Talk 1: Evidence and hedges: Uncertainty in diagnostic statements

Maria R. Dahm & Carmel Crock

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It is estimated that each year more people in Australia die from diagnostic errors than on the road. Diagnostic error encompasses a failure to establish a timely explanation for a patient’s problem and failure to communicate that explanation to the patient. If uncertain, clinicians are encouraged to indicate so and share their working diagnosis. However, little is known about how uncertainty and is communicated in diagnostic statements and how it relates to diagnostic errors, trust, and shared understanding in the encounter.

 

Preliminary results from analysis of a corpus of 16 video-recorded and transcribed role-plays showed that in interactions with an incorrect diagnosis, clinicians provided more evidence in their diagnostic statements than in interactions with correct diagnoses. This suggests that clinicians might seek to support uncertain diagnosis with evidence. Similarly, clinician providing incorrect diagnosis expressed uncertainty indirectly, (hesitations, false starts and lengthy evidence-heavy introductory phrases). Such features were less common for interactions with the correct diagnosis.

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Speaker's bio:

Dr. Mary Dahm is a Research Fellow at the Institute for Communication in Health Care (ICH) with a keen interest in communication in transition of care, diagnostic error and the communication of diagnostic uncertainty and a commitment to improve diagnosis, patient safety and quality of care through innovative consumer-driven research.

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Talk 2: Managing parental uncertainty on a paediatric palliative care telephone support line

Holly Sansone

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Background: Families of children with life-limiting prognoses are often the primary care providers. Their child’s variable condition and changing care requirements can result in a family’s uncertainty while managing certain tasks required for their child’s care.

 

Methods: Recorded routine telephone conversations between parents and clinicians of a paediatric palliative care service were analysed using Conversation Analysis.

 

Findings: When parents report uncertainty about specific care tasks, they can attribute a causal relationship between their enactment of the care task and an adverse outcome for their child. Clinicians recurrently respond to this by refuting the parent’s causal attribution, offering accounts to support their assessment, and an irrefutable statement about fundamental priorities for care. These actions project agreement from the parent as relevant, and when this occurs parents treat the clinicians’ utterances as reassuring.

 

Conclusion: Through reassurance that prioritises emotional support of families, expert paediatric palliative care clinicians demonstrate family-centred care in action.

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Speaker's Bio:

Holly Sansone is a Doctoral Candidate in the School of Psychology and Counselling at Queensland University of Technology. Her interest in palliative care has led to her current line of research of real-world communicative practices in paediatric palliative care using conversation analysis.

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Talk 3:  “What’s Going on With My Ears? ”: Some Reflections on Managing Uncertainty in the Audiology Consultation

Jennifer Watermeyer

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When patients visit an audiologist, they generally want to know one thing: is there a problem with their hearing. In response, audiologists tend to bombard patients with complex information and neglect to answer this central concern in a simple, uncomplicated manner. Patients may leave the consultation feeling confused, uncertain or concerned about their hearing and the recommended next steps. This presentation focuses on some exploratory work on communication processes in audiological consultations within a context of tuberculosis care characterized by significant uncertainty. These interactions differed substantially from other observed audiology consultations in terms of aspects such as the length of interactions, the type of information given to patients, and a substantial amount of mitigative, vague, and exaggerated language. I offer some reflections on this data using a lens of uncertainty management theory and explore factors within the broader context that may contribute to the interactional features observed.

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Speaker's Bio:

Jennifer Watermeyer is an Associate Professor in the Department of Speech Pathology, and Director of the Health Communication Research Unit (HCRU) at the University of the Witwatersrand in Johannesburg, South Africa. Jennifer’s research focuses on cross-cultural healthcare encounters, cultural understandings of illness, and healthcare interpreting practices, amongst other topics.