Conversation Analytic Methods Research Articles

Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study

BackgroundChoosing to have dialysis or conservative kidney management is often challenging for older people with advanced kidney disease. While we know that clinical communication has a major impact on patients’ treatment decision-making, little is known about how this occurs in practice. The OSCAR study (Optimising Staff-Patient Communication in Advanced Renal disease) aimed to identify how clinicians present kidney failure treatment options in consultations with older patients and the implications of this for patient engagement.MethodsAn observational, multi-method study design was adopted. Outpatient consultations at four UK renal units were video-recorded, and patients completed a post-consultation measure of shared decision-making (SDM-Q-9). Units were sampled according to variable rates of conservative management. Eligible patients were ≥ 65 years old with an eGFR of ≤ 20 mls/min/1.73m2 within the last 6 months. Video-recordings were screened to identify instances where clinicians presented both dialysis and conservative management. These instances were transcribed in fine-grained detail and recurrent practices identified using conversation-analytic methods, an empirical, observational approach to studying language and social interaction.Results110 outpatient consultations were recorded (105 video, 5 audio only), involving 38 clinicians (doctors and nurses) and 94 patients: mean age 77 (65–97); 61 males/33 females; mean eGFR 15 (range 4–23). There were 21 instances where clinicians presented both dialysis and conservative management. Two main practices were identified: (1) Conservative management and dialysis both presented as the main treatment options; (2) Conservative management presented as a subordinate option to dialysis. The first practice was less commonly used (6 vs. 15 cases), but associated with more opportunities in the conversation for patients to ask questions and share their perspective, through which they tended to evaluate conservative management as an option that was potentially personally relevant. This practice was also associated with significantly higher post-consultation ratings of shared decision-making among patients (SDM-Q-9 median total score 24 vs. 37, p = 0.041).ConclusionsPresenting conservative management and dialysis as on an equal footing enables patient to take a more active role in decision-making. Findings should inform clinical communication skills training and education.Clinical trial numberNo trial number as this is not a clinical trial.

Supporting cancer-related fatigue self-management: A conversation analytic study of nurse counsellor and cancer survivor consultations

PurposeCancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by people affected by cancer. A breakdown of the clinician-patient partnership and suboptimal clinician communication has been identified as a significant barrier to implementing into clinical practice effective self-management strategies for CRF. This study examined the use and impact of communication practices employed by trained cancer nurse counsellors when providing CRF self-management support to cancer survivors. MethodsInteractions from 41 telehealth consultations between three nurse counsellors and 23 cancer survivors in a CRF self-management support clinic in Queensland, Australia were recorded and analysed using conversation analysis methods. ResultsAnalysis found that in instances where nurses established the agenda of a consultation from the outset of a session (e.g., focusing on fatigue self-management support), cancer survivors displayed clearer understandings of their self-management role, the tasks, and goals of a session; and displayed less difficulty engaging in supportive care discussions. Furthermore, clinicians used formulation practices, such as summarising dialogue, to sustain focus on fatigue during consultations, and to close discussion matters not ostensibly pertinent to fatigue self-management planning supporting the goals of the CRF SMS clinic consultations. ConclusionFor supportive care sessions targeting fatigue management, clinicians should ideally focus discussion on CRF support early, by clearly introducing the agenda at the outset of the consultation while also asking for client agreement. Periodically summarising patient's talk allows clinicians to maintain a focus on matters relevant for self-management fatigue planning and provide support within the typically constrained timeframes allocated for addressing CRF.

Peer support amongst autistic children: an examination of the communication structure in small-group discussions

