title: Applying a deliberation model to the analysis of consultations in haemophilia: Implications for doctor-patient communication.
abstract: Literature highlights the importance of communication in order to achieve patient's adherence. However, the specific dialogical components likely to favor patient adherence are not clear. In this study, the deliberation dialogue model was applied as an ideal model of optimal deliberation to real physician-patient consultations in the field of hemophilia in order to identify misalignments with the model and possible improvements in physician-patient communication.
  
  
  
  By applying the deliberation model, we analyzed a corpus of 30 check-up consultations in hemophilia.
  
  
  
  Of 30 consultations, 24 (80%) contained 43 deliberation dialogues. Twenty-two (51%) deliberation dialogues were complete (e.g., included an opening stage with a clear statement of the problem, an argumentation stage in which both physician and patient participated, and a closing stage with an explicit patient commitment), whereas 21 (49%) deliberations were incomplete. These featured: Lack of/partial argumentation stage; Lack of closing stage; Lack of/partial argumentation stage and lack of closing stage.
  
  
  
  The deliberation model can be applied to empirical data and allows to identify causes for suboptimal realizations of deliberation.
  
  
  
  Once a problem is acknowledged, attention could be paid to engage hemophilic patients in the argumentation stages and elicit their explicit commitment.
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy. Electronic address: giulia.lamiani@hunimed.eu.
authors.forename: Giulia
authors.initials: G
authors.lastname: Lamiani
authors.affiliation: Department of Linguistic Sciences and Foreign Literatures, Catholic University of Milan, Milan, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bigi
authors.affiliation: Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Fondazione IRCCS Ca' Granda, Policlinico Hospital, Milan, Italy.
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Mancuso
authors.affiliation: Centro di Riferimento Regionale per le Emocoagulopatie, Policlinico Università Federico II, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Coppola
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Vegni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003657:Decision Making; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013637:Tape Recording; D055815:Young Adult
keywords: Behavior change; Chronic care; Communication; Deliberation dialogue; Hemophilia; Patient-Centeredness; Shared decision making