title: How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: a micro-analysis.
abstract: People with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; 'direct', 'embedded', and 'oblique'. Both settings provided interactional 'slots' for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated 'oblique' formats. We suggest that the attenuation of the 'oblique' format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns.
authors.affiliation: Centre for Primary Care, Floor 5, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Electronic address: John.chatwin@manchester.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Chatwin
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 67, Highfield, Southampton SO17 1BJ, UK. Electronic address: A.Kennedy@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Centre for Primary Care, Floor 5, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Electronic address: Adam.firth@postgrad.manchester.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Firth
authors.affiliation: Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Electronic address: Andrew.povey@manchester.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Povey
authors.affiliation: Faculty of Health Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK. Electronic address: A.E.Rogers@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Centre for Primary Care, Floor 6, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Electronic address: Caroline.sanders@manchester.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
mesh_terms: D003142:Communication; D004739:England; D058005:General Practitioners / Q000523:psychology*; D006302:Health Services Research; D006801:Humans; D008175:Lung Neoplasms; D009722:Nurse Practitioners / Q000523:psychology*; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D013637:Tape Recording
keywords: COPD; Conversation analysis (CA); Lung cancer; Medical interactions; Socio-linguistics; Symptom presentation; UK