Purpose Over the past decade, many studies have investigated peer support between neurotypical and neurodivergent children. Less is known about how autistic children support each other in educational contexts, especially in basic education, where child-adult interactions are still predominant. This study aims to investigate whether and how autistic children supported each other in small-group discussions in the first years of basic education. This paper focused on unraveling the communication structures of these supportive events, aiming to understand further how autistic children make sense of social interactions and intersubjective processes that require peer support. Design/methodology/approach Building on conversation analysis methods, this paper analyzed the transcripts of the small-group discussions, identifying and analyzing the construction of support in children’s dialogues. Nine Finnish children (7–10 years old) attending mainstream school in Finland under intensified support in part-time special classrooms participated in this study. The study adopted a specific method called Idea Diary to frame the small-group discussions. The teacher guided the conversations, providing a dynamic structure for children’s interactions, but students were encouraged to interact among themselves. This paper recorded 11 sessions within the six-month implementation of the Idea Diary, totaling 240 min of data. Findings Results show that the children recognized situations where other children needed support in interactions and intervened in ways that promoted the continuation of the conversation and the clarification of ideas. Autistic children were sensitive to peers’ unspoken needs, capable of identifying subtle nuances of conversation dynamics and able to express support through comments and questions during the small-group discussions. Originality/value This study provides insights into the understudied phenomenon of peer support among autistic children in small-group discussions. It contributes to the growing corpus of research dedicated to exploring and revealing social competencies among autistic people. It discusses implications for developing educational practices that foster social interactions respecting the quality of autistic interactions and the interests of autistic students.

Missing Responses as an Interactional Warning Sign

In this study, we aim to find out what happens in moments of collaborative situations when a response is treated as missing, irrelevant, or insufficient, how such moments are handled, and what underlying interactional trouble those instances can reveal. The data are video recordings from multinational military observer training. Using the method of ethnomethodological conversation analysis (EMCA), we examine a team of two people taking part in a simulated patrolling exercise. We focus on instances when one team member, the driver, attempts to get the other, the team leader, to verbalise or confirm some decision regarding a future (joint) action.

Dialogues as an Involvement Strategy in Kadare’s novel "The Fall of the Stone City"

Discourse is not just a form of language use, but also a cognitive and social accomplishment within a communicative context. This article aims to interpret dialogues in Kadare’s novel The Fall of the Stone City through a combination of methods of discourse analysis and conversation analysis. The object of this analysis are the direct dialogues, in which characters are represented through their own voice, and where the narrator evades his/her own intervention during the transmission of the character’s sensory experience and does not give to the reader an indication of any sort of privileged information regarding the condition of the character. The central focus of this analysis is involvement strategies, as the basic principle in both conversational and literary discourse. The spoken genre is characterized by fragmentation and involvement, whereas the written genre is characterized by integration and detachment. The comparison of spoken and written narratives suggests that normal conversation and literary discourse have many similarities between them. The examination of the dialogues in Kadare’s novel The Fall of the Stone City clearly shows that the author combines involvement with integration in building scenes and triggering emotions. He uses familiar strategies, like repair and repetition in creating coherence and involvement, which are intentional in creating meaning.

When and how patients' self-claims are challenged in psychotherapy

Abstract The article describes the practices through which patients’ self-presentations are challenged in psychotherapy. Based on the analysis of thirty-eight instances from psychodynamic psychotherapy and psychoanalysis, analyzed with methods of conversation analysis, narrative analysis, and coding, this article reports on how therapists challenge patients’ self-conceptualizations in response to patients’ self-presentations. Challenges mostly follow patients’ descriptive, narrative, or evaluative accounts that include a strong claim about their self. Challenges to the self pertain to core issues of the therapeutic projects. They are mostly built in ways that show its sensitivity to probable rejection by the patient. Overwhelmingly, the challenge is accounted for by reference to shared knowledge built in the participants’ shared interactional history. Arguably, psychotherapy is a particular setting where the organization of face-work is modified, as occasional challenging of the co-interactant's self-presentation is part of the institutional task of the professional participant. Data are in Finnish and German. (Self, psychotherapy, Goffman, conversation analysis)*

Using a picture-based book to support epilepsy care in clinical consultations for people with intellectual disabilities

Background and aimsPeople with intellectual disabilities are more likely to have epilepsy than the general population. A picture-based book, Getting on with Epilepsy, may help to improve their epilepsy management and quality of life. The present study aimed to explore how the book could be best used in routine clinical care. MethodsTwenty people with epilepsy and intellectual disabilities were video-recorded using the Getting on with Epilepsy book with a nurse or doctor. This was analysed using conversation analytic methods. Eighteen patients and five clinicians took part in interviews to explore their views on book use, which were thematically analysed. All data were then synthesised to form themes. ResultsThree themes were identified which demonstrated the importance of (1) understanding the book depicted seizures (2) relating the book to the participants’ experiences (3) using the book as an education and information tool. The themes highlighted the techniques and approaches that clinicians used to facilitate understanding. Some tensions and differences were noted between training and implementation in routine practice, particularly around prompts in themes 1 and 3 intended to correct or change participants’ interpretation of the book. ConclusionsThe Getting on with Epilepsy book can be used in routine clinical practice to support people with intellectual disabilities and epilepsy. There was a balance between exploring patients’ narratives and understanding with the need to convey clinical information, and this may also apply to the use of other accessible resources.

