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How companions speak on patients’ behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations

journal contribution
posted on 23.12.2021, 13:39 by Marco PinoMarco Pino, Victoria Land
Companions are individuals who support patients and attend healthcare appointments with them. Several studies characterised companions’ participation in broad terms, glossing over the details of how they time and design their actions, and how patients and healthcare practitioners (HCPs) respond to them. This paper aims to examine these aspects in detail by using conversation analysis, focusing on actions whereby companions speak on patients’ behalf—mentioning delicate aspects of patients’ experience (specifically, by alluding to patients’ thoughts or feelings about dying). Some studies suggest that these actions undermine patients’ autonomy. By contrast, through examination of palliative care consultations in a UK hospice, we found that these interventions are warranted by contextual circumstances: they are either invited by patients or HCPs (through questions or gaze) or volunteered to help with the progression of an activity (e.g., when a patient does not answer an HCP’s question). Additionally, all parties collaborate in constructing these companion interventions as temporary departures from an otherwise prevailing normative orientation to patients’ right to speak for themselves. The study contributes to the sociology of health an illness by characterising how companions contribute to the ways in participant coordinate their relative rights and responsibilities, and ultimately their relationships, within healthcare interactions.


The Health Foundation [Grant IDs: AIMS 1273316, AIMS 1273743 / GIFTS 7210]

National Institute for Health Research Academy Career Development Fellowship to project lead Ruth Parry: “Enhancing staff-patient communication in palliative and end of life care” (Grant ID CDF-2014-07-046)



  • Social Sciences and Humanities


  • Communication and Media

Published in

Sociology of Health and Illness




AM (Accepted Manuscript)

Publisher statement

This is the peer reviewed version of the following article: Pino, M. and Land, V., (2022). How companions speak on patients’ behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations. Sociology of Health and Illness, In Press, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

Acceptance date









Dr Marco Pino. Deposit date: 21 December 2021