Communication in Health Care
We have collaborated on projects locally with physicians and nurses at the British Columbia Cancer Agency, Vancouver Island Centre (BCCA/VIC) and Jennifer Gerwing works internationally in Oslo, Norway using microanalysis of face to face dialogue to study communication between patients and health care providers.
Communication between patients and health care providers
Jennifer Gerwing is a senior researcher at the Health Services Research Unit at Akershus University
Hospital (Oslo, Norway) and associate professor at Oslo Metropolitan University, Department for
prehospital education and research, Institute for Nursing and Health promotion. Her research team has
numerous publications using microanalysis of face-to-face dialogue, which they have adapted to the
clinical setting (Gerwing, Healing, Menichetti, 2023).
Gerwing, J., Healing, S., Menichetti, J. Microanalysis of Clinical Interaction (MCI) (2023) in Rossi, M G., Bigi, S. (Eds) A pragmatic agenda for healthcare: fostering inclusion and active participation through shared understanding (pp. 43-74). John Benjamins.
Menichetti, J., Gulbrandsen, P., Landmark, A., Lie, H., Gerwing, J. (accepted) How do physicians frame medical information in talks with their patients? An inductive microanalysis. Qualitative Health Research.
Gerwing, J., White, A.E., Henry, S. G. (accepted) Doctor corrections of patient misconceptions. Health Communication.
Larsen, B. H., Gulbrandsen, P., Førde, R., Sundeby, T., Gerwing, J. (2022) Physicians’ responses to advanced cancer patients’ existential concerns: A video-based analysis. Patient Education and Counseling, 105(10), 3062-3070. https://doi.org/10.1016/j.pec.2022.06.007
Larsen, B. H., Lundeby, T., Gerwing, J., Gulbrandsen, P., & Førde, R. (2022) “Eh – What type of cells are these – flourishing in the liver?” Cancer patients’ disclosure of existential concerns in routine hospital consultations. Patient Education and Counseling, 105 (7), 2019-2026. https://doi.org/10.1016/j.pec.2021.11.010
Nordfalk, J. M., Menichetti, J., Thomas, O., Gulbrandsen, P., & Gerwing, J., (2022) Three strategies when physicians provide complex information in interactions with patients: How to recognize and measure them. Patient Education and Counseling, 105(6), 1552-1560.
Gerwing, J., Steen-Hansen, J. E., Mjaaland, T., Fossli Jensen, B., Eielsen, O., Thomas, O., Gulbrandsen, P., (2021) Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: A pilot study of communication behaviours. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1) pp. 1-8.
Menichetti, J., Gerwing, J., Borghi, L., Gulbrandsen, P., & Vegni, E. (2021) Saying “I don’t know”: A video-based study on physicians’ claims of no-knowledge in assisted reproductive technology consultations. Frontiers of Psychology, 11. doi: 10.3389/fpsyg.2020.611074
Siddiqui, T. G., Cheng, S., Mellingsæter, M., Grambaite, R., Gulbrandsen, P., Lundqvist, C., & Gerwing, J. (2020). “What should I do when I get home?” treatment plan discussion at discharge between specialist physicians and older in-patients: mixed method study. BMC health services research, 20(1), 1-11.
Henry, S. G., White, A., Magnan, E. M., Hood-Medland, E. A., Gosdin, M., Kravitz, R. L., Torres, P. J., Gerwing, J. (2020) Making the most of video recorded clinical encounters: Optimizing impact and productivity through interdisciplinary teamwork. Patient Education and Counseling, 103, 2178-2184. https://doi.org/10.1016/j.pec.2020.06.005
Gerwing, J. & Li, S. (2019) Body-oriented gestures as a practitioner’s window into interpreted communication. Social Science & Medicine, 233, 171-180. https://doi.org/10.1016/j.socscimed.2019.05.040
Svennevig, J., Gerwing, J., Jensen, B.U. & Allison, M. (2019) Pre-empting understanding problems in L1/L2 conversations: Evidence of effectiveness from simulated emergency calls. Applied Linguistics, 40 (2), 205-227. https://doi.org/10.1093/applin/amx021
Gerwing, J., & Gulbrandsen, P. (2017) The perils of information giving: What an accidental incident taught us about messages and roles. Patient Education and Counseling, 100, 2109-2115. http://dx.doi.org/10.1016/j.pec.2017.05.009
Gerwing, J. (2017) Introducing body-directed gestures as a semiotic resource in patient-physician dialogues. In P. Paggio & C. Navarretta (Eds.), Proceedings of the 4 th European and 7 th Nordic Symposium on Multimodal Communication (MMSYM 2016), Copenhagen, 29-30 September 2016 (pp. 85-93). Linköping: Linköping University Electronic Press. ISBN: 978-91-7685-423-5.
