Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying

Objective: To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design: Conversation analysis of video- and audio-recorded consultations. Participants: Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting: Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results: Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce Ð then later further articulate Ð EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions: Through communicating Ð via open elaboration solicitations Ð in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue

Soliciting children’s views on other-perspectives in child mental health assessments

Child mental health assessments are complex and involve the analysis of data from multiple sources to inform treatment decisions. Question sequences are central to mental health assessments; however, little research has examined the functions of questions in child mental health interactions, particularly questions that aim to elicit information from children that might be used to inform diagnosis and treatment. In this study, we utilize a large corpus of video-recorded child mental health assessments to examine the use and function of a particular kind of wh-question—circular questions—that is, questions that seek clients’ views on other family members’ feelings, actions, and thoughts. Using conversation analysis, we identified three “broad” functions of circular questions in child mental health assessment. Our findings provide clinicians with clinically relevant examples for using circular questions to more fully involve children in the assessment process and acquire valuable information for diagnosis. © The Author(s) 2022

"It is not my intention to be a killjoy..." : objecting to a licence application : the complainers

This paper explores the constructed nature of legal complaints through the adoption of a socio-linguistic model with an emphasis upon pragmatics and elements of conversation analysis. When making a legal complaint, we posit that there is a conflict between effective communication and the uptake of politeness strategies. Furthermore, how complaints are ‘worked up’ in situ is a product of the arena in which such complaints are made. Through a textual analysis of the methods of complaining adopted by those who make representations to the licensing authority, for the purposes of objecting to a licence application, we show the tension between making oneself clear and being polite, and how complaints in different settings take different forms. We conclude by exploring the implications of our findings for legal processes—is it reasonable, for instance, to talk of ‘consistency’ in testimony if each complaint is worked up in situ—and for pragmatic theory more generally, i.e the applicability of Brown and Levinson’s politeness model for legal processes

Doing disagreement in the House of Lords: ‘Talking around the issue’ as a context-appropriate argumentative strategy

This paper is in closed access.In this article I analyze talk in a political setting to demonstrate how disagreement-relevant practices are fitted to context to accomplish a kind of argumentative strategy. I propose that in the British Parliament’s House of Lords, interlocutors deal with dilemmas of disagreement by doing something I refer to as ‘talking around the issue’, a practice involving 1) institutional positioning, 2) display of emotionality, and 3) orientation to the issue. I suggest that these practices are indicative of institutional norms, but also comprise some of the argumentative resources available to interactants in everyday argumentative practice. These practices also reflect key areas of interest in disagreement and conflict research related to context, style, and issues in conflict

Show Concessions

Making a show of conceding by using a three-part structure of proposition, concession and reassertion has the effect - in contrast to other ways of conceding - of strengthening one's own position at the expense of a counter-argument. This three-part structure can be also exploited so as to carry the battle to the enemy, as it were, and make the concession do more offensive work. We detail three such ways: Trojan Horseswhere the speaker imports a caricature of the opposition into the conceded material; stings in the tail, where the speaker specifically overturns the concession they have just made in the original claim; and cheapeners, where the speaker works pragmatically to devalue even a positive endorsement of the opposition's case. In all their variety, what marks the concession as being hearably in the speaker's own interest is the robust, normative three-part proposition - concession - reprise structure. It is available for use in supporting or demeaning any position, whether mundane or explicitly ideological

Struggle as metaphor in European Union discourses on unemployment.

This study looks at how, over a period of several years, unemployment in two genres (speeches and Presidency Conclusions) generated in organizations of the European Union (EU) is constructed both as a `problem' and a `fight' and how these formulations can be viewed as closely connected under an overarching metaphor of `struggle'. A synthesis of discourse analytic and cognitive-semantic analyses, this article begins by demonstrating how struggle is invoked and then proceeds to decompose the notion into several categories, using statistical analysis to show their distribution. Ultimately, it is demonstrated that the differences between the two genres are connected to their respective purposes and target audiences, with Presidency Conclusions examples of internal organizational discourse and commissioners' speeches as external organizational discourse. The similarities between the two genres reflect the functions of the struggle metaphor in EU discourses of unemployment in general, the ways in which its dimensions serve various legitimizing functions in these genres' capacity as political discourse, and the connection between discourses on unemployment and the prevailing EU economic philosophy