Project

health communication; medical consultation; doctor-patient argumentation; patient participation; ICF; argumentation theory; doctor-patient critical discussion; treatment delivery; chronic pain; disability and health; pragma-dialectic

Lead
Lay summary
In patient-clinician communication about chronic conditions there are main obstacles to patient participation due to the divide between the biomedical background of clinicians versus the lived experience of the health conditions of patients. This projects attempts to overcome these obstacles by proposing a model of communication based on the World Health Organization International Classification of Functioning, Disability and Health (ICF). In the last two decades, the doctor-patient relationship has moved from an essentially paternalistic model of communication towards a model of mutuality that facilitates shared decision making. Patient participation in the medical consultation is advocated as a means to improve a spirit of cooperation which leads to more satisfaction, willingness to follow specific intervention instructions and better self-management. Yet, there are main obstacles to this participation due to an essential difference of perspectives between the doctor and the patient anchored, respectively, in the world of biomedicine and in the lived experience of the health condition. To address the above mentioned obstacles, the proposed research explores the value of the 2001 World Health organization Classification of Functioning, Disability and Health (ICF) as a conceptual instrument to facilitate doctor-patient argumentation about treatments and interventions in the chronic field. The ICF embodies a bio-psycho-social model of health that accounts for the physical, personal and contextual factors at the basis of the difficulties in individuals' functioning. The study is grounded in a corpus of 20 consultations, followed by semi-structured interviews and focus groups with doctors and patients. The analysis is conducted by relying on the theoretical framework of argumentation theory and, in particular, of pragma-dialectics. The study is expected to contribute to the rich qualitative research on doctor-patient interaction by pioneering the exploration of, firstly, the use of the ICF in the medical encounter and, secondly, the analytical insights of argumentation theory. In terms of its broader impact, the study is expected to contribute to the conceptualisation of methods to enhance doctor-patient argumentative skills, and of ways of implementing them in the medical encounter.

Direct link to Lay Summary

Last update: 21.02.2013

Active participation

Active participation

In the last two decades, the doctor-patient relationship has moved from an essentially paternalistic model of communication towards a model of mutuality that facilitates shared decision making. Patient participation in the medical consultation is advocated as a means to improve a spirit of cooperation which leads to more satisfaction and willingness to follow specific intervention instructions. Yet, there are main obstacles to this participation due to an essential difference of perspectives between the doctor and the patient anchored, respectively, in the world of biomedicine and in the lived experience of the health condition. To address these obstacles, the proposed research explores the value of the 2001 World Health Organization Classification of Functioning, Disability and Health (ICF) as a conceptual instrument to facilitate doctor-patient argumentation about treatments and interventions. The ICF framework is a theoretical model that helps to describe the difficulties in human functioning - both physiological and social - that are associated with a health condition. It embodies a biopsychosocial model of health and functioning that explicitly takes into account the role of contextual factors that determine the level and extent of the difficulties an individual may experience in life. So far the ICF has been tested for its role in the management of rehabilitation practice. The novelty of the prospected investigation rests on its aim to assess the value of the ICF in medical practice communication.By moving from a qualitative perspective - grounded in the analysis of a corpus of medical consultations in the field of chronic pain, and semi-structured interviews and focus groups with doctors and patients - the project will explore the ICF’s potential to bridge between the clinical perspective and the point of view of the patient. The specific objectives are to show that the ICF 1) provides a common vocabulary to describe the perspectives of the doctor and the patient, 2) offers a ground to structure argumentation between the two actors, 3) works as the basis for negotiation and 4) enhances self-perceptions of participation and mutual understanding. The research will be conducted by relying on a body of theory known as ‘argumentation theory’, which has a ‘descriptive dimension’ for examining argumentative reality but also a ‘normative dimension’ by which the strength of arguments can be judged. In relation to the use of the ICF in the medical encounter, the analysis will extract the essential argumentative instances and will individuate the impact of the ICF on the development of doctor-patient argumentative exchange. The ICF is a WHO classification that has received extensive worldwide academic and institutional attention. By investigating and evaluating the effectiveness of ICF in an application that has so far not been studied, this project will open up new avenues of interest and research on the ICF and its applicability. This study will then contribute to the rich qualitative research on doctor-patient interaction and on argumentation theory by, firstly, providing insight into new aspects and dimensions of doctor-patient argumentation and, secondly, by pioneering the analytical power of argumentation theory in the field. In terms of its broader impact, results from the study are expected to find expression in recommendations for clinical practice, and in the development of content for communication skills improvement.