Fragetypen zur Lösungsentwicklung im Business Coaching – Eine gesprächsanalytisch motivierte Untersuchung ihrer sprachlichen, frage- und interaktionstypspezifischen Charakteristika

Abstract According to coaching literature, coaches’ questions serve as a central intervention to support clients’ learning and development, i. e., solution-generation and change. To date, there is very little empirical research regarding coaching-specific questions and how they function as agents of change in this professional helping format. The few available psychological coaching outcome studies address ‘solution-focused questions’ due to its (theoretical) endemic orientation towards identifying solutions. Linguistic research, drawing on (methods of) Conversation Analysis, has only recently started to address coaching as a field of scientific inquiry. This paper builds on the scant available research and focusses on questions that support solution generation as the ‘target actions’ of question sequences. These question types are sequence-initiating actions that are intended to generate ideal solution projections and to help identify client’s resources or hindrances; they also focus on solution strategies and measures to find solutions as well as the interim results within the client’s change process. The goal of this contribution is to document and analyze the formal, functional, thematic, and semantic features of questions that generate solutions in business coaching and – on this basis of this analysis – to describe their interaction- and question-type specificities, something which has hitherto not been done. The data analysed here are 12 audio-/video-recorded and transcribed sessions from three authentic coaching processes that form part of a larger corpus of systemic solution-oriented business coaching in German.

Formulating cancer worries: How doctors establish medical expertise and authority to facilitate patients’ care choices

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of “we worry” (and at times, non-specific and second person “you”), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients' choices. In all cases patients agreed and displayed minimal resistance to doctors’ worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.

Understanding Facilitator Interventions in the Swedish Service “Taltjänst”

The Swedish Communication Facilitation Service “Taltjänst” provides support to people with communication disorders, commonly caused by neurological disabilities, and their conversation partners. This study aims to investigate interaction within ”Taltjänst”, focusing on facilitator interventions by exploring; 1) When do facilitators intervene? 2) When do the primary conversation participants manage the conversation without facilitator support? Multimodal interaction/ Conversation analytical methods were used to analyse two phone calls involving a facilitator and clients with communication disorders. One client had congenital dysarthria, while the other had acquired aphasia, allowing for comparison of the interactional challenges faced by the facilitator when addressing different disorders. The analyses revealed that; 1) facilitators are commonly invited to intervene by their client’s eye gaze, and 2) there is a routine of intervening after every non-interrupted turn of the client with dysarthria, while the intervention pattern for the client with aphasia is more varied. These findings provide insights into the work of communication facilitators, and anyone supporting phone calls involving participants with a communication disorders. Furthermore, an increased understanding of interactional practices can contribute to the development of this essential, yet underexplored service.

Clients’ first names in social work encounters: maintaining and mitigating asymmetry in institutional interaction

ABSTRACT In encounters between social workers and clients, social workers occasionally address clients by their first name, while clients more rarely use social workers’ names. In this article, we examine uses of clients’ first names in social work encounters set in public employment services. Drawing on conversation analytic findings and methods, we focus particularly on the sequential environment surrounding the use of clients’ names to discuss their role in the interaction. The article offers new contributions in two main respects: one is to the field of social work by exploring in detail how a recurrent practice such as the use of clients’ first names is involved in the production and maintenance of institutional roles and in managing power and asymmetry in the client–worker relationship. The second is that the analyses demonstrate how first name address terms are involved in performing context-specific functions in encounters between social workers and clients in a welfare-to-work setting.

