Congratulations to Alexandra Tate on the award for best student paper for her “Treatment Recommendations in Oncology Visits: Implications for Patient Agency and Physician Authority,” published in Health Communication, 2018.
This study provides an exemplar of medical CA at its best; it provides new insights into how doctor-patient interaction varies across stages of the oncology encounter. The crucial question asked by Tate is how physician-oncologist and patient negotiate decision making for treatment and, in particular, how physicians assert their authority — and balance it with an orientation to the patient’s agency — in oncology regarding treatment. Making use of Stivers’ typologies for primary care treatment recommendations, Tate found that while oncologists’ proposals were most common in the initial stage of oncologist/patient interaction, when the oncologist needed the patient to buy into a certain treatment, during other stages (mid-course treatment and ancillary treatments) pronouncements were made. Differentiated forms of verbal action are accounted for with respect to the trajectory of the voyage of cancer treatment. A deviant case provides insight into the importance of the relationship of doctor and patient regarding how negotiation proceeds; when a relationship is new midcourse of treatment, then the oncologist must work to gain the acceptance of the client, and will not make pronouncements. The careful design of the study permitted such nuanced understandings of changes in doctor/patient medical encounters across time within a context in medical conversation analysis (oncology) which has received less attention than primary care.
There are important policy implications for medical care which result from this study. In the US physicians initially seek patients’ acceptance of treatment, and therefore want the patient’s input. However, having obtained their signing onto cancer treatments, physicians in the mid course context view patient agency as having been somewhat transferred to them. Participants then have little opportunity to consider alternative therapies, stop treatment or shift to palliative or supportive care. The paper makes important points in showing how this happens and, implicitly, in providing for opportunities to medical staff to become aware of opportunities to enhance the patient’s participation.
Marjorie Goodwin, Lorenza Mondada and Anssi Peräkylä