Formulating cancer worries: How doctors establish medical expertise and authority to facilitate patients' care choices.

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions.

The Pursuit of Positive Impacts: Translating Longitudinal Cancer Studies into Successful Health Communication Interventions.

Over a decade ago, in the 100th issue of (; 2010), 30 "impact" articles addressed how our collective research findings had been translated to make a positive difference for persons across diverse communities. It is laudable to develop projects helping others to enhance their awareness about healthy living, refine practical communication skills to promote behavioral change, and rely on findings to enact important practices and policies giving priority to how well and long we live in contemporary society. As a preview, however, an article entitled "Why is it so difficult to talk about impact?" raised a series of inherent challenges faced whenever we conduct our research to advance basic knowledge by pursuing meaningful translation opportunities.

Communication About Negative and Uncertain Results: Interactional Dilemmas During a Genetic Telehealth Consult.

This case study focuses on a video telehealth consult to discuss genetic testing results. Participants include a Genetic Counselor (GC) and a Patient (P) previously diagnosed with ovarian cancer who is currently undergoing chemotherapy treatments. Utilizing conversation analysis (CA), attention is first given to a series of interactional dilemmas as GC delivers and P responds to negative, uncertain, and complex test results.

Enacting Woundedness and Compassionate Care for Recurrent Metastatic Breast Cancer.

This analysis integrates Arthur Frank's timeless revelations about woundedness within the communication context of an oncology interview. A Patient whose life is threatened by recurrent metastatic breast cancer claims personal knowledge and visibly demonstrates impacts from illness experiences. Conversation Analysis (CA) was conducted on a video recorded and transcribed case study involving a Patient, her husband, and co-present oncologists.

Defining Moments, Revisited.

'Defining moments' are revealed by weaving three strands together in this essay. First, by reenacting stories as 'tell-aboutables,' 'defining moments' are achieved through participants' methods for drawing attention to significant events. Occasioned reconstructions are designed by speakers as timely and worthy to be heard, responded to, and appreciated by recipients.

A White Family's Oral Storytelling About Cancer Generates More Favorable Evaluations From Black American Audiences.

One proposition of Entertainment Education (EE) suggests that actors communicating messages should be ethnically and culturally homogenous with targeted audiences. The present study challenges this assumption by investigating audience evaluations of When Cancer Calls..

Patient-Initiated Pain Expressions: Interactional Asymmetries and Consequences for Cancer Care.

Only minimal attention has been given to analyzing interactional moments when patients and providers talk about "pain" in general consultations and primary care, and no attention has focused on how pain gets managed during oncology interviews. Conversation analysis (CA) is used to examine a sampling of instances drawn from a collection of 146 pain instances across 65 video recorded and transcribed clinical encounters in a comprehensive cancer clinic. Specific attention is drawn to how pain descriptions are not static but malleable as cancer patients upgrade, downgrade, and produce combined orientations when making their experiences available to oncologists.

"Tiny Tiny Little Nothings": Minimization and Reassurance in the Face of Cancer.

Drawing from a sub-sample of video recorded and transcribed oncology interviews, Conversation Analysis is used to examine moments when cancer is portrayed as absent or minimally present but not dangerously invasive. Though cancer patients and their doctors invest considerable efforts pursuing life-affirming and hopeful possibilities advancing the quality of living and healing outcomes, little is known about how"good news" and thus hopeful social actions get organized. An interactional practice is identified for depicting tumor sizes as small or shrinking - a displayed preference to tumors that are large, growing, and spreading (i.

Making Cancer Visible: Unmasking Patients' Subjective Experiences.

, an article and patient's painting published nearly 15 years ago, has contributed in significant ways to a body of research focusing on communication during oncology interviews. Impacts from this painting helped to create a sensitivity for analyzing naturally occurring video recordings, including moments when patients' subjective experiences are raised and responded to. Analysis begins with how a melanoma patient's facial expression bears striking resemblance to the painting, vocal and other visible social actions (e.

