Patient-centred communication in British, Italian and Spanish ‘Ask-the-Expert’ healthcare websites
DOI:
https://doi.org/10.1558/cam.27231Keywords:
advice, ‘Ask-the-Expert’ healthcare websites, discourse analysis, empathy, patient-centred communication, pragmaticsAbstract
Existing studies on the online asynchronous consultation mode afforded by ‘Ask-the-Expert’ health websites (e.g. Thomson et al. 2012) are concerned with the possible loss in the quality of interaction between patients and clinicians in this type of consultation. The potential loss is worrying, given the central role of patient-centred communication (PCC), particularly empathy, in medical consultation practice and patients’ increasing use of and reliance on online consultations. This study addresses the following three related questions: (1) To what extent is PCC represented in ‘Ask-the-Expert’ healthcare websites? (2) Are there noticeable differences in PCC between sites operating in different linguistic and cultural settings (the UK, Spain and Italy)? (3) What are the implications of the above? Seventy exchanges from the leading independent health websites NetDoctor (UK), Netdoctor (Spain) and Medicitalia (Italy) were analysed, adapting a framework developed for the linguistic analysis of clinical empathy (combining discourse analytical and pragmatic categories – Pounds 2011) and drawing on existing definitions of PCC and classifications of advice-giving structures. The analysis shows that PCC is used on these sites to varying degrees, conforming to the site’s affordances. The significance of the findings and potential further applications of the analytical framework are discussed in the final part.References
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Morrow, P. R. (2006) Telling about problems and giving advice in an Internet discussion forum: Some discourse features. Discourse Studies 8 (4): 531–548. http://dx.doi.org/10.1177/1461445606061876
Moulton, L. (2007) The Naked Consultation.: A Practical Guide to Primary Care Consultation Skills. Oxford: Radcliffe Medical Press.
O’Keeffee, A., Clancy, B. and Adolphs, S. (2011) Introducing Pragmatics in Use. London: Routledge.
Piasecky, M. (2003) Clinical Communication Handbook. Oxford: Blackwell Science.
Pounds, G. (2011) Empathy as ‘appraisal’: A new language-based approach to the exploration of clinical empathy. Journal of Applied Linguistics and Professional Practice 7 (2): 139–162.
Roter, D. and Larson, S. (2002) The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling 46 (4): 243–251. http://dx.doi.org/10.1016/S0738-3991(02)00012-5
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Sarangi, S. (2010) Practising discourse analysis in healthcare settings. In I. Bourgeault, R. Dingwall and R. de Vries (eds) The Sage Handbook of Qualitative Analysis in Healthcare Settings, 397–416. London: Sage. http://dx.doi.org/10.4135/9781446268247.n21
Shaw, C., Potter, J. and Hepburn, A. (2015) Advice-implicative actions: Using interrogatives and assessments to deliver advice in mundane conversation. Discourse Studies 17 (3): 317–342. http://dx.doi.org/10.1177/1461445615571199
Silverman, J., Kurtz, S. and Draper, J. (2013) Skills for Communicating with Patients. Third edition. Abingdon, UK: Radcliffe Medical Press.
Sinclair, J. M. and Coulthard, M. (1975) Towards an Analysis of Discourse. Oxford: Oxford University Press.
