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Communicating bodily changes: Physicians' ways of enabling patient understanding in gastrointestinal cancer consultations

Published online by Cambridge University Press:  02 May 2014

Febe Friberg ,
Eva Lidén ,
Cecilia Håkanson  and
Joakim Öhlén
Febe Friberg*
Affiliation:
Department of Health Studies, University of Stavanger, Norway, and University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
Eva Lidén
Affiliation:
Institute of Health and Care Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sweden, and University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
Cecilia Håkanson
Affiliation:
Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden, and Department of Neurobiology, Care Science, and Society, Karolinska Institutet, Stockholm, Sweden
Joakim Öhlén
Affiliation:
Ersta Sköndal University College and Ersta Hospital, Stockholm, and Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, and University of Gothenburg Centre for Person-Centred Care, Sweden
*
Address correspondence and reprint requests to: Febe Friberg, Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway. E-mail: [email protected]
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Abstract

Objective:

To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations.

Method:

Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001).

Results:

Two overarching communicative strategies were identified: (1) “visualizing strategies,” with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) “contrasting strategies,” with the dimensions: contrasting subjective experiences and contrasting between the patient and other people.

Significance of results:

The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

Keywords

Bodily changesCancerCommunicationMedical consultationsPedagogical strategies
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 661 - 671
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Barnes, K.A., Barlow, C.A., Harrington, J., et al. (2011). Advance care planning discussions in advanced cancer: Analysis of dialogues between patients and care planning mediators. Palliative & Supportive Care, 9, 73–79.Google Scholar
Beaver, K., Campbell, M., Craven, O., et al. (2009). Colorectal cancer patients' attitudes towards involvement in decision making. Health Expectations, 12, 27–37.10.1111/j.1369-7625.2008.00515.xGoogle Scholar
Berger, P.L. & Luckman, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. New York: Doubleday.Google Scholar
Cersosimo, R.J. (2013). Management of advanced colorectal cancer, part 1. American Journal of Health–System Pharmacy, 70, 395–406.10.2146/ajhp110532Google Scholar
Chapman, K., Abraham, C., Jenkins, V., et al. (2003). Lay understanding of terms used in cancer consultations. Psycho-Oncology, 12, 557–566.Google Scholar
Ekman, I., Swedberg, K., Taft, C., et al. (2011). Person-centred care: Ready for prime time. European Journal of Cardiovascular Nursing, 10, 248–251.10.1016/j.ejcnurse.2011.06.008Google Scholar
Fagerlind, H., Lindblad, A.K., Bergström, I., et al. (2008). Patient–physician communication during oncology consultations. Psycho-Oncology, 17, 975–985.10.1002/pon.1410Google Scholar
Fagerlind, H., Kettis, A., Bergstrom, I., et al. (2012). Different perspectives on communication quality and emotional functioning during routine oncology consultations. Patient Education and Counseling, 88, 16–22.10.1016/j.pec.2011.12.002Google Scholar
Fallowfield, L.J., Jenkins, V.A. & Beveridge, H.A. (2002). Truth may hurt but deceit hurts more: Communication in palliative care. Palliative Medicine, 16, 297–303.10.1191/0269216302pm575oaGoogle Scholar
Fine, E., Reid, M.C., Shengelia, R., et al. (2010). Directly observed patient–physician discussions in palliative and end-of-life care: A systematic review of the literature. Journal of Palliative Medicine, 13, 595–603.10.1089/jpm.2009.0388Google Scholar
Gaston, C.M. & Mitchell, G. (2005). Information giving and decision making in patients with advanced cancer: A systematic review. Social Science & Medicine, 61, 2252–2264.Google Scholar
Heyn, L., Ruland, C.M. & Finset, A. (2012). Effects of an interactive tailored patient assessment tool on eliciting and responding to cancer patients' cues and concerns in clinical consultations with physicians and nurses. Patient Education and Counseling, 86, 158–165.10.1016/j.pec.2011.04.024Google Scholar
