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Providing opportunities for patients to say more about their pain without overtly asking: a conversation analysis of doctors repeating patient answers in palliative care pain assessment
Background: As the main symptom in palliative care, pain requires careful assessment. Repeating patient answers is one recommended communication technique for enabling patients to feel heard, and to encourage them to say more.
Aim: To examine doctor-repeats of patient answers to determine whether or not the repeats invite additional talk, and if so, how they do so.
Method: Conversation analysis of 23 episodes where experienced doctors repeat a patient’s answer with downward-final intonation, captured in pain assessments video-recorded in 37 consultations in a large UK hospice.
Results: There are lexical and prosodic features of doctors’ repeated pain answers that signal completion of the sequence. At the same time, because the patient has greater (epistemic) access to their own pain, a repeat can also invite (dis)confirmation. The patients in our data sometimes (15/23) – but not always - respond to the repeat with confirmation or further talk.
Conclusion: Repeating patient answers with mirrored rhythm and downward-final intonation provides a no-obligation opportunity for patient-led (dis)confirmation/expansion of pain descriptions, particularly when the pain matter is new, revised, or has been problematic to accomplish.
This work was supported by a Research Development Fund grant from the University of Nottingham’s Centre for Advanced Studies; the Health Foundation [grant number RU33/GIFTS 7210]; the National Institute for Health Research Career Development Fellowship award [grant number CDF-2014-07-046]; and the National Institute for Health Research (NIHR).
- Social Sciences and Humanities
- Communication and Media