Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations.
OBJECTIVE
To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations.


METHODS
Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001).


RESULTS
Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people.


CONCLUSIONS
The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.
Department of Health Studies,University of Stavanger,Norway,and University of Gothenburg Centre for Person-Centred Care,Gothenburg,Sweden.
Febe
F
Friberg
Institute of Health and Care Sciences,the Sahlgrenska Academy at the University of Gothenburg,Sweden,and University of Gothenburg Centre for Person-Centred Care,Gothenburg,Sweden.
Eva
E
Lidén
Ersta Sköndal University College and Ersta Hospital,Stockholm,Sweden,and Department of Neurobiology,Care Science,and Society,Karolinska Institutet,Stockholm,Sweden.
Cecilia
C
Håkanson
Ersta Sköndal University College and Ersta Hospital,Stockholm,and Institute of Health and Care Sciences,the Sahlgrenska Academy,University of Gothenburg, and University of Gothenburg Centre for Person-Centred Care,Sweden.
Joakim
J
Öhlén
D003142:Communication; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D010820:Physicians; D012017:Referral and Consultation; D013663:Teaching / Q000379:methods*
Bodily changes; Cancer; Communication; Medical consultations; Pedagogical strategies