RESUMEN
BACKGROUND: Breast asymmetry is a common post-operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions. OBJECTIVE: To examine clinical communication about breast symmetry in real-time consultations in a breast cancer clinic. DESIGN: Seventy-three consultations between 16 clinicians and 47 patients were video-recorded, transcribed and analysed using conversation analysis. RESULTS: In most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient. CONCLUSION: Current clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient's individual stance on breast symmetry, and optimize doctor-patient alignment.
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Neoplasias de la Mama , Instituciones de Atención Ambulatoria , Comunicación , Femenino , Humanos , Relaciones Médico-Paciente , Derivación y ConsultaRESUMEN
BACKGROUND: Cognitive behavioural treatments are recommended for people with psychosis. Core beliefs regarding the self and others are a key part of the models underpinning cognitive behavioural therapy but detailed understanding of these putative beliefs in people with psychosis are limited. A greater understanding of these mechanisms is necessary to improve and refine treatments. AIMS: This study utilized a qualitative approach to explore core schematic beliefs in psychosis (strongly held positive and negative beliefs about the self and others) and their relation to hallucinations and delusions. METHOD: Twenty individuals with psychosis participated in individual semi-structured interviews. Inductive thematic analysis was used to analyse the interviews. RESULTS: Four emergent themes were identified: (i) the solidity and permanency of core beliefs, (ii) the causes and development of core beliefs, (iii) a synergistic relationship between core beliefs and symptoms, and (iv) core beliefs associated with images and their influence on psychotic symptoms. CONCLUSIONS: This study provides new insights into the range and character of core beliefs in psychosis and provides important data to guide ongoing and future development of treatment approaches for psychosis.
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Cultura , Deluciones/diagnóstico , Deluciones/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adolescente , Adulto , Terapia Cognitivo-Conductual/métodos , Deluciones/terapia , Femenino , Alucinaciones/diagnóstico , Alucinaciones/psicología , Humanos , Imaginación , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/terapia , Investigación Cualitativa , Esquizofrenia/terapia , Adulto JovenRESUMEN
'Self-deprecation' (SD) is widely understood within social psychology and popular culture as a form of self-talk that reflects a cognitive state, such as low self-esteem or negative self-regard. However, most research on SD suffers theoretical and methodological problems that fail to account for how its cognitive and linguistic aspects can be reconciled. We know little about SD as it occurs in interactional settings. Utilizing a conversation analytic (CA) perspective that brackets cognitive explanations for linguistic phenomena, this paper draws on more than 100 hours of transcribed recordings of interactions from diverse settings to systematically examine the form and function of a common class of SD: critical comments by a speaker on their current talk or actions (self-deprecatory meta-comments; SDMCs). Analyses demonstrate that SDMCs are used in environments of possible or actual interactional trouble, and manage this trouble in different sequential positions. The paper shows that SDs can be treated as a communication practice. Rigorous analysis of SDMCs can enrich understanding of the construction of 'identities' in talk. It advances a CA understanding of the ascription of social actions, and the preference for self-criticism over criticism by others. Findings suggest that widespread advice to self-deprecate less may be invalid.
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Comunicación , Relaciones Interpersonales , Autoimagen , Conducta Social , Adulto , Humanos , Investigación Cualitativa , Autoevaluación (Psicología)RESUMEN
OBJECTIVES: Effective clinical communication is fundamental to tackling overweight and obesity. However, little is known about how weight is discussed in non-weight-specific settings where the primary purpose of the interaction concerns clinical matters apparently unrelated to weight. This study explores how mental health clinicians initiate discussions about a patient's possible weight problem in the non-weight-specific setting of a UK NHS Gender Identity Clinic (GIC), where weight is topicalized during discussions about the risks of treatment. DESIGN: A conversation analytic study. METHODS: A total of 194 recordings of routine clinician-patient consultations were collected from the GIC. Weight talk was initiated by four clinicians in 43 consultations. Twenty-one instances contained reference to a possible weight problem. Transcripts were analysed using conversation analysis. RESULTS: Clinicians used three communication practices to initiate discussion of a possible weight problem with patients: (1) announcing that patients are overweight; (2) asking patients whether they are overweight; and (3) deducing that patients are overweight or obese via a body mass index (BMI) calculation. Announcing that patients are overweight is the least aligning practice that denies patient's agency and grammatically constrains them to agree with a negative label. Asking patients whether they are overweight treats them as having limited agency and generates comparatively aligning, but occasionally resistant, responses. Jointly deducing that patients are overweight or obese via a BMI calculation is the most aligning practice, which deflects responsibility for labelling the patient onto an objective instrument. CONCLUSIONS: Small differences in the wording of turns that initiate discussions about a possible weight problem can have significant consequences for interactional alignment. Clinicians from different specialities may benefit from considering the interactional consequences of different practices for initiating discussions about weight during the kinds of real-life discussions considered here. Statement of contribution What is already known on this subject? There is a correlation between clinical communication about weight and patient weight loss. Clinicians from all specialties are encouraged to discuss diet and exercise with patients, but communication about weight remains problematic. Health psychologists have identified an urgent need for communication training to raise sensitive topics like weight without damaging the doctor-patient relationship. What does this study add? Clinicians in a non-weight-specific setting use three communication practices to introduce the possibility that a patient's weight may be a problem. These practices have varying consequences for the interaction and doctor-patient relationship. Conversation analytic findings may be useful in training clinicians how to initiate discussions about weight with patients.
