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.