Comet Conference 2019

PANEL SUMMARIES

Language, Health and Anthropological Demography: Local Logistics of Health-Seeking Behaviour

Papers in this panel address two main problem areas, which are closely related. One, is that standard demographic categories/measures used in health programmes commonly do not fit well with people’s language and experience in societies in the ‘developing world’. The second is that, to improve this situation requires contextualisation of how people make sense of health in local languages. In other words, we have to study language in the context of how societies are changing in these places. Once we understand that, we can comment intelligently on the standard health demography categories. The three dimensions of such change to be addressed in the panel are closely related: 1. Sub-population differences which mean that people belong to different social and economic status groups (with varying family and community organisation, etc) as they relate to health-seeking behaviour; 2. Generational differences, as people of different ages in these groups have had different experiences as local societies try to cope with Western influences; and 3. Languages are changing too, especially as local languages are invaded by the national language employed in programmes.

Panel Convener/Coordinator
Philip Kreager, Institute of Human Sciences, University of Oxford

Presenters
Philip Kreager, Institute of Human Sciences, University of Oxford
Chan Wan Ting, Nanyang Technical University, Singapore
Samuel J. Clark, Department of Sociology & Institute for Population Research, The Ohio State University, USA
Brian Houle, Australian National University, Australia
Clarissa Surek-Clark, Department of Sociology, The Ohio State University, USA
Raquel Barbosa de Lima, Ministry of Health of Brazil, Secretariat of Health Surveillance, Department of NCD Surveillance and Health Promotion, Brazil

Complexity and Context in Interactional Health Care Spaces

Complexity is an inherent, dynamic part of health systems and of care itself, yet its theoretical and empirical basis is not well understood. The notion of complexity (as a set of processes and objects that interact with each other) has typically been studied at the level of health systems, rather than at an interactional level. Health interactions are particularly complex, as a result of factors such as the topic (which may be sensitive or involve bad news), asymmetries between patient and health professional, the level of information to be conveyed (which may include uncertainty or risk), the need to balance expectations and agendas, and the ‘business’ of decision making, to name a few. Language and cultural differences may add additional layers of complexity.

Because care is complex, institutions need to be explicit and mindful about the components of care. Thus, analysing communication practice might have considerable value in understanding and improving care. Given the acknowledged need to focus on ways of using research to understand barriers to healthcare and improve care practices, a broader conceptualisation of complexity at the interactional level seems necessary. The ‘macro’ institutional and societal contexts may add significant additional layers of complexity that play out in the ‘micro’ elements of clinical interactions.

In this panel, we will present some interactional data from several South African healthcare studies that have prompted us to engage more deeply with notions of complexity and consider how complexity theory might have applicability at an interactional level. Drawing together different kinds of data from multiple sources, we will consider in more detail how the context may contribute to observed interactional complexity. We will also describe some analytical paradoxes and dilemmas that we have encountered in our analysis.

Panel Convener/Coordinator
Jennifer Watermeyer, Health Communication Research Unit, University of the Witwatersrand, South Africa

Presenters
Jennifer Watermeyer, Health Communication Research Unit, University of the Witwatersrand, South Africa
Johanna Beukes, Health Communication Research Unit, University of the Witwatersrand, South Africa
Rhona Nattrass, Health Communication Research Unit, University of the Witwatersrand, South Africa

Finding Voice in Ethical Practice: an example from physiotherapy practice and education

The healthcare landscape in Australia and internationally is becoming increasingly complex for both clients and health professionals to navigate. Greater cultural and linguistic diversity of communities and organisations, system constraints on the provision of care and extended scopes of practice all contribute to a working context where physiotherapists are experiencing challenging ethical issues in their everyday practice. Within this contemporary landscape, physiotherapists need to have the capacity to both understand and enact their ethical obligations as health professionals.

This panel will explore the notion that a capacity to articulate ethics is necessary but not sufficient to fulfil ethical obligations as a health professional. The topic will be unpacked in three parts. First, we will explore an understanding of ethical practice as both an individual and a social process in healthcare. Perspectives on the potential constraint of workplace culture on moral agency and the communicative expertise required to overcome it, from the literature and from our own experiences of teaching and clinical practice, will be discussed. Secondly, we will present the findings from research with Australian physiotherapists that explored their perspectives on the integral role of communication in ethical practice, and we will relate how this has informed the revision of a professional association’s code of conduct. Thirdly, we will share the content and evaluation of an active learning approach conducted with physiotherapy students to build capacity in the communication skills needed to be moral agents on their clinical placements and after graduation. The panel presentation will finish with an opportunity for questions and discussion.

