How to communicate with patients about future illness progression and end of life: a systematic review

Background: Conversation and discourse analytic research has yielded important evidence about skills needed for effective, sensitive communication with patients about illness progression and end of life. Objectives To: Locate and synthesise observational evidence about how people communicate about sensitive future matters; Inform practice and policy on how to provide opportunities for talk about these matters; Identify evidence gaps. Design: Systematic review of conversation/ discourse analytic studies of recorded interactions in English, using a bespoke appraisal approach and aggregative synthesis. Results: 19 publications met the inclusion criteria. We summarised findings in terms of eight practices: fishing questions - open questions seeking patients’ perspectives (5/19); indirect references to difficult topics (6/19); linking to what a patient has already said — or noticeably not said (7/19); hypothetical questions (12/19); framing difficult matters as universal or general (4/19); conveying sensitivity via means other than words, for example, hesitancy, touch (4/19); encouraging further talk using means other than words, for example, long silences (2/19); and steering talk from difficult/negative to more optimistic aspects (3/19). Conclusions: Practices vary in how strongly they encourage patients to engage in talk about matters such as illness progression and dying. Fishing questions and indirect talk make it particularly easy to avoid engaging — this may be appropriate in some circumstances. Hypothetical questions are more effective in encouraging on- topic talk, as is linking questions to patients’ cues. Shifting towards more ‘optimistic’ aspects helps maintain hope but closes off further talk about difficulties: practitioners may want to delay doing so. There are substantial gaps in evidence

Systematically reviewing and synthesizing evidence from conversation analytic and related discursive research to inform healthcare communication practice and policy: an illustrated guide

Background: Healthcare delivery is largely accomplished in and through conversations between people, and healthcare quality and effectiveness depend enormously upon the communication practices employed within these conversations. An important body of evidence about these practices has been generated by conversation analysis and related discourse analytic approaches, but there has been very little systematic reviewing of this evidence. Methods. We developed an approach to reviewing evidence from conversation analytic and related discursive research through the following procedures:.• reviewing existing systematic review methods and our own prior experience of applying these.• clarifying distinctive features of conversation analytic and related discursive work which must be taken into account when reviewing.• holding discussions within a review advisory team that included members with expertise in healthcare research, conversation analytic research, and systematic reviewing.• attempting and then refining procedures through conducting an actual review which examined evidence about how people talk about difficult future issues including illness progression and dying. Results: We produced a step-by-step guide which we describe here in terms of eight stages, and which we illustrate from our 'Review of Future Talk'. The guide incorporates both established procedures for systematic reviewing, and new techniques designed for working with conversation analytic evidence. Conclusions: The guide is designed to inform systematic reviews of conversation analytic and related discursive evidence on specific domains and topics. Whilst we designed it for reviews that aim at informing healthcare practice and policy, it is flexible and could be used for reviews with other aims, for instance those aiming to underpin research programmes and projects. We advocate systematically reviewing conversation analytic and related discursive findings using this approach in order to translate them into a form that is credible and useful to healthcare practitioners, educators and policy-makers

Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research

© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd Background: Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. Objective: To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale)

Sprache – Macht – Integration: Afrikanische Migrantinnen und die deutsche Sprache

Afrikanische Migrant*innen müssen sich aufgrund der großen kulturellen und strukturellen Unterschiede im Vergleich zu ihren Herkunftsländern in der Regel in Deutschland neu gesellschaftlich positionieren. Die vorliegende Studie zeigt exemplarisch anhand von qualitativen Interviews mit afrikanischen Migrantinnen aus West- und Zentralafrika, dass sie gesellschaftliche Anerkennung und Integration vor allem über den Erwerb der deutschen Sprache anstreben. Obwohl die Migrantinnen meist mehrsprachig sind, kann dieses kulturelle Kapital aber nur selten in Deutschland in Wert gesetzt werden. Gute Deutschkenntnisse sind daher für die interviewten Migrantinnen essentiell für eine erfolgreiche Positionierung in Alltag, Ausbildung und auf dem Arbeitsmarkt, aber auch zum Schutz vor Diskriminierung. Auf Basis der Analyse des Sprechens des französischen Soziologen Pierre Bourdieu wird gezeigt, dass Deutschlernen und -sprechen für die Migrantinnen mit erheblicher Mühe, Abwertung und Frustration verbunden sind. Dies liegt zum einen daran, dass das Sprachkönnen am Standardhochdeutschen als einzig legitim geltender Sprache gemessen wird und zum anderen, dass die Bewertung der Sprachkompetenzen häufig von negativen Statuszuschreibungen aufgrund von zugeschriebener Fremdheit sowie Vorstellungen von mangelnder fachlicher Kompetenz und Intelligenz überlagert werden. Language – Power – Integration: African Migrants and the German Language African migrants usually have to position themselves in the German society due to the cultural and structural differences with respect to their countries of origin. The present study shows exemplarily on the basis of qualitative interviews with female migrants from West and Central Africa that they pursue societal recognition and integration primarily through the German language. While most African migrants are multilingual, their language skills are often of little value in Germany. An excellent knowledge of German is therefore essential for the interviewed migrants to position themselves successfully in everyday life, vocational training and employment as well as to protect themselves from discrimination. Based on the analysis of language by the French sociologist Pierre Bourdieu, the present study shows that learning and speaking German involves a good deal of trouble, devaluation and frustration for the migrants. This is on the one hand because their language skills are compared with the only legitimate standard language, and on the other hand because the assessment of the migrants’ command of language often interferes with negative status attribution due to foreignness and notions of deficient professional expertise and intelligence

