Pain talk in oncology outpatient clinics.
Despite improvements in cancer management over the past 25 years, unrelieved symptoms continue to be reported. Little is known about how patients' problems and concerns are communicated to professionals during oncology treatment. This research investigates communication between cancer patients and clinicians in hospital outpatient clinics. Data were collected by non-participant observation and audio recording of consultations. Analyses were by qualitative content analysis and conversation analysis. An Objectives, Strategies and Tactics model was applied to organise the findings. 74 consultations between cancer patients and 15 doctors were observed and audio recorded. Pain talk is defined and identified as a substantial topic, occurring in 39/74 consultations. Doctor-initiated questions are the predominant discourse feature occupying over two-fifths of pain talk sequences. Their questions are prominent not only in initiating discussions but also in directing further talk. In other words, clinicians' questions control both the content and order of talk within pain talk sequences ( eg, over three-quarters of doctor-initiated questions are in a closed form which focus narrowly on limited physical aspects of patients' pain). It is argued that this limited information exchange alongside other communication tactics, is used to identify the 'right kind' of pain which may benefit from cancer therapy and to truncate talk of problems perceived to be outside of this specialist remit.
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