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BackgroundMultiple myeloma (MM) is an incurable cancer with complex treatment options. Trusting patient-clinician relationships are essential to promote effective shared decision-making that aligns best clinical practices with patient values and preferences. This study sought to shed light on the development of trust between MM patients and clinicians.MethodsNineteen individual semi-structured interviews were conducted with MM patients within 2 years of initial diagnosis or relapse for this qualitative study. Interviews were recorded and transcripts were coded thematically.ResultsWe identified three main themes: (1) externally validated trust describes patients' predisposition to trust or distrust clinicians based on factors outside of patient-clinician interactions; (2) internally validated trust describes how patients develop trust based on interactions with specific clinicians. Internally validated trust is driven primarily by clinician communication practices that demonstrate competence, responsiveness, listening, honesty, and empathy; and (3) trust in relation to shared decision-making describes how patients relate the feeling of trust, or lack thereof, to the process of shared decision-making.ConclusionMany factors contribute to the development of trust between MM patients and clinicians. While some are outside of clinicians' control, others derive from clinician behaviors and interpersonal communication skills. These findings suggest the possibility that trust can be enhanced through communication training or shared decision-making tools that emphasize relational communication. Given the important role trust plays in shared decision-making, clinicians working with MM patients should prioritize establishing positive, trusting relationships.

This study examines patient-initiated additional concern presentations in general surgery visits to assess which factors contribute to them getting “helped.” Concern presentations were analyzed for a variety of design features (e.g., social action (inquiry vs. informing), when patients initiate during a visit, how patients fit topic to previous talk or activity) and contextual factors (e.g., concern falls inside or outside surgeon’s domain of expertise, chronic vs. acute concern-types, the history of the patient-physician relationship). This study uses a mixed-methods approach, combining case-level conversation analysis and aggregatelevel statistical analysis. Data are video recordings of office visits from 2013–2015, with a longitudinal focus of following the same patients across time. In total, 62 patients spanning 175 visits were analyzed. 377 patient-initiated additional concerns were found, and 188 received help. Several factors were found to increase the likelihood of patients’ concerns getting helped such as designing the concern as an inquiry, raising the concern early in the visit, and mentioning the concern more than once. These findings can help guide patients on how to better design additional concerns presentations to receive help and can benefit physicians by identifying more subtle practices patients are already using to broach concerns to help reduce unnoticed or unhelped concerns.

Patient-clinician interactions are central to technical and interpersonal processes of medical care. Video recordings of these interactions provide a rich source of data and a stable record that allows for repeated viewing and analysis. Collecting video recordings requires navigating ethical and feasibility constraints; further, realizing the potential of video requires specialized research skills. Interdisciplinary collabo-rations involving practitioners, medical educators, and social scientists are needed to provide the clinical perspectives, methodological expertise, and capacity needed to make collecting video worthwhile. Such collaboration ensures that research questions will be based on scholarship from the social sciences, resonate with practice, and produce results that fit educational needs. However, the literature lacks suggested practices for building and sustaining interdisciplinary research collaborations involving video data. In this paper, we provide concrete advice based on our experience collecting and analyzing a single set of video-recorded clinical encounters and non-video data, which have so far yielded nine distinct studies. We present the research process, timeline, and advice based on our experience with interdisciplinary collaboration. We found that integrating disciplines and traditions required patience, compromise, and mutual respect; learning from each other enhanced our enjoyment of the process, our productivity, and the clinical relevance of our research.

This analysis focuses on the institutional talk of sea-kayak guides and their clients in order to understand how guides negotiate the interactional balance of giving orders to maintain a safe and timely excursion while facilitating a fun and recreational experience. Using a mixed-method analysis including Conversation Analysis, ethnography, and statistics, this study examines 576 instances of directives found in video recordings of twenty-five Alaskan kayaking ecotourism excursions and explores the practices guides use in their talk to maintain control of an excursion while not coming across as domineering. By systemically examining directives’  design, directives are found to reveal both their temporal urgency in addition to the precipitating events that necessitate them, such as client behaviors or environmental stimuli. This study’ s analysis contributes to our understanding of how interactants mitigate face-threatening actions and focuses attention on the interactional work that directives and their accounts achieve in an institutional setting currently underinvestigated

The present study investigates the ways that members of society refer to time. Concrete methods for communicating about points in time and locating events in relation to them make relevant and thereby ground abstract time-reckoning in the lives of interactants. Through a taxonomy of references to time—termed absolute and event-relative, each with subcategories— we describe the intrinsic affordances that different designs provide coparticipants engaging in social interaction. In analyzing talk from both ordinary and institutional contexts, we demonstrate how these affordances can be mobilized in the co-construction and maintenance of intersubjectivity, in managing interpersonal relationships, and in conjunction with a variety of social actions. By describing how sociotemporal ordering is invoked, put into use, and contextually achieved in the immediacy of quotidian conduct, we posit that time-reckoning categories are social not only in their construction but also in their everyday use.

This study examines patient-initiated additional concern presentations in general surgery visits to assess which factors contribute to them getting "helped." Concern presentations were analyzed for a variety of design features (e.g., social action (inquiry vs. informing), when patients initiate during a visit, how patients fit topic to previous talk or activity) and contextual factors (e.g., concern falls inside or outside surgeon's domain of expertise, chronic vs. acute concern-types, the history of the patient-physician relationship). This study uses a mixed-methods approach, combining case-level conversation analysis and aggregate-level statistical analysis. Data are video recordings of office visits from 2013–2015, with a longitudinal focus of following the same patients across time. In total, 62 patients spanning 175 visits were analyzed. 377 patient-initiated additional concerns were found, and 188 received help. Several factors were found to increase the likelihood of patients' concerns getting helped such as designing the concern as an inquiry, raising the concern early in the visit, and mentioning the concern more than once. These findings can help guide patients on how to better design additional concerns presentations to receive help and can benefit physicians by identifying more subtle practices patients are already using to broach concerns to help reduce unnoticed or unhelped concerns. [ABSTRACT FROM AUTHOR]

This analysis focuses on the institutional talk of sea-kayak guides and their clients in order to understand how guides negotiate the interactional balance of giving orders to maintain a safe and timely excursion while facilitating a fun and recreational experience. Using a mixed-method analysis including Conversation Analysis, ethnography, and statistics, this study examines 576 instances of directives found in video recordings of twenty-five Alaskan kayaking ecotourism excursions and explores the practices guides use in their talk to maintain control of an excursion while not coming across as domineering. By systemically examining directives' design, directives are found to reveal both their temporal urgency in addition to the precipitating events that necessitate them, such as client behaviors or environmental stimuli. This study's analysis contributes to our understanding of how interactants mitigate face-threatening actions and focuses attention on the interactional work that directives and their accounts achieve in an institutional setting currently underinvestigated (Directives, mixed-methods, Conversation Analysis, ethnography, ecotourism) [ABSTRACT FROM AUTHOR]