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Peso Corporal , Comunicación en Salud/métodos , Sobrepeso/psicología , Sobrepeso/terapia , Relaciones Médico-Paciente , Derivación y Consulta/estadística & datos numéricos , Índice de Masa Corporal , Humanos , Reino UnidoRESUMEN
RATIONALE: Prostate cancer and its treatment have significant sexual side effects that necessitate timely patient information and open communication with healthcare professionals. However, very little is known about men's experiences of talking to clinicians about the psychosexual difficulties associated with the disease. OBJECTIVE: This study aims to advance understanding of men's perceptions of the communication and information challenges associated with the psychosexual aspects of prostate cancer and its treatment. METHOD: Between October 2013 and April 2014, semi-structured interviews were conducted with 21 men from the UK who had been treated for prostate cancer. Interview transcripts were analysed using thematic analysis. RESULTS: Three themes describe the communication challenges men face: (1) It can be too soon to talk about sex; (2) the psychology of sex is missing; (3) communication is not individually tailored. CONCLUSIONS: Clinicians might usefully (1) consider and discuss with patients how their psychosexual communication needs and information processing abilities may fluctuate across the cancer timeline; (2) initiate discussions about the consequences of treatment that extend beyond biological and mechanical aspects to include emotional and relational factors; (3) tailor communication to the dynamic mix of attributes that shape men's individual psychosexual needs, including their relationship status, sexual orientation, sexual motivations and values. Skills-based training in communication and psychosexual awareness may facilitate the proactive and permissive stance clinicians need to discuss sexual side effects with a heterogeneous group of patients.
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Comunicación , Percepción , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/terapia , Conducta Sexual/psicología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Conducta Sexual/fisiologíaRESUMEN
RATIONALE: Prostate cancer is a leading cause of cancer in men, affecting one in eight. An ageing population coupled with increased testing indicates that the incidence of early-stage prostate cancer is rising rapidly. Treatments are effective, but all can result in chronic sexual side effects and impact on the psychological, emotional and relational components of sexual functioning. Whilst the physical consequences of treatment are well documented, we lack a comprehensive picture of the effects of localised prostate cancer treatment on men's experience of sexual intimacy and how this may affect survivorship and recovery. OBJECTIVE: This study synthesises the qualitative literature related to men's experience of sexual intimacy in the context of localised prostate cancer. METHODS: A systematic search strategy identified 12 studies, which were assessed using a modified version of the Critical Appraisal Skills Programme. Using Noblit and Hare's (1988) approach, a meta-synthesis was conducted. RESULTS: Findings are organised within four inter-related themes that form the basis of a new conceptual explanatory model: (i) Loss and grief: Destroyed intimacy; (ii) Going through the motions: Artificial intimacy; (iii) Fear of failure: Avoiding intimacy and (iv) Breaking barriers: Constructing an alternative intimacy. CONCLUSION: The LMAC (Loss, Motions, Avoidance and Construction) model provides a new way of conceptualising sexual recovery following prostate cancer treatment and opportunities for health care professionals to support men and their partners.
