Search

Background: Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions. Methods/design: The paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged ≥ 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template. Discussion: This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood. Systematic review registration: PROSPERO CRD42019139376 [ABSTRACT FROM AUTHOR]

This paper explores pragmatic socialization by examining episodes of two to three - year-old children's crying and adults' responses to this crying in two preschools: Sweden and Japan. Based on approximately 100 hours of naturally occurring interactions, it focuses on crying episodes that emerged within peer conflict, and analyzes ways that teachers structured a triadic framework of mediation. The results show how teachers mediated by using (1) question-response sequences to clarify what happened and (2) directives and declaratives to convey norms of behaving/speaking and to attune children to the crying of others as a negative affective act that requires a remedial response. The results reveal similarities and variations in adults' responses to children's crying in the two preschools. Although the findings in part instantiate traditional models of socialization in these two societies, they also suggest ways that departed from these models. • Analysis examines preschool teachers' responses to crying in peer conflict. • Methods utilize multimodal conversation analysis. • Analysis shows teachers' triadic mediation utilizing questions, directives, and declaratives. • Findings are discussed in relation to children's pragmatic socialization. [ABSTRACT FROM AUTHOR]

We illuminate third-party research participant consent with, for, and by adults with developmental disabilities by examining consent as an iterative, ongoing process. We use an instrumental case study of three adults with developmental disabilities who, together with their third-party consent providing parents, participated in a broader conversation and video analysis study of how family members are part of decision-making by adults with developmental disabilities. Adults with developmental disabilities comprising our case demonstrated discomfort that left us with questions about the relational nature of third-party consent. We performed a directed content analysis of transcripts and video data corresponding to moments of discomfort, resulting in categories of one- distress, two- non-disclosure, and three- evasion. Our findings illustrate ambiguities where consent was at stake and where there appeared to be no ultimate "Yes" or "No" interpretation. We conclude that expressions of resistance to research participation by adults with developmental disabilities displayed in our data were assertions of autonomy that occurred in relation, yet ran counter to, the agendas of researchers and third-party consent providing parents. We offer recommendations for researchers in the developmental disability field and for qualitative researchers more broadly who might encounter similar ambiguities amidst the relational workings of consent. Greater analytic attention to the relational dynamics of consent has potential to expand ethical commitments of qualitative researchers beyond the limited range of meanings offered in ethics board approvals and signed consent forms. [ABSTRACT FROM AUTHOR]

Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However, child therapy has received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley, 2006). Psychotherapy process researchers in adult therapy (Stiles et al., 2015) have found that therapists "invent" a new therapy for each patient (Norcross and Wampold, 2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of "unexplainable rage." The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe "doing contrariness," as a conversational practice producing epistemic and affiliative disruptions, while "avoiding doing contrariness" and "remedying contrariness" are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding. [ABSTRACT FROM AUTHOR]