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Communicating bodily changes: Physicians' ways of enabling patient understanding in gastrointestinal cancer consultations

Published online by Cambridge University Press:  02 May 2014

Febe Friberg ,
Eva Lidén ,
Cecilia Håkanson  and
Joakim Öhlén
Febe Friberg*
Affiliation:
Department of Health Studies, University of Stavanger, Norway, and University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
Eva Lidén
Affiliation:
Institute of Health and Care Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sweden, and University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
Cecilia Håkanson
Affiliation:
Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden, and Department of Neurobiology, Care Science, and Society, Karolinska Institutet, Stockholm, Sweden
Joakim Öhlén
Affiliation:
Ersta Sköndal University College and Ersta Hospital, Stockholm, and Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, and University of Gothenburg Centre for Person-Centred Care, Sweden
*
Address correspondence and reprint requests to: Febe Friberg, Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway. E-mail: [email protected]
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Abstract

Objective:

To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations.

Method:

Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001).

Results:

Two overarching communicative strategies were identified: (1) “visualizing strategies,” with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) “contrasting strategies,” with the dimensions: contrasting subjective experiences and contrasting between the patient and other people.

Significance of results:

The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

Keywords

Bodily changesCancerCommunicationMedical consultationsPedagogical strategies
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 661 - 671
Copyright
Copyright © Cambridge University Press 2014 

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