Smedberg, A. (2007) How to combine the online community with Ask the Expert system in a health care site: A comparison of online health systems usage. ICDS’07: Proceedings of the First International Conference on the Digital Society, 15. Washington, DC: IEEE Computer Society. http://dx.doi.org/10.1109/ICDS.2007.19
Suchman, A. L., Markakis K., Beckman, H. B. and Frankel, R. (1997) A model of empathic communication in the medical interview. Journal of American Medical Association 277 (8): 678–682. http://dx.doi.org/10.1001/jama.277.8.678
Thomson, O., Koumanakos, G. and Hadjri, K. (2012) The ethical and policy implications of e-health and telemedicine: An ageing-focused review. Clinical Ethics 7 (4): 147–156. http://dx.doi.org/10.1258/ce.2012.012020
Umefjord, G., Hamberg, K., Malker, H. and Petersson, G. (2006) The use of an Internet-based Ask the Doctor service involving family physicians: Evaluation by a web survey. Family Practice 23 (2): 159–166. http://dx.doi.org/10.1093/fampra/cmi117
Wade, S. L., Wolfe, C. R. and Pestian, J. P. (2004) A web-based family problem-solving intervention for families of children with traumatic brain injuries. Behaviour Research Methods, Instruments and Computers 36 (2): 261–269. http://dx.doi.org/10.3758/BF03195572
Wynn, R. and Wynn, M. (2006) Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics 38 (9): 1385–1397. http://dx.doi.org/10.1016/j.pragma.2005.09.008
Bromme, R., Jucks, R. and Wagner, T. (2005) How to refer to ‘diabetes’? Language in online health advice. Applied Cognitive Psychology 19 (5): 569–586. http://dx.doi.org/10.1002/acp.1099
Cook, J. E. and Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyberpsychology and Behaviour 5 (2): 95–105. http://dx.doi.org/10.1089/109493102753770480
Dedding, C., van Doorn, R., Winkler, L. and Reis, R. (2011) How will e-health affect patient participation in the clinic? A review of e-health studies and the current evidence for changes in the relationship between medical professionals and patients. Social Science and Medicine 72 (1): 49–53. http://dx.doi.org/10.1016/j.socscimed.2010.10.017
Epstein, R. (2011) Distance therapy comes of age: Recent studies show that psychotherapy delivered through electronic devices can benefit patients. Scientific American Mind 22 (2): 60–63. http://dx.doi.org/10.1038/scientificamericanmind0511-60
Epstein, R. M., Franks, P., Fiscella, K., Shields, K. G., Meldrum, S. C., Kravitz, R. L. and Duberstein, P. R. (2005) Measuring patient-centred communication in patient-physician consultations: Theoretical and practical issues. Social Science and Medicine 61 (7): 1516–1528. http://dx.doi.org/10.1016/j.socscimed.2005.02.001
Health on the Net Foundation. (1997) The HON Code of Conduct for medical and health web sites (HONcode). Retrieved from https://www.hon.ch/HONcode/Conduct.html
Hojat, M., Gonnella, J. S., Nasca, T. J., Mangione, S., Veloksy, J. J. and Magee, M. (2002) Physician empathy: Definition, components, measurement and relationship to gender and specialty. American Journal of Psychiatry 159 (9): 1563–1569. http://dx.doi.org/10.1176/appi.ajp.159.9.1563
Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J. M., Gonnella, J. S., Erdmann, J. B., Veloski, J. and Magee, M. (2001) The Jefferson Scale of physician empathy: Development and preliminary psychometric data. Educational and Psychological Measurement 61 (2): 349–365. http://dx.doi.org/10.1177/00131640121971158
Garrod, S. and Pickering, M. J. (2004) Why is conversation so easy? Trends in Cognitive Science 8 (1): 8–11. http://dx.doi.org/10.1016/j.tics.2003.10.016
Grimsbø, G. H., Ruland, C. M. and Finset A. (2012) Cancer patients’ expression of emotional cues and concerns and oncology nurses’ responses, in online patient-nurse communication service. Patient Education and Counseling 88 (1): 36–43. http://dx.doi.org/10.1016/j.pec.2012.01.007
Kurtz, S. M. and Silverman, J. D. (1996) The Calgary–Cambridge Observation Guides: An aid to defining the curriculum and organising the teaching in communication training programmes. Medical Education 30 (2): 83–89. http://dx.doi.org/10.1111/j.1365-2923.1996.tb00724.x
Locher, M. A. (2010) Health Internet sites: A linguistic perspective on health advice columns. Social Semiotics 20 (1): 43–59. http://dx.doi.org/10.1080/10350330903438402
Locher, M. A. and Hoffmann, S. (2006) The emergence of the identity of a fictional expert advice-giver in an American Internet advice column. Text and Talk 26 (1): 69–106. http://dx.doi.org/10.1515/TEXT.2006.004
Lovejoy, T. I., Demireva, P. D., Grayson, L. J. and McNamara, J. R. (2009) Advancing the practice of online psychotherapy: An application of Rogers’ diffusion of innovations theory. Psychotherapy theory, Research, Practice, Training 46 (1): 112–124. http://dx.doi.org/10.1037/a0015153
Markham, A. and Buchanan, E. (2012) Ethical Decision-making and Internet research 2.0: Recommendations from the AoIR Ethics Working Committee. Association of Internet Researchers (AoIR). Retrieved from: http://www.aoir.org/reports/ethics2.pdf
Martinovski, B., Traum, D. and Marsella S. (2007) Rejection of empathy in negotiation. Group Decision and Negotiation 16 (1): 61–76. http://dx.doi.org/10.1007/s10726-006-9032-z
McCormack, A. and Coulson, N. (2009) Individuals with eating disorders and the use of online support groups as a form of social support. Journal of Psychosocial Research on Cyberspace 3 (2): Article 5.