Laughter in Interpersonal Communication: When Laughter Conveys Disaffiliation

Laughter serves primarily as a social instrument, functioning as a social facilitator commonly observed in interpersonal interactions, and playing a crucial role in fostering and maintaining relationships. Affiliation and disaffiliation are interactive phenomena that are externally and measurably manifested, serving as pivotal components in the establishment of social bonds. Affiliation entails the overt demonstration of endorsement and concordance among interacting individuals, whereas disaffiliation within social relationships typically materializes through assessments, leading to disagreements and side-arguments. Laughter, when serving as a tool for strengthening social bonds between individuals, it not only signals affiliation but also disaffiliation among conversational partners. Through the method of conversation analysis and interactional linguistics, this article will specifically analyze the role of laughter as a means of conveying disaffiliation. Focusing on analyzing three specific functions of laughter to show disaffiliation, which encompass self-image preservation, face-saving, and transitioning from an embarrassing to a non-embarrassing context, the thesis will present three prototypical dialogues originating from diverse backgrounds as exemplars to elucidate the three functions.

K- Part’s Choice of Tag Question at the End of the TCU

In daily conversation, there are many types of interrogative questions that can be used to confirm information. In the reporting sequence environment, it is a very dangerous behavior for K- to report to K+ or for K- to give feedback to K+. In the process of sequence development, both sides of the conversation will inevitably show their stance on the relevant events in the turn design. When K - need to make statement for the related event, from the perspective of epistemic primacy, K- Do not have the right to affirm, so K - party usually choose a tag question with optimization at the end of the turn, the purpose is that can show their own emotional tendencies and appropriately at the same time reduce the power of emotional statement. The use of such conversational conventions enables both parties to know each other’s stance while maintaining harmonious social relations. This study uses the method of conversation analysis to explore the specific sequence environment of tag questions and the social effects of tag questions.

Negotiating joint commitment in collaborative work project: Focus on text-based requests and news deliveries in atypical work

The shift to service and gig economy and increasing polymediality have created communicative contexts where the workers have to construct varying social relations in different kinds of digital and text-based interaction environments. This article examines how transprofessional collaboration is managed in such contexts in the field of applied arts. Based on email and mobile messaging data, we study a project where an artist creates an installation artwork for the use of an organisation. By applying the methods of conversation analysis, we investigate text-based requests and news delivery sequences related to applying for external project funding. Our results show how the participants negotiate the aspects of knowledge, power and emotion within these sequences, and by doing so, maintain mutual professional relationships and display various levels of commitment to the continuation of the project. The article illuminates the facets of transprofessional collaboration in digital professional communication and in atypical work.

Empathy in clinical performance examinations: Medical students’ use of empathic statements in interaction with standardized patients

This paper examines interactional functions of empathic statements in clinical performance examinations by using the method of conversation analysis. In video-recordings of 170 consultations between medical students and standardized patients (individuals trained to play the role of the patient), medical students produce empathic utterances in three sequential positions and accomplish different interactional jobs. First, medial students produce empathic statements before the initiation of history taking. They check whether patients have concerns in addition to those in problem presentation. Second, medical students construct empathic statements during history taking. They treat a particular symptom as problematic, in alignment with patients’ display of a problem. Finally, medical students produce empathic statements before the delivery of diagnosis. They portray the upcoming diagnosis as made in recognition of the troublesome nature of patients’ problems. This suggests that functions of empathic statements can vary according to the specific demands of interaction in different sequential contexts.

‘Proto-conversation’ as a practice in late-stage dementia care

Abstract This study suggests that the concept of proto-conversation may be used to describe and understand communication with people with late-stage dementia who have lost their abilities to produce verbal language. In the study, a multimodal conversation analytic method is used to analyze sequences of interactions between professional caregivers in an elderly care home and people with late-stage dementia. The study shows how minimal actions (shift of gaze directions, vocalizations or bodily movements) not instantly recognizable as intentional, communicative conduct, may be recognized and treated as communicative contributions by engaging the person living with dementia in proto-conversations. In such interactional sequences, the caregivers do not only turn the contributions of persons with dementia into actions through their responses, but they also treat the persons as agentive actors and position them as partners in interaction.