The Transformative Power of Authentic Conversations About Cancer.

Entertainment-education (E-E) assumes that actors performing content should be ethnically and culturally homogeneous with targeted audiences. The present study challenges this basic E-E assumption. Findings are presented from audience members who viewed When Cancer Calls… This theatrical production was constructed from verbatim transcriptions of naturally occurring telephone conversations between White family members as they communicated about and through their cancer journey.

Laughter, Humor, and Cancer: Delicate Moments and Poignant Interactional Circumstances.

Conversation analysis is employed to examine transcribed excerpts drawn from a subsample of 75 naturally occurring and video recorded interviews between cancer patients and 30 doctors. Close examination is provided of how cancer patients initiate, and doctors respond, to laughter and humor during oncology interviews. Interactions demonstrate that communication about the disease "cancer" shares qualities similar to other medical areas (e.

The Conversations About Cancer (CAC) Project-Phase II: National findings from viewing When Cancer Calls…and implications for Entertainment-Education (E-E).

Objective: We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls…(WCC…), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone.

Methods: A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members.

Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews.

New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists.

"Having an ovary this big is not normal": physicians' use of normal to assess wellness and sickness during oncology interviews.

During oncology interviews, physicians and patients routinely employ the term normal to describe patients' condition and overall health status. Surprisingly prevalent but little understood, normal is recruited to achieve an array of social actions comprising a primal aspect of patient-provider interactions: determining, assessing, and treating patients' health status as well and/or sick. Utilizing conversation analysis (CA) to examine a collection of 136 normal references across 61 oncology interviews, this article draws from a subsample of 101 instances to examine how physicians use normal to perform four specific sets of social actions: (a) invoking normal as a preferred range, (b) utilizing normal as evidence that does not explicitly label patients' conditions, (c) treating the absence of normal as indicative of sickness, and (d) providing reassurance to patients in the presence of normal and not normal circumstances.

The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play.

Basic communication research has identified a major social problem: communicating about cancer from diagnosis through death of a loved one. Over the past decade, an award-winning investigation into how family members talk through cancer on the telephone, based on a corpus of 61 phone calls over a period of 13 months, has been transformed into a theatrical production entitled The Cancer Play. All dialogue in the play is drawn from naturally occurring (transcribed) interactions between family members as they navigate their way through the trials, tribulations, hopes, and triumphs of a cancer journey.

Patients' efforts to justify wellness in a comprehensive cancer clinic.

Conversation analysis (CA) is employed to examine oncology interviews within a comprehensive cancer clinic. Data are drawn from a sampling of 75 video-recorded and transcribed encounters involving 30 oncologists. During history-taking, by expanding answers to doctor's questions designed to solicit "yes/no" responses, patients manage constraints on interaction by initiating and pursuing distinct courses of action.

Disclosing and responding to cancer "fears" during oncology interviews.

Video-excerpts from routine oncology interviews are examined to reveal how patients demonstrate and doctors respond to "fears" about cancer. Vocally and visually, embodied impacts of dealing with dreaded consequences of cancer are apparent when addressing both good and potentially bad cancer news. Even a "brush" with cancer can promote negative and ongoing impacts provoking unresolved illness dilemmas.

Between dad and son: initiating, delivering, and assimilating bad cancer news.

The opening moments of a phone call reveal how a father informs his son, for the 1st time, that his mom's tumor is malignant. An extended phone opening reveals how delaying talk about the mom's condition allows for important interactional work: Displaying resistance to announce the bad news directly, projecting and anticipating the valence of forthcoming news prior to its announcement, and delicately sharing ownership of a serious health condition at the outset of a family cancer journey. Enacting a biomedical demeanor, replete with technical language and withholdings of emotional and personal reactions, subsequent delivery and reception of the bad news is managed stoically-a normalized resource employed by consequential figures when managing and coping with dreaded news events.