Healthcare professionals’ assertions and women's responses during labour: A conversation analytic study of data from One born every minute

© 2016 Elsevier Ireland Ltd Objective Communication during labour is consequential for women's experience yet analyses of situated labour-ward interaction are rare. This study demonstrates the value of explicating the interactional practices used to initiate ‘decisions’ during labour. Methods Interactions between 26 labouring women, their birth partners and HCPs were transcribed from the British television programme, One Born Every Minute. Conversation analysis was used to examine how decisions were initiated and accomplished in interaction. Findings HCPs initiate decision-making using interactional practices that vary the ‘optionality’ afforded labouring women in the responsive turn. Our focus here is on the minimisation of optionality through ‘assertions’. An ‘assertive’ turn-design (e.g. ‘we need to…’) conveys strong expectation of agreement. HCPs assert decisions in contexts of risk but also in contexts of routine activities. Labouring women tend to acquiesce to assertions. Conclusion The expectation of agreement set up by an assertive initiating turn can reduce women's opportunities to participate in shared decision-making (SDM). Practice implications When decisions are asserted by HCPs there is a possible dissonance between the tenets of SDM in British health policy and what occurs in situ. This highlights an educational need for HCPs in how best to afford labouring women more optionality, particularly in low-risk contexts

Water Uptake by Evaporating pMDI Aerosol Prior to Inhalation Affects Both Regional and Total Deposition in the Respiratory System

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)As pulmonary drug deposition is a function of aerosol particle size distribution, it is critical that the dynamics of particle formation and maturation in pMDI sprays in the interim between generation and inhalation are fully understood. This paper presents an approach to measure the evaporative and condensational fluxes of volatile components and water from and to solution pMDI droplets following generation using a novel technique referred to as the Single Particle Electrodynamic Lung (SPEL). In doing so, evaporating aerosol droplets are shown capable of acting as condensation nuclei for water. Indeed, we show that the rapid vaporisation of volatile components from a volatile droplet is directly correlated to the volume of water taken up by condensation. Furthermore, a significant volume of water is shown to condense on droplets of a model pMDI formulation (hydrofluoroalkane (HFA), ethanol and glycerol) during evaporative droplet ageing, displaying a dramatic shift from a core composition of a volatile species to that of predominantly water (non-volatile glycerol remained in this case). This yields a droplet with a water activity of 0.98 at the instance of inhalation. The implications of these results on regional and total pulmonary drug deposition are explored using the International Commission of Radiological Protection (ICRP) deposition model, with an integrated semi-analytical treatment of hygroscopic growth. Through this, droplets with water activity of 0.98 upon inhalation are shown to produce markedly different dose deposition profiles to those with lower water activities at the point of inspiration.Peer reviewe

Communication practices that encourage and constrain shared decision making in health-care encounters: systematic review of conversation analytic research

Background: Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters.Objective: To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM.Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics’ collections.Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion)was present and where the data and analysis focused on health/illness-related decision making.Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively.Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs’ responses to patients’ resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs’ practices may constrain or encourage this participation.Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision’s rationale)

Protocol for the implementation and evaluation of a community-based intervention seeking to reduce dietary salt intake in Lithgow, Australia

Excess dietary salt is a leading risk for health. Multiple health, government, industry and community organisations have identified the need to reduce consumption of dietary salt. This project seeks to implement and evaluate a community-based salt reduction intervention