Metaphors and problematic understanding in chronic care communication

Macagno, Fabrizio; Rossi, Maria Grazia

doi:10.1016/j.pragma.2019.03.010

Cited by 21 publications

(10 citation statements)

References 50 publications

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“…The findings from this study provide support for the use of metaphors as a communication tool useful in facilitating healthcare communication, especially for youth with anxiety, and reducing knowledge translation barriers. Communication in healthcare is a characterized by cross-cultural interactions (e.g., age, social class, professional background) [ 31 ] and an epistemic imbalance between the patient and the healthcare provider [ 99 ]. Culture denotes the cognitive schemata a group of people use to make sense of new information [ 100 ].…”

Section: Discussionmentioning

confidence: 99%

“…Every mental illness experience, especially anxiety [ 13 , 89 ] and depression [ 12 , 101 , 102 ], is unique to the individual and embedded in their context. For this reason, a clinician’s use of metaphor should be tailored to the patient’s context and individual characteristics (e.g., cultural values, background, illness type and stage) [ 17 , 31 , 36 ]. By attending and responding to a patient’s chosen metaphors, a clinician stands to gain a deeper understanding of the many languages of mental illness and, in particular, their patient’s language.…”

Section: Discussionmentioning

confidence: 99%

“…The contemporary theory pioneered by Lakoff and Johnson [ 26 ] elaborates on the cognitive processes used by individuals to interpret language and holds that metaphors define and reflect deeply entrenched cultural understandings [ 27 , 28 , 29 ]. Members of a “given group of people” [ 30 ] share a cultural context, a linguistic code, and backgrounds (e.g., historical, social, professional) [ 31 ] have the same collective cognitive models [ 17 ], meaning they are more likely to have a similar understanding of a metaphor. In addition, metaphor interpretation is also shaped by personal conception and experiences, considered part of our individual partial cognitive models [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Woodgate

Tennent

Legras

2021

IJERPH

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Living with anxiety can be a complex, biopsychosocial experience that is unique to each person and embedded in their contexts and lived worlds. Scales and questionnaires are necessary to quantify anxiety, yet these approaches are not always able to reflect the lived experience of psychological distress experienced by youth. Guided by hermeneutic phenomenology, our research aimed to amplify the voices of youth living with anxiety. Fifty-eight youth living with anxiety took part in in-depth, open-ended interviews and participatory arts-based methods (photovoice and ecomaps). Analysis was informed by van Manen’s method of data analysis with attention to lived space, lived body, lived time, and lived relationships, as well as the meanings of living with anxiety. Youth relied on the following metaphors to describe their experiences: A shrinking world; The heavy, heavy backpack; Play, pause, rewind, forward; and A fine balance. Overall, youth described their anxiety as a monster, contributing to feelings of fear, loss, and pain, but also hope. The findings from this study can contribute to the reduction of barriers in knowledge translation by encouraging the use of narrative and visual metaphors as a communicative tool to convey youth’s lived experience of anxiety to researchers, clinicians, and the public.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Woodgate

Tennent

Legras

2021

IJERPH

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“…Moreover, it does not differentiate nor fully address the complex relationship between recall and understanding, even if it includes rules to credit recall when the information is heavily paraphrased, attempting to catch patient ‘gist’ understanding as well as more precise recollections. There is a recently published coding scheme that would be better equipped to detect mismatch between the intended meaning of the health care provider and the understanding of the patient [36].…”

Section: Discussionmentioning

confidence: 99%

Development of a measurement system for complex oral information transfer in medical consultations

Nordfalk

Gulbrandsen

Gerwing

et al. 2019

BMC Med Res Methodol

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Background Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. Methods The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. Results Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. Conclusions A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials. Electronic supplementary material The online version of this article (10.1186/s12874-019-0788-7) contains supplementary material, which is available to authorized users.

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“…Therefore, considering key distinctions made in pragmatics and linguistics (Bazzanella and Damiano, 1999a,b;Weigand, 1999;Yus, 1999;Verdonik, 2010), it included different types of problematic understandings, grouped into three main categories based on their strength of linguistic evidence. Following the procedures described in previous studies (Macagno and Rossi, 2019;Rossi and Macagno, 2020), two researchers (MGR and JM) independently worked on the transcripts of the consultations and detected the seven different types of problematic understandings considered by the coding scheme. The two researchers met several times along the process to discuss doubts, and a third researcher (EV) was involved in case of disagreement.…”

Section: Analysis Of Problematic Understandingmentioning

confidence: 99%

Misunderstandings in ART Triadic Interactions: A Qualitative Comparison of First and Follow-Up Visits

2021

Self Cite

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BackgroundMisunderstandings in medical interactions can compromise the quality of communication and affect self-management, especially in complex interactions like those in the assisted reproductive technology (ART) field. This study aimed to detect and describe misunderstandings in ART triadic visits. We compared first and follow-up visits for frequency, type, speakers, and topics leading to misunderstandings.MethodsWe purposively sampled 20 triadic interactions from a corpus of 85 visits. We used a previously developed coding scheme to detect different types of misunderstandings (i.e., with strong, acceptable, and weak evidence). We analyzed also the different topics leading to strong misunderstandings (direct expressions of lack of understanding, pragmatic alternative understandings, semantic alternative understandings) to provide insights about the contents of the consultation that may need particular attention and care.FindingsWe detected an overall number of 1078 misunderstandings in the 20 selected visits. First visits contained almost two-third of the misunderstandings (n = 680, 63%). First visits were particularly rich in misunderstandings with acceptable evidence (e.g., clarifications and checks for understanding), compared to follow-up visits. In first visits, doctors’ turns more frequently than couples’ turns contained misunderstandings, while in follow-up visits it was the other way around. Looking at the couple, the majority of the misunderstandings were expressed by the woman (n = 241, 22%) rather than by the man (n = 194, 18%). However, when weighting for their number of turns, 9% of the men’s turns included an expression of misunderstanding, compared to the 7% of the women’s turns. Finally, more than half of the misunderstandings with strong evidence were about history-taking and treatment-related topics, and while the history-taking ones were particularly frequent in first visits the treatment-related ones were more present in follow-up visits.DiscussionFindings indicate that first visits may deserve particular attention to avoid misunderstandings, as they are the moment where a shared understanding can be harder to reach. In particular, misunderstandings happening in first visits seem mostly related to physicians having to reconstruct the clinical history of patients, while those in the follow-up visits seem to reflect residual and unsolved doubts from the couple, especially concerning treatments.

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Metaphors and problematic understanding in chronic care communication

Cited by 21 publications

References 50 publications

Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Development of a measurement system for complex oral information transfer in medical consultations

Misunderstandings in ART Triadic Interactions: A Qualitative Comparison of First and Follow-Up Visits

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