A brief conversation analytic communication intervention can change history-taking in the seizure clinic

Abstract Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional...

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Bibliographic Details
Published in:Epilepsy & behavior 2015-11, Vol.52 (Pt A), p.62-67
Main Authors: Jenkins, Laura, Cosgrove, Jeremy, Ekberg, Katie, Kheder, Ammar, Sokhi, Dilraj, Reuber, Markus
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Communication
Conversation analysis
Diagnosis, Differential
Doctor–patient communication
Epilepsy
Epilepsy - diagnosis
Epilepsy - psychology
Female
Humans
Intervention
Interview, Psychological
Male
Medical History Taking - methods
Middle Aged
Neurology
Nonepileptic seizures
Physician-Patient Relations
Seizures - diagnosis
Seizures - psychology
Young Adult
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Summary:Abstract Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p < .001). While patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 min, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations.
ISSN:1525-5050
1525-5069
DOI:10.1016/j.yebeh.2015.08.022