diverse audiences. Future directions for advancing research, education, and training across diverse academic and health care professions are discussed.