Mercer, S. W., Maxwell, M., Heaney, D. and Watt, G. C. M. (2004) The consultation and relational (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice 21 (6): 699–705. http://dx.doi.org/10.1093/fampra/cmh621
Miller, T. E. and Derse A. R. (2002) Between strangers: The practice of medicine online. Health Affairs 21 (4): 168–179. http://dx.doi.org/10.1377/hlthaff.21.4.168
Morrow, P. R. (2006) Telling about problems and giving advice in an Internet discussion forum: Some discourse features. Discourse Studies 8 (4): 531–548. http://dx.doi.org/10.1177/1461445606061876
Moulton, L. (2007) The Naked Consultation.: A Practical Guide to Primary Care Consultation Skills. Oxford: Radcliffe Medical Press.
O’Keeffee, A., Clancy, B. and Adolphs, S. (2011) Introducing Pragmatics in Use. London: Routledge.
Piasecky, M. (2003) Clinical Communication Handbook. Oxford: Blackwell Science.
Pounds, G. (2011) Empathy as ‘appraisal’: A new language-based approach to the exploration of clinical empathy. Journal of Applied Linguistics and Professional Practice 7 (2): 139–162.
Roter, D. and Larson, S. (2002) The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling 46 (4): 243–251. http://dx.doi.org/10.1016/S0738-3991(02)00012-5
Roter, D. L., Larson, S., Sands, D. Z., Ford D. E. and Houston, T. (2008) Can e-mail messages between patients and physicians be patient-centred? Health Communication 23 (1): 80–86. http://dx.doi.org/10.1080/10410230701807295
Sarangi, S. (2010) Practising discourse analysis in healthcare settings. In I. Bourgeault, R. Dingwall and R. de Vries (eds) The Sage Handbook of Qualitative Analysis in Healthcare Settings, 397–416. London: Sage. http://dx.doi.org/10.4135/9781446268247.n21
Shaw, C., Potter, J. and Hepburn, A. (2015) Advice-implicative actions: Using interrogatives and assessments to deliver advice in mundane conversation. Discourse Studies 17 (3): 317–342. http://dx.doi.org/10.1177/1461445615571199
Silverman, J., Kurtz, S. and Draper, J. (2013) Skills for Communicating with Patients. Third edition. Abingdon, UK: Radcliffe Medical Press.
Sinclair, J. M. and Coulthard, M. (1975) Towards an Analysis of Discourse. Oxford: Oxford University Press.
Smedberg, A. (2007) How to combine the online community with Ask the Expert system in a health care site: A comparison of online health systems usage. ICDS’07: Proceedings of the First International Conference on the Digital Society, 15. Washington, DC: IEEE Computer Society. http://dx.doi.org/10.1109/ICDS.2007.19
Suchman, A. L., Markakis K., Beckman, H. B. and Frankel, R. (1997) A model of empathic communication in the medical interview. Journal of American Medical Association 277 (8): 678–682. http://dx.doi.org/10.1001/jama.277.8.678
Thomson, O., Koumanakos, G. and Hadjri, K. (2012) The ethical and policy implications of e-health and telemedicine: An ageing-focused review. Clinical Ethics 7 (4): 147–156. http://dx.doi.org/10.1258/ce.2012.012020
Umefjord, G., Hamberg, K., Malker, H. and Petersson, G. (2006) The use of an Internet-based Ask the Doctor service involving family physicians: Evaluation by a web survey. Family Practice 23 (2): 159–166. http://dx.doi.org/10.1093/fampra/cmi117
Wade, S. L., Wolfe, C. R. and Pestian, J. P. (2004) A web-based family problem-solving intervention for families of children with traumatic brain injuries. Behaviour Research Methods, Instruments and Computers 36 (2): 261–269. http://dx.doi.org/10.3758/BF03195572
Wynn, R. and Wynn, M. (2006) Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics 38 (9): 1385–1397. http://dx.doi.org/10.1016/j.pragma.2005.09.008
Published
2016-11-07
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How to Cite
Pounds, G., & De Pablos-Ortega, C. (2016). Patient-centred communication in British, Italian and Spanish ‘Ask-the-Expert’ healthcare websites. Communication and Medicine, 12(2-3), 225–241. https://doi.org/10.1558/cam.27231
