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

As the main symptom in palliative care, pain requires careful assessment. Repeating patient answers is one recommended communication technique for helping convey to patients that they have been heard, and to encourage them to say more. We examined 23 episodes where experienced doctors repeat patients' answers with mirrored rhythm and downward-final intonation, captured in pain assessments video-recorded in 37 consultations in a large UK hospice. Using conversation analysis, our aim was to determine whether or not the repeats invite additional talk, and if so, how they do so. Our findings reveal 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 confirmation or disconfirmation. The patients in our data sometimes—but not always—respond to the repeat with confirmation or further talk. We conclude that repeating patient answers with mirrored rhythm and downward-final intonation provides a no-obligation opportunity for patient-led confirmation, disconfirmation, or expansion of pain descriptions, particularly when the pain matter is new, revised, or has been problematic to report.