The three panel presenters share expertise from a deeper connection than a shared academic interest, as they are all experienced physiotherapists who are working together to enhance the capacity of student physiotherapists to be ethical practitioners during training and as professional graduates.

Panel Convener/Coordinator
Caroline Fryer, University of South Australia, Australia

Presenters
Caroline Fryer University of South Australia, Australia
Gisela Van Kessel, University of South Australia, Australia
Ian Edwards, University of South Australia, Australia

Teaching, Learning, and Researching Clinical Communication in Health Professions’ Education

Clinical communication is well established as a central component of clinical skills training in medical school curricula (von Fragstein et al. 2008; Brown 2008), with the Australian Medical Council including communication skills as an element requiring comprehensive coverage (Australian Medical Council 2009). A number of health profession accreditation bodies including audiology, speech pathology, and physiotherapy acknowledge the importance of clinical communication in the curriculum; however, learning, teaching, and assessment of clinical communication tends to be less well established in these disciplines. While clinical communication curriculum and pedagogy in medicine can inform curriculum development in other health professions, health professions’ educators need to be aware of its conceptual limitations, including the narrow focus on history taking and task orientation, and the emphasis on assessing students’ competence in the controlled setting of an Objective Structured Clinical Examination (OSCE). Such evaluation measures arguably provide only limited insight into student communicative behaviour and the effectiveness of their communication with patients, or other health professionals.

One aim of this interdisciplinary panel is to raise educator awareness about the scope of learner health professional communication, including the range of communication activities, the defining disciplinary communication tasks, inter and intraprofessional communication, and intercultural communication. A second aim is to raise awareness about the benefits of researching authentic learner health professional-patient/client interactions and health-professional inter and intraprofessional communication to inform both pedagogy and professional development needs. Panel contributor research approaches include discourse analysis by clinician researchers to examine authentic interactions in learner settings. Each contributor considers the implications for curriculum, pedagogy and professional development, within as well as beyond the disciplinary boundaries of each health profession represented.

Panel Convenor
Robyn Woodward-Kron, Melbourne Medical School, University of Melbourne, Australia

Presenters
Samantha Tai, Department of Audiology, School of Health Sciences, University of Melbourne
Susan Philip, University of Melbourne, Australia; 2Victoria University, Australia
Nayia Cominos, University of South Australia, Australia

The Linguist as Consultant and Collaborator: applying linguistics to improve communication practices in health care

Despite the international rise of research into ‘healthcare communication’ and the increased policy focus on ‘consumer-centred care’, linguistics has not been a discipline at the forefront of publications in the field. Given that much of health care can only be achieved through language, linguistics should potentially play a key role in increasing the safety and quality of healthcare practices. The low profile of linguistics is in part due to the dominance of quantitative, positivist and science-based methodologies in health but may also be ascribed to reticence by linguists to adapt their analytical tools to make them accessible and relevant to solving real-world healthcare problems. We believe that an applicable linguistics starts from the problems and issues identified by health services, clinicians, health profession educators and consumers, and adapts its linguistic tools to deliver practical, implementable communication improvements.

In this panel, each paper will focus on how linguistics can provide invaluable insights into the complexities and problems in communication in healthcare settings. Presenters will show how they have drawn on linguistic theories and tools in strategic ways to describe healthcare data and apply linguistic findings to produce education, training or policy frameworks that are practical and relevant to healthcare stakeholders.

Panel Conveners/Coordinators
Diana Slade, Australian National University
Suzanne Eggins, Australian National University

Presenters
Diana Slade, Australian National University
Suzanne Eggins, Australian National University
Lesley Stirling, University of Melbourne
Jean Paul, University of Melbourne
Robyn Woodward-Kron, University of Melbourne
Susy Macqueen, Australian National University
Christine Phillips, Australian National University
Tina Campbell, Australian National University
Zhengdao Ye
Johanna Rendle-Short, Australian National University
Katrina Anderson, Australian National University

How We Talk When We Talk About Pain

Pain is a very common experience and, thus, a very popular topic between patients and health professionals, but also between patients and caregivers. Commonly, we think of pain as something dangerous. In fact, pain is the most efficient protective system we can count on, and it works by alerting us about potential danger {Moseley, 2015 #2303}. For example, in case of a broken bone, pain will force individuals to rest to promote the healing process. However, pain can become over-protective, yielding to a constant feeling of being ‘in danger’ (e.g. tissues are healed, but pain is still present). The words commonly used to talk about pain strengthen this notion of “pain-as-a-danger”. What happens, though, when we try to rebuild people’s vocabulary towards a more “pain-as-a-protection” frame?

