IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v113y2014icp120-136.html
   My bibliography  Save this article

How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis

Author

Listed:
  • Chatwin, John
  • Kennedy, Anne
  • Firth, Adam
  • Povey, Andrew
  • Rogers, Anne
  • Sanders, Caroline

Abstract

People with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; ‘direct’, ‘embedded’, and ‘oblique’. Both settings provided interactional ‘slots’ for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated ‘oblique’ formats. We suggest that the attenuation of the ‘oblique’ format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns.

Suggested Citation

  • Chatwin, John & Kennedy, Anne & Firth, Adam & Povey, Andrew & Rogers, Anne & Sanders, Caroline, 2014. "How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis," Social Science & Medicine, Elsevier, vol. 113(C), pages 120-136.
    • Handle: RePEc:eee:socmed:v:113:y:2014:i:c:p:120-136
    DOI: 10.1016/j.socscimed.2014.04.048
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795361400286X
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2014.04.048?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Bourhis, Richard Y. & Roth, Sharon & MacQueen, Glenda, 1989. "Communication in the hospital setting: A survey of medical and everyday language use amongst patients, nurses and doctors," Social Science & Medicine, Elsevier, vol. 28(4), pages 339-346, January.
    2. Heritage, John & Stivers, Tanya, 1999. "Online commentary in acute medical visits: a method of shaping patient expectations," Social Science & Medicine, Elsevier, vol. 49(11), pages 1501-1517, December.
    3. Corner, Jessica & Hopkinson, Jane & Roffe, Liz, 2006. "Experience of health changes and reasons for delay in seeking care: A UK study of the months prior to the diagnosis of lung cancer," Social Science & Medicine, Elsevier, vol. 62(6), pages 1381-1391, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Tate, Alexandra, 2020. "Invoking death: How oncologists discuss a deadly outcome," Social Science & Medicine, Elsevier, vol. 246(C).
    2. Llanwarne, Nadia & Newbould, Jennifer & Burt, Jenni & Campbell, John L. & Roland, Martin, 2017. "Wasting the doctor's time? A video-elicitation interview study with patients in primary care," Social Science & Medicine, Elsevier, vol. 176(C), pages 113-122.
    3. Gibson, Mark & Neil Jenkings, K. & Wilson, Rob & Purves, Ian, 2006. "Verbal prescribing in general practice consultations," Social Science & Medicine, Elsevier, vol. 63(6), pages 1684-1698, September.
    4. White, Anne Elizabeth Clark, 2020. "When and how do surgeons initiate noticings of additional concerns?," Social Science & Medicine, Elsevier, vol. 244(C).
    5. Maynard, Douglas W., 2006. ""Does it mean I'm gonna die?": On meaning assessment in the delivery of diagnostic news," Social Science & Medicine, Elsevier, vol. 62(8), pages 1902-1916, April.
    6. Macdonald, Sara & Conway, Elaine & Bikker, Annemieke & Browne, Susan & Robb, Kathryn & Campbell, Christine & Steele, Robert JC. & Weller, David & Macleod, Una, 2019. "Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal?," Social Science & Medicine, Elsevier, vol. 223(C), pages 31-39.
    7. Broom, Alex & Broom, Jennifer & Kirby, Emma, 2014. "Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing," Social Science & Medicine, Elsevier, vol. 110(C), pages 81-88.
    8. Andersen, Rikke Sand & Paarup, Bjarke & Vedsted, Peter & Bro, Flemming & Soendergaard, Jens, 2010. "'Containment' as an analytical framework for understanding patient delay: A qualitative study of cancer patients' symptom interpretation processes," Social Science & Medicine, Elsevier, vol. 71(2), pages 378-385, July.
    9. MacLean, Alice & Hunt, Kate & Smith, Sarah & Wyke, Sally, 2017. "Does gender matter? An analysis of men's and women's accounts of responding to symptoms of lung cancer," Social Science & Medicine, Elsevier, vol. 191(C), pages 134-142.
    10. Montenegro, Roberto E. & Dori-Hacohen, Gonen, 2020. "Morality in sugar talk: Presenting blood glucose levels in routine diabetes medical visits," Social Science & Medicine, Elsevier, vol. 253(C).
    11. Flore, Jacinthe & Kokanović, Renata & Broom, Alex & Heynemann, Sarah & Lai-Kwon, Julia & Jefford, Michael, 2023. "Entanglements and imagined futures: The subject(s) of precision in oncology," Social Science & Medicine, Elsevier, vol. 317(C).
    12. Roscigno, Cecelia I. & Savage, Teresa A. & Grant, Gerald & Philipsen, Gerry, 2013. "How healthcare provider talk with parents of children following severe traumatic brain injury is perceived in early acute care," Social Science & Medicine, Elsevier, vol. 90(C), pages 32-39.
    13. Dooley, Jemima & Barnes, Dr Rebecca, 2022. "Negotiating ‘the problem’ in GP home visits to people with dementia," Social Science & Medicine, Elsevier, vol. 298(C).
    14. Stefanie Lopriore & Amanda LeCouteur & Katie Ekberg & Stuart Ekberg, 2019. "“You'll have to be my eyes and ears”: A conversation analytic study of physical examination on a health helpline," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(1-2), pages 330-339, January.
    15. Zhang, Xi & Wei, Xin & Zhang, Te & Tan, Yahe & Xu, Dongming & Ordóñez de Pablos, Patricia, 2023. "How platform-based internet hospital innovation affects doctors’ active stress coping efforts: The conservation of resource theory perspective," Technovation, Elsevier, vol. 121(C).
    16. Vrana, Scott R. & Vrana, Dylan T. & Penner, Louis A. & Eggly, Susan & Slatcher, Richard B. & Hagiwara, Nao, 2018. "Latent Semantic Analysis: A new measure of patient-physician communication," Social Science & Medicine, Elsevier, vol. 198(C), pages 22-26.
    17. Turowetz, Jason, 2022. "Interaction order and the labeling of disorder: How parents mobilize personal knowledge in the clinic to resist medicalization of their children's behavior," Social Science & Medicine, Elsevier, vol. 294(C).
    18. Stivers, Tanya & Timmermans, Stefan, 2021. "Arriving at no: Patient pressure to prescribe antibiotics and physicians’ responses," Social Science & Medicine, Elsevier, vol. 290(C).
    19. Bridges, Susan & Drew, Paul & Zayts, Olga & McGrath, Colman & Yiu, Cynthia K.Y. & Wong, H.M. & Au, T.K.F., 2015. "Interpreter-mediated dentistry," Social Science & Medicine, Elsevier, vol. 132(C), pages 197-207.
    20. Lindström, Anna K.B. & Tängdén, Thomas, 2022. "Introducing the C-reactive protein point-of-care test: A conversation analytic study of primary care consultations for respiratory tract infection," Social Science & Medicine, Elsevier, vol. 315(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:113:y:2014:i:c:p:120-136. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.