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Miedo/psicología , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/terapia , Conducta Sexual/psicología , Disfunciones Sexuales Fisiológicas/etiología , Adaptación Psicológica , Pesar , Humanos , Masculino , Neoplasias de la Próstata/complicaciones , Disfunciones Sexuales Fisiológicas/complicaciones , Encuestas y CuestionariosRESUMEN
This article deals with the topic of social psychological research methods in practice, by examining how informed consent is gained from research participants. In most research, the consent-gaining process is hidden from analytic scrutiny and is dealt with before data collection has begun. In contrast, conversation analytic research, which records interactional encounters from beginning to end, enables examination of this methodological 'black box'. We explored how 'requests' to consent in research played out across different institutional settings. We found that participants had to 'opt-out' of a research process that was already underway. Consent-gaining sequences constrained opting out in two ways: (1) because research activity was already underway, it must be stopped affirmatively by participants; (2) consent-gaining turns were tilted in favour of continued participation, making opting out a dispreferred response. We also found a mismatch between what ethics guidelines specify about consent-gaining 'in theory' and what actually happens 'in practice'. Finally, we make suggestions about interventions in and recommendations for existing practice to best achieve informed consent.
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Comunicación , Ética en Investigación , Consentimiento Informado/ética , Psicología Social/ética , Humanos , Reino UnidoRESUMEN
Twenty-seven adult females' responses from an online qualitative questionnaire were analyzed to explore their views on being recovered from an experience of sexual assault, and identify aspects of their postassault health service encounters that facilitated or impeded their recovery process. Being recovered involved accepting the experience, being freed from negative states, regaining control and trust, and receiving help from and being believed by others. Participants predominantly reported negative experiences with health services. Factors perceived as impeding the recovery process include health professionals' inexperience in dealing with survivors of sexual assault, adhering to rape myths and stereotypes, and disrespectful or inconsiderate treatment of survivors. We argue that these postassault negative experiences revictimized survivors. Addressing these factors may reduce revictimization, facilitate recovery, and decrease assaulted women's long-term use of health services.
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Actitud del Personal de Salud , Víctimas de Crimen/psicología , Satisfacción del Paciente , Relaciones Profesional-Paciente , Sobrevivientes/psicología , Adulto , Actitud Frente a la Salud , Femenino , Humanos , Relaciones Interpersonales , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Estados Unidos , Adulto JovenRESUMEN
This article provides the first systematic examination of the ways 'talk about sex' is occasioned and managed by doctors and patients in real-life interactions in a National Health Service Gender Identity Clinic. Drawing on a corpus of 194 recordings of psychiatric assessment sessions, the article examines how parties initiate and develop talk about sex, and which strategies appear to work best for doctor-patient alignment. The analyses revealed that the most aligning methods were for clinicians to make transitions from asking questions about relationships in general to talk about sex, or to build opportunistically on patients' relationship talk. However, talk about sex that lacked specificity or which made inaccurate presumptions about patients' sex lives, generated misalignment between clinician and patient. I suggest that such misalignment is not intrinsically bad. Rather, it provides evidence for the virtues of a more nuanced understanding of patient-centred communication. The article concludes with a discussion of the importance of grounding communication skills training and clinical practice in recordings of actual consultations.
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Comunicación , Identidad de Género , Relaciones Médico-Paciente , Conducta Sexual/psicología , Educación Médica , Femenino , Humanos , Masculino , PsiquiatríaRESUMEN
OBJECTIVE: To explore transsexual patients' perceptions of communication with psychiatrists in a Gender Identity Clinic and advance understanding of patient centered communication (PCC) in psychiatric, 'gatekeeping' settings. METHODS: 21 qualitative interviews with a convenience sample of clinic patients. Interviews were coded at a semantic level and subject to an inductive thematic analysis. RESULTS: Patients' perceptions clustered into three themes: (1) aspects of communication that patients described liking; (2) aspects of communication that patients described disliking; and (3) aspects of communication that patients deemed challenging but necessary or useful. CONCLUSION: Patients described liking or disliking aspects of communication that reflect existing understandings of PCC. However, a striking feature of their accounts was how they were able to rationalize and reflect pragmatically on their negative communication experiences, welcoming doctors' challenges as an opportunity to consider their life-changing decision to transition from their natal gender. PRACTICE IMPLICATIONS: In certain clinical settings, current operationalizations of PCC may not apply. Patients' perceptions of communication may be enhanced if an analysis of their experiences formed part of the professional training of doctors, who could be invited to consider the functional specificity of communication across settings and the consequences (both immediate and post hoc) of their communication practices.