Aside from anecdotal reports and some behavioural studies, there is very little research on pain language. Interestingly, the McGill Pain Questionnaire {Melzack, 1975 #3392} remains the most widely used tool to ask patients to describe their pain. Patients can choose from a list of pain descriptors, but they often report that those are not words that they would spontaneously use to describe their pain. Dr Valeria Bellan (School of Psychology, UniSA) will show some neurophysiological data on the relationship between language and pain. Dr Emma Karran (School of Health Sciences, UniSA) will focus on the context of pain recovery, by showing data about how practitioners explain pain experience based on clinical information they have access to. Finally, Tim Cocks (Neuro Orthopaedic Institute, Adelaide) will focus on an internationally taught education program used to develop patients’ awareness between pain language and pain physiology, in the context of pain recovery.

Panel Convener/Coordinator
Valeria Bellan, University of South Australia

Presenters
Valeria Bellan, University of South Australia
Emma Karran, University of South Australia
Tim Cocks, Neuro Orthopaedic Institute

The Role of Communication in Determining Health Care Safety, Quality and Equity for Indigenous Australians

In the Northern Territory and remote regions of Western Australia Aboriginal languages remain strong: in the NT 30% of the population are Aboriginal and almost 70% speak an Aboriginal language at home. However, few health service providers share the language or cultural background of their Aboriginal clients and ineffective communication is pervasive. This seriously compromises the safety and quality of health care as well as equity of access to health services for Aboriginal people who do not speak English as their primary language. Research in northern Australia has identified serious consequences of ineffective communication but implementation of strategies to improve communication – and therefore health outcomes - remains inadequate. This panel will bring together diverse perspectives, drawing on both research and practice, to uncover and explore challenges in intercultural health communication that are often unrecognized. Such challenges include: cultural differences in conceptualisations of health and communication; compounding disadvantage for those with a communication disability; unconscious bias; incorrect assumptions about extent of shared understanding and challenges in ensuring informed consent. Strategies to reveal and address these ‘hidden issues’ will also be explored: innovative education for health staff to address unconscious bias and negative assumptions; uncovering sources of miscommunication, particular in consent processes, and increasing staff competence in engaging with interpreters. The audience will also be invited to contribute to a discussion about how sustained improvements in communication between health staff and their Aboriginal clients can be achieved, recognizing this as fundamental to ensuring equity, safety and quality of services – and to improving health outcomes.

Panel Convener/Coordinator
Anne Lowell, Charles Darwin University

Presenters
Galathi Dhurrkay, Menzies School of Health Research
Deborah Hersh, Edith Cowan University
Ben Grimes, Charles Darwin University
Vicki Kerrigan, Menzies School of Health Research
Elise O’Connor, Top End Health Service
Robyn Aitken (PANEL CHAIR), Top End Health Service and Menzies School of Health Research

Navigating without Maps: Communicative Expertise in Psychiatry, Aged Care and Care-in-place.

In the context of accelerating complexity in healthcare provision, there are increasing demands on the communicative expertise required of practitioners, clients and their families to navigate the processes involved (Iedema et al. 2015). This panel focuses on three examples that illustrate the need for research that explores the nature of this communicative expertise with a view to informing training and support.

The first paper focuses on how psychiatrists and people experiencing thought disorder with delusions navigate the complexities of talk that arise in the context of the clinical interview. Thought disorder is exceptional in not having a clinical or training literature on communication between clinicians and patients associated with it, and more generally there is a need for research that can inform training for the psychiatric interview (Galletly & Crichton, 2011). The second paper examines how nurses and direct care workers develop methods on the ground (Garfinkel, 1967) to navigate interactions whose trajectories are not anticipated in care literature or training. There is an increasing and urgent need for research that investigates the nature of such communicative expertise and how it can be included in training and support. The third paper explores how a daughter navigates the multiple, emergent and competing narrative trajectories (Riessman, 2008) that arise in supporting her mother with dementia throughout permanent transition from care-in-place to long-term care. This is an area where research, training and support have not kept up with the policy shifts towards ageing-in-place.

The panel presenters bring an interdisciplinary focus (applied linguistic, psychiatric, age care, speech pathology) and a shared interest in research that can enhance understandings and approaches to developing the communicative expertise of practitioners and supporting clients and their families.

Panel Convener/Coordinator
Jonathan Crichton, University of South Australia

Presenters
Jonathan Crichton, University of South Australia
Fiona O’Neill, University of South Australia
Jessica Young, Flinders University, Australia; Western University, Canada
SA Health & Medical Research Institute