Jones, R.B. (2000). Developments in consumer health informatics in the next decade. Health Libraries, 17, 26–31.10.1046/j.1365-2532.2000.00257.xGoogle Scholar
Jones, R.B., Hampshire, A.J., Tweddle, S., et al. (2001). The clinician's role in meeting patient information needs: Suggested learning outcomes. Medical Education, 35, 565–571.10.1046/j.1365-2923.2001.00924.xGoogle Scholar
Kenne Sarenmalm, E., Thoren-Jonsson, A.L., Gaston-Johansson, F., et al. (2009). Making sense of living under the shadow of death: Adjusting to a recurrent breast cancer illness. Qualitative Health Research, 19, 1116–1130.Google Scholar
Liden, E., Öhlen, J., Hyden, L.C., et al. (2010). Ways of talking about illness and prognosis in palliative cancer care consultations: Two interactional frames. Supportive Care in Cancer, 18, 399–408.10.1007/s00520-009-0673-8Google Scholar
Lithner, M., Johansson, J., Andersson, E., et al. (2012). Perceived information after surgery for colorectal cancer: An explorative study. Colorectal Disease, 14, 1340–1350.Google Scholar
Main, C.J., Buchbinder, R., Porcheret, M., et al. (2010). Addressing patient beliefs and expectations in the consultation. Best Practice & Research: Clinical Rheumatology, 24, 219–225.Google Scholar
Marton, F. (1981). Phenomenography-describing conceptions of the world around us. Instructional Science, 10, 177–200.Google Scholar
Marton, F. & Booth, S. (1997). Learning and awareness. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
McCormack, B. & McCance, T.V. (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing, 56, 472–479.Google Scholar
Öhlen, J., Carling-Elofsson, L. & Hydén, L.C. (2008). Exploration of communicative patterns of consultations in palliative cancer care. European Journal of Oncology Nursing, 12, 44–52.10.1016/j.ejon.2007.07.005Google Scholar
Öhlen, J., Wallengren Gustafsson, C. & Friberg, F. (2013). Making sense of receiving palliative treatment: Its significance to palliative cancer care communication and information provision. Cancer Nursing, 36, 265–273.10.1097/NCC.0b013e31826c96d9Google Scholar
Parker, S.M., Clayton, J.M., Hancock, K., et al. (2007). A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information. Journal of Pain and Symptom Management, 34, 81–93.10.1016/j.jpainsymman.2006.09.035Google Scholar
Polanyi, M. (2009). The tacit dimension. Chicago: University of Chicago Press.Google Scholar
Potter, J. & Wetherell, M. (2001). Unfolding discourse analysis. In Discourse theory and practice. A reader. Wetherell, M. et al. (eds.), pp. 350–356. London: Sage Publications.Google Scholar
Rainbird, K., Perkins, J., Sanson-Fisher, R., et al. (2009). The needs of patients with advanced, incurable cancer. British Journal of Cancer, 101, 759–764.10.1038/sj.bjc.6605235Google Scholar
Renehan, A.G., Egger, M., Saunders, M.P., et al. (2002). Impact on survival of intensive follow up after curative resection for colorectal cancer: Systematic review and meta-analysis of randomised trials. BMJ, 324, 813.10.1136/bmj.324.7341.813Google Scholar
Rogers, M.S. & Todd, C. (2010). Can cancer patients influence the pain agenda in oncology outpatient consultations? Journal of Pain and Symptom Management, 39, 268–282.10.1016/j.jpainsymman.2009.05.024Google Scholar
Stewart, M.A. (1995). Effective physician–patient communication and health outcomes: A review. Canadian Medical Association Journal, 152, 1423–1433.Google Scholar
Taylor, C., Richardson, A. & Cowley, S. (2010). Restoring embodied control following surgical treatment for colorectal cancer: A longitudinal qualitative study. International Journal of Nursing Studies, 47, 946–956.10.1016/j.ijnurstu.2009.12.008Google Scholar
Tullis, J.A. (2012). Personhood and communication at the end of life. Journal of Medicine and the Person, 10, 103–113.Google Scholar
van de Wiej, M., van den Bossche, P., Janssen, S., et al. (2011). Exploring deliberate practice in medicine: How do physicians learn in the workplace? Advances in Health Science Education, 16, 81–95.Google Scholar
Wetherell, M., Taylor, S. & Yates, S.J. (2001). Discourse theory and practice: A reader. London: Sage Publications.Google Scholar
Yardley, S.J., Davis, C.L. & Sheldon, F. (2001). Receiving a diagnosis of lung cancer: Patients' interpretations, perceptions and perspectives. Palliative Medicine, 15, 379–386.10.1191/026921601680419429Google Scholar