Patient participation and learning in medical consultations about congenital heart defects

Abstract

In this article, patient activity in 8 audio recorded specialist consultations on fetal cardiology is investigated in order to explore how, why and when patients tend to participate in encounters in which the doctor dominates the interaction. The overall question is: How can the participation of patients in the consultations be connected to the development of higher levels of health literacy, i.e. to interactive literacy and to critical literacy? Patient participation is here understood as interactive action and is analyzed in terms of different interactive moves, which are related to different recurring topics. Despite the highly standardized format of the consultations, there is a large variation between the patients’ participation: between 0.7 and 2.8 moves per minute. The patients participate most during the topics ‘Prevalence’ and ‘Consultations’ and least during the topic ‘The normal heart’. Although most of the patients' moves are responses to what the doctor says, they remarkably often pose questions and use so called rejoinders. By posing questions, they take control of the information flow and sometimes even change the topics. By using rejoinders, they analyze the problems involved in the discussion e.g. by asking for clarifications or confirmation. Patients with a low over-all participation rate also use fewer moves that indicate higher literacy levels. The qualitative analysis problematizes the idea of a simple scale from basic literacy to critical literacy. Moves that indicate basic literacy skills are interactively important for the learning activity, led by the doctor. However, patients who mainly support the doctor’s initiatives don’t take the opportunity to influence the flow of information in ways that might favor their health literacy development.

“I Just Want You to Hear That Term”: Characterizing Language Used in Fetal Cardiology Consultations

“…While prior studies have assessed parental perceptions and clinician-reported practices when counseling about a prenatal CHD diagnosis [ 1 , 34 , 42 ], this study is one of the first, to our knowledge, to examine the language used in fetal cardiology consultations by analyzing audio-recordings of those encounters [ 43 ]. As clinician discourse styles may vary based on prior experiences, training, geographical region, and sociocultural factors, the generalizability of our study findings may be limited as the data analyzed was from one academic institution and limited to five fetal cardiology clinicians.…”

Flerkulturalitet i opplæring av helsefagarbeidere

“…Helsekommunikasjon handler altså om måter å kommunisere på som kan arte seg ulikt for ulike kulturer. Det kan ofte vise seg at det kan vaere betydelig avstand mellom det helsepersonell antar at pasienter forstår og det pasientene faktisk forstår (Bellander & Karlsson, 2019;Jenum & Pettersen, 2014). Horntvedt (2015) sier at enhver kultur har tause regler og normer som former og styrer våre handlinger og måter å kommunisere på, noe som kan føre til usikkerhet og misforståelse for andre.…”