Dynamics of Telling Jokes in Plautus. The Case of the Self-Repair Routine

The study concerns one recurrent type of conversational joke in Plautus, which consists of three different steps: (1) some problematic formulation by the joke-teller, (2) a request for an explanation by the interlocutor, and (3) a punchline. Using methods of Conversation Analysis, I interpret the routine as a case of a self-repair sequence and examine responses it triggers in all the comedies by Plautus. According to the quantitative part of the study, in half of the cases, humour is not acknowledged by the in-play recipient of the joke who may understand it literally or ignore it whatsoever. In the rest of the examples the joker’s interlocutor mostly reacts negatively (with some form of verbal aggression or complaint) or continues the non-serious mode of talking by launching another joke. Ultimately, the jocular routine is associated with the figure of rebellious slave, who uses the powerful joker’s position to tease and abuse the rules of a collaborative conversation.

A conversation analytic approach to schizophrenic interaction: methodological reflections on disruptions of the common-sense world.

Certain schools of phenomenological psychiatry conceive of schizophrenia as a pathology of common-sense. Ethnomethodological enquiry, with its roots in Schutzian social phenomenology, takes as its domain, topic, and substance of study the ongoing achievement of a common-sense world between social members. Yet, dialogue between psychiatry and ethnomethodological approaches is thin. In this article, we discuss a conversation analytic approach to schizophrenic interaction which has generated and utilized a model of a five-world manifold to frame analyses of talk-in-interaction. 'Worlds' are conceived, after Schutz, as finite domains of meaning, and the model operates as a breach of natural attitude assumptions to examine mechanisms of the constitution of the one-world-in-common of common-sense. It is suggested that certain aspects of schizophrenic talk might receive account in terms of a loss of integration between these five domains of meaning. Conversation Analytic methods were applied to transcripts of audio recordings of psychiatric interviews but encountered hurdles that motivated the broadening of methodological scope. Such hurdles included a weakening of the next turn proof procedure, implicit reification of the schizophrenia construct, and problems of translation presented by the analyst's normative membership encountering non-normative life-worlds of schizophrenic experience. Strategic responses to these hurdles included exploring linkages between phenomenological psychiatry and ethnomethodological approaches, as well as an engagement of ethnomethodological self-reflection and conceptual clarification of the schizophrenia construct in line with Garfinkel's unique adequacy requirement. The manifold model is glossed, and interaction between two of its worlds - a world of concrete, situational immediacies and another of abstract organizations - is explored in more detail via analysis of conversational data. It is suggested that the five-world model, along with further micro-analysis of talk-in-interaction, might have implications in psychiatry for topics such as autism, double bookkeeping, concretism, theories of disturbed indexicality, and insight attribution. We conclude that the consideration of atypical interaction obliges the interaction analyst to take account of their own implicit normative world-frames and that the use of domain-specific top-down models in conjunction with the inductive approach of Conversation Analysis may extend the reach of CA to facilitate productive dialogue with other disciplines.

“Are you otherwise fit and well?”: Past medical history questions in UK paediatric consultations

Accurate diagnosis and treatment depend upon detailed knowledge of both the child’s presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. ObjectiveTo examine the function of the question “are you otherwise fit and well?” to elicit a child’s general medical history in UK paediatric allergy outpatient consultations. MethodsExamination of 30 video-recorded UK paediatric outpatient consultations involving children (2–10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question’s micro-design elements and their consequences for the consultation’s trajectory. ResultsAsking “Are you otherwise fit and well?” is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of “fitness” and “wellness”; negotiating opportunities for children’s participation; and importantly, a shift towards discussing more general wellbeing. ConclusionPast medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. Practice implicationsClinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question ‘Are you otherwise fit and well’ clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.

“Say, are you a little ashamed?” – Shame allocation and accountability in Israeli news interviews

In light of the growing emotionalization of public discourse, this article deals with the action of shame allocation in Israeli accountability interviews. A qualitative analysis of tokens of the Hebrew verb lehitbayesh ‘to be ashamed’ in political interviews was conducted using Discursive Psychology and Conversation Analysis methods. The findings show that in this public context the verb lehitbayesh is mostly not used to convey an emotional state, nor can its meaning be explained by the classic theoretical conceptualization of shame. Instead, lehitbayesh is mobilized to allocate shame to another actor, and portrays the allocator as morally superior and as someone who sacrifices for what is right. Lehitbayesh is part of the negotiations between journalists and politicians over the question of who is accountable for a transgressive act, what the desired response is, and who the relevant audience for the moral lesson is.