Discussing care decisions at the internal medicine outpatient clinic: A conversation analysis

Saskia Briedé*, Tessa C. van Charldorp, Karin A.H. Kaasjager

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

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
Number of pages8
JournalPatient Education and Counseling
Volume105
Issue number7
DOIs
Publication statusPublished - Jul 2022

Keywords

  • Care decisions
  • Communication training
  • Conversation analysis
  • Outpatient clinic
  • Patient education
  • Physician-patient communication
  • Treatment limitations

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