Landmark, A.M.D., Svennevig, J., Gerwing, J. & Gulbrandsen, P. (2017) Patient involvement and language barriers: problems of agreement or understanding? Patient Education and Counseling, 100, 1092-1102. http://dx.doi.org/10.1016/j.pec.2016.12.006
Gerwing, J., Indseth, T., & Gulbrandsen, P. (2016). A microanalysis of the clarity of information in physicians’ and patients’ discussions of treatment plans with and without language barriers. Patient Education and Counseling, 99, 522-529. DOI: 10.1016/j.pec.2015.10.012
Gerwing, J., & Indseth, T. (2016). Enhancing comprehensibility in emergency calls with a language barrier: Operators in the role of addressee. International Journal of Listening, 30:3, 163-179. http://dx.doi.org/10.1080/10904018.2015.1056878
Gerwing, J. & Dalby, A. M. (2014). Gestures convey content: An exploration of the semantic functions of physicians’ gestures. Patient Education and Counseling, 96, 308-314. [Special issue of top papers from the International Conference on Communication in Healthcare, Montreal, Canada, 2013]
Recognizing patient-centered information
Sara Healing has developed a method for recognizing the patient’s unique contributions to his or her medical consultations, using video recordings of actual consultations at the BCCA/VIC. Her analysis can reliably distinguish between when the patient is contributing biomedical information (e.g., the presence of a symptom) versus patient-centered information (e.g., how the symptom affects the patient’s daily life). Training health care professionals to recognize and attend to patient-centered information adds a new dimension to patient-centered care. That is, patient-centered care is not limited to unilateral actions by the health care professional; it also includes recognizing and incorporating the information that an individual patient can provide about his or her experience of the illness. https://dspace.library.uvic.ca/handle/1828/4835
Delivering Bad News
Our first study focused on how physicians solve the dilemma of delivering bad news honesty but as kindly as possible. Earlier experiments on the use of implicit language in difficult situations (Bavelas, Black, Chovil, & Mullett, 1990) led to Del Vento’s analogue experiment that compared physicians’ language when delivering bad versus good news. The good-news condition produced explicit, direct language, while the bad-news condition revealed the use of many subtle conventions for accomplishing a truthful but less harsh version.
Training DVD on evidence-based communication principles
In collaboration with Sara Healing, Christine Tomori, and Vancouver Island Health Authority Multi-media services, Dr. Gerwing has produced a three-module training DVD about communication for health care professionals. The modules are:
Patient-Centered Assessment of Symptoms and Activities (P-CASA)
Christine Tomori has developed an open-ended assessment, the P-CASA, which examines each individual patient’s symptoms within the context of his or her daily life. P-CASA obtains information about the activities most important to the patient, what interferes with these activities, and any coping strategies the patient may have. Based on initial validation with advanced cancer patients at the BCCA/VIC Pain and Symptom Management Clinic, the P-CASA elicits information about symptoms and their severity that is not available with a standardized symptom rating list, such as the Edmonton Symptom Assessment System. The tool and full details are available to practitioners and researchers who wish to collaborate on further validation. Contact ctomori [at] uvic [dot] ca or bavelas [at] uvic [dot] ca.
Communication between patients and health care providers
Jennifer Gerwing is a senior researcher at the Health Services Research Unit at Akershus University
Hospital (Oslo, Norway) and associate professor at Oslo Metropolitan University, Department for
prehospital education and research, Institute for Nursing and Health promotion. Her research team has
numerous publications using microanalysis of face-to-face dialogue, which they have adapted to the
clinical setting (Gerwing, Healing, Menichetti, 2023).
Gerwing, J., Healing, S., Menichetti, J. Microanalysis of Clinical Interaction (MCI) (2023) in Rossi, M G., Bigi, S. (Eds) A pragmatic agenda for healthcare: fostering inclusion and active participation through shared understanding (pp. 43-74). John Benjamins.
Menichetti, J., Gulbrandsen, P., Landmark, A., Lie, H., Gerwing, J. (accepted) How do physicians frame medical information in talks with their patients? An inductive microanalysis. Qualitative Health Research.
Gerwing, J., White, A.E., Henry, S. G. (accepted) Doctor corrections of patient misconceptions. Health Communication.
