Linguistic features of power dynamics in triadic dementia diagnostic conversations

Abstract

Objective The purpose of this study was to examine linguistic expressions of power during dementia diagnosis disclosure. Methods Videotapes of dementia diagnosis disclosure sessions were reviewed to examine linguistic features of 86 physician-patient-companion triads. Verbal dominance and pronoun use were measured as indications of power. Results Physicians dominated the conversation, speaking 83% of the total time. Patients spoke more than companions (10% versus 6%). Dementia status was only related to the amount of time companions spent talking. Physicians used fewer first person singular and more first person plural pronouns than patients and companions. Power indices did not predict anxiety, depression, or satisfaction with the medical visit. Conclusion During the disclosure of a dementia diagnosis, physicians tend to dominate the conversation, exerting their social status through a variety of linguistic features. Patients and companions are not more distressed or dissatisfied as a result and exert their own subtle attempts to assert their role in the conversation. Practice implications Recognition of a hierarchical structure within healthcare interactions may be the first step toward maximizing patient outcomes. Evaluating patient expectations and preferences regarding physician communication style may be the most effective way of promoting patient-centered healthcare communication.

A trustful relationship—the importance for relatives to actively participate in the meeting with the physician

“…In previous research, no uniform picture emerges of the role of relatives in the meeting between the elderly patient and physician. Some studies indicate that the elderly patient's role may be diminished by the relative's involvement (Greene, Majerovitz, Adelman, & Rizzo, 1994; Ho, 2008), while other studies indicate the opposite effect (Brown, Brett, Stewart, & Marshall, 1998; Glasser et al, 2001; Labrecque, Blanchard, Ruckdeschel, & Blanchard, 1991; Sakai & Carpenter, 2011; Shields et al, 2005; Wilz & Meichsner, 2012; Wolff et al, 2012). Possible explanations for this discrepancy could be that the role and effect of the relative depends on the situation, the relationship with the patient, the patient's state of health, or on the physician's demeanor toward both the elderly patient and the relative, or on the physician's willingness and ability to accommodate patients’ and families’ capabilities, needs, and preferences (Beisecker, 1989; Hesselink et al, 2012; Silliman, 2000).…”

“Let him speak:” a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment

“…Despite the importance of communication in the care of persons with cognitive impairment, older adult, family companion, and primary care clinician perspectives in this arena are not well understood. Most studies have examined the linguistic features of diagnosis disclosures in memory clinics (Sakai and Carpenter, ), verbal activity during visits by various interlocutors (Schmidt et al, ), or physician responses to hypothetical scenarios (Werner et al, ). To our knowledge, no study has specifically asked patients, families, or clinicians about the role of family companions during primary care visits of older patients with cognitive impairment.…”

Assessment meetings between care managers and persons living with dementia : Citizenship as practice

“…This has some implication for how the results can be generalized. There are different types of institutional conversations occurring between different professionals and persons with dementia, such as doctor-patient conversations (Sakai & Carpenter, 2011), and task-specific conversations between assistant nurses and care receivers (Plejert, Jansson & Yazdanpanah, 2014). As pointed out, these meetings share the institutional features of conversations (Drew & Heritage, 1992), as do the studied assessment meetings in this thesis.…”