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This study identified ways in which patients and medical specialists negotiated decisions about cancer treatment by observing decision-making discussion in situ. Audio-recordings of cancer care consultations with 18 patients, their support people, and their medical specialists, including medical oncologists, radiation oncologists and surgeons were collected in different regions of New Zealand. Patients were followed up with interviews and specialists provided consultation debriefings. The interpretation of the data drew on the concepts of epistemic and deontic rights to argue that in complex consultations, such as occur in cancer care, we need to reconsider the simple dichotomy of preferred consultations styles as paternalistic or based on shared decision-making. Decision-making is a dynamic process with specialists and patients linked into networks that impact on decision-making and where rights to knowledge and rights to decision-making are interactionally negotiated. The level of information and understanding that patients desire to exercise rights needs to be reconsidered. [ABSTRACT FROM AUTHOR]

Background There is an assumption that there is a similarity between surgeon-patient and primary care consultations. Yet, surgeon communication has had far less analytic attention than its primary care counterparts. Therefore, this assumption of similarity (and the proposition here of dissimilarity) has yet to be evidenced through detailed interactional analysis. Methods Conversation analysis ( CA) is a methodology used to understand both mundane and institutional interactions. Using CA, we have developed an understanding of surgeon-patient interactions in outpatient clinic settings in New Zealand. Rather than attempting to determine what 'bad' communication is, we describe and analyse what occurs routinely in surgeon-patient consultations, particularly how these interactions are built up by both patient and doctor. Results This research shows that while surgeon-patient consultations share some similarities to the overall structure of primary care consultations, there are two unique structures that occur in surgical consultations. These structures follow a logical progression of activities and are influenced by the type of visit (referred versus follow-up). Discussion This article summarizes the first comprehensive description of the overall interactional structure of surgeon-patient consultations. It demonstrates that surgeon-patient consultations are structurally distinct from primary care consultations. This key finding has implications for surgeon-specific research and education, highlighting the need to question current assumptions in communication training and in clinical practice. [ABSTRACT FROM AUTHOR]

Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design. Analysis of video-recorded primary care consultationsSetting. New Zealand General Practice.Methods. Interactional content analysis of AOD consultations between 15 GP’s and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. [ABSTRACT FROM PUBLISHER]

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients. [ABSTRACT FROM AUTHOR]

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure. [ABSTRACT FROM AUTHOR]