Theme-oriented discourse analysis of medical encounters

Roberts, Celia; Sarangi, Srikant

doi:10.1111/j.1365-2929.2005.02171.x

Cited by 194 publications

(140 citation statements)

References 26 publications

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“…However, analyses included targets of inference beyond (larger than) those traditionally examined by conversation analysts, and findings were open to greater subjective interpretation. In this sense, our approach is in line with the interdisciplinary application of discourse analytical methodology, and comparable to the discourse work of Sarangi and Roberts [16].…”

Section: Discussionmentioning

confidence: 60%

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The role of companions in outpatient seizure clinic interactions: A pilot study

Robson

Drew

Reuber

2016

Epilepsy & Behavior

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Section: Discussionmentioning

confidence: 60%

“…The topical content of consultation history-taking phases was thematically analysed using Discourse Analysis methods according to "what gets talked about" [16].…”

Section: Discussionmentioning

confidence: 99%

The role of companions in outpatient seizure clinic interactions: A pilot study

Robson

Drew

Reuber

2016

Epilepsy & Behavior

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“…15 This involves a multi-step process of content, thematic and discourse analysis to achieve a 'thick' understanding of the text. Initially, each letter was inductively coded to allow characterisation of the structural form (content analysis) and the identification of themes (thematic analysis) common to the letters.…”

Section: Letter Analysismentioning

confidence: 99%

“…Discourse analysis can be described as 'anything beyond the sentence' 17 including the 'largely unconscious ways in which we process text and talk'. 15 We analysed doctors' use of stance 18 to investigate their degree of commitment to their statements (epistemic stance) and attitudes (affective stance) towards VUS. Stance marking relates to how people position themselves in relation to what they are communicating.…”

Section: Letter Analysismentioning

confidence: 99%

Communicating microarray results of uncertain clinical significance in consultation summary letters and implications for practice

et al. 2016

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Letter-writing is an integral practice for genetic health professionals. In Victoria, Australia, patients with a chromosomal variant of uncertain clinical significance (VUS) referred to a clinical geneticist (CG) for evaluation receive consultation summary letters. While communication of uncertainty has been explored in research to some extent, little has focused on how uncertainty is communicated within consultation letters. We aimed to develop a multi-layered understanding of the ways in which CGs communicate diagnostic uncertainty in consultation summary letters. We used theme-oriented discourse analysis of 49 consultation summary letters and thematic analysis of a focus group involving eight CGs. Results showed that CGs have become more confident in their description of VUS as 'contributing factors' to patients' clinical features, but remain hesitant to assign definitive causality. CGs displayed strong epistemic stance when discussing future technological improvements to provide hope and minimise potentially disappointing outcomes for patients and families. CGs reported feeling overwhelmed by their workload associated with increasing numbers of patients with VUS, and this has led to a reduction in the number of review appointments offered over time. This study provides a rich description of the content and process of summary letters discussing VUS. Our findings have implications for letter-writing and workforce management. Furthermore, these findings may be of relevance to VUS identified by genomic sequencing in clinical practice. European Journal of Human Genetics (2017) 25, 22-30; doi:10.1038/ejhg.2016.135; published online 16 November 2016 INTRODUCTIONChromosomal microarray (CMA) is currently recommended as a firsttier diagnostic test for children with global developmental delay, intellectual disability and autism spectrum disorder. 1 The higher resolution of CMA in detecting copy number variations (CNVs) has resulted in a 15-20% diagnostic yield compared to 3% with conventional karyotyping in this patient cohort. 1 Additionally, CMA has resulted in a greater detection of chromosomal variants of uncertain clinical significance (VUS). 2,3 Although VUS are enriched in patient cohorts, they are also identified in apparently healthy control populations, and therefore their clinical significance is uncertain.The Victorian Clinical Genetics Services (VCGS) in Melbourne, Australia began using CMAs diagnostically in 2009 and has reported approximately 37 000 CMA results, including approximately 1500 VUS at the time of this study. Two recurrent microdeletions consistently reported at the time by the VCGS laboratory as VUS involve chromosome regions 15q11.2 (containing the NIPA1 and NIPA2 genes) and 16p13.11 (containing the NDE1 gene). These microdeletions can be inherited or arise de novo. They are incompletely penetrant, and phenotypic expressivity is often highly variable even within families. 4,5 Patients in whom a VUS is detected by CMA are seen by a clinical geneticist (CG) for clinical evaluation and genetic...

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“…The advantage of discourse analysis is the way in which it helps illuminate and develop understanding of the practice of professional work as it unfolds by enabling a 'slowing down' of the activity being researched. When shared with practitioners in an accessible way, this detailed unpacking of what is going on can, we hope, provide a new lens for looking at practice and inspire new understandings of work activity (Roberts & Sarangi, 2004).…”

Section: Discourse Analysismentioning

confidence: 99%

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

Russell¹,

Greenhalgh²

2011

Evidence, Inference and Enquiry

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This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process.

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Theme-oriented discourse analysis of medical encounters

Cited by 194 publications

References 26 publications

The role of companions in outpatient seizure clinic interactions: A pilot study

The role of companions in outpatient seizure clinic interactions: A pilot study

Communicating microarray results of uncertain clinical significance in consultation summary letters and implications for practice

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

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