Larsen, B. H., Gulbrandsen, P., Førde, R., Sundeby, T., Gerwing, J. (2022) Physicians’ responses to advanced cancer patients’ existential concerns: A video-based analysis. Patient Education and Counseling, 105(10), 3062-3070. https://doi.org/10.1016/j.pec.2022.06.007
Larsen, B. H., Lundeby, T., Gerwing, J., Gulbrandsen, P., & Førde, R. (2022) “Eh – What type of cells are these – flourishing in the liver?” Cancer patients’ disclosure of existential concerns in routine hospital consultations. Patient Education and Counseling, 105 (7), 2019-2026. https://doi.org/10.1016/j.pec.2021.11.010
Nordfalk, J. M., Menichetti, J., Thomas, O., Gulbrandsen, P., & Gerwing, J., (2022) Three strategies when physicians provide complex information in interactions with patients: How to recognize and measure them. Patient Education and Counseling, 105(6), 1552-1560.
Gerwing, J., Steen-Hansen, J. E., Mjaaland, T., Fossli Jensen, B., Eielsen, O., Thomas, O., Gulbrandsen, P., (2021) Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: A pilot study of communication behaviours. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1) pp. 1-8.
Menichetti, J., Gerwing, J., Borghi, L., Gulbrandsen, P., & Vegni, E. (2021) Saying “I don’t know”: A video-based study on physicians’ claims of no-knowledge in assisted reproductive technology consultations. Frontiers of Psychology, 11. doi: 10.3389/fpsyg.2020.611074
Siddiqui, T. G., Cheng, S., Mellingsæter, M., Grambaite, R., Gulbrandsen, P., Lundqvist, C., & Gerwing, J. (2020). “What should I do when I get home?” treatment plan discussion at discharge between specialist physicians and older in-patients: mixed method study. BMC health services research, 20(1), 1-11.
Henry, S. G., White, A., Magnan, E. M., Hood-Medland, E. A., Gosdin, M., Kravitz, R. L., Torres, P. J., Gerwing, J. (2020) Making the most of video recorded clinical encounters: Optimizing impact and productivity through interdisciplinary teamwork. Patient Education and Counseling, 103, 2178-2184. https://doi.org/10.1016/j.pec.2020.06.005
Gerwing, J. & Li, S. (2019) Body-oriented gestures as a practitioner’s window into interpreted communication. Social Science & Medicine, 233, 171-180. https://doi.org/10.1016/j.socscimed.2019.05.040
Svennevig, J., Gerwing, J., Jensen, B.U. & Allison, M. (2019) Pre-empting understanding problems in L1/L2 conversations: Evidence of effectiveness from simulated emergency calls. Applied Linguistics, 40 (2), 205-227. https://doi.org/10.1093/applin/amx021
Gerwing, J., & Gulbrandsen, P. (2017) The perils of information giving: What an accidental incident taught us about messages and roles. Patient Education and Counseling, 100, 2109-2115. http://dx.doi.org/10.1016/j.pec.2017.05.009
Gerwing, J. (2017) Introducing body-directed gestures as a semiotic resource in patient-physician dialogues. In P. Paggio & C. Navarretta (Eds.), Proceedings of the 4 th European and 7 th Nordic Symposium on Multimodal Communication (MMSYM 2016), Copenhagen, 29-30 September 2016 (pp. 85-93). Linköping: Linköping University Electronic Press. ISBN: 978-91-7685-423-5.
Landmark, A.M.D., Svennevig, J., Gerwing, J. & Gulbrandsen, P. (2017) Patient involvement and language barriers: problems of agreement or understanding? Patient Education and Counseling, 100, 1092-1102. http://dx.doi.org/10.1016/j.pec.2016.12.006
Gerwing, J., Indseth, T., & Gulbrandsen, P. (2016). A microanalysis of the clarity of information in physicians’ and patients’ discussions of treatment plans with and without language barriers. Patient Education and Counseling, 99, 522-529. DOI: 10.1016/j.pec.2015.10.012
Gerwing, J., & Indseth, T. (2016). Enhancing comprehensibility in emergency calls with a language barrier: Operators in the role of addressee. International Journal of Listening, 30:3, 163-179. http://dx.doi.org/10.1080/10904018.2015.1056878
Gerwing, J. & Dalby, A. M. (2014). Gestures convey content: An exploration of the semantic functions of physicians’ gestures. Patient Education and Counseling, 96, 308-314. [Special issue of top papers from the International Conference on Communication in Healthcare, Montreal, Canada, 2013]
Recognizing patient-centered information
Sara Healing has developed a method for recognizing the patient’s unique contributions to his or her medical consultations, using video recordings of actual consultations at the BCCA/VIC. Her analysis can reliably distinguish between when the patient is contributing biomedical information (e.g., the presence of a symptom) versus patient-centered information (e.g., how the symptom affects the patient’s daily life). Training health care professionals to recognize and attend to patient-centered information adds a new dimension to patient-centered care. That is, patient-centered care is not limited to unilateral actions by the health care professional; it also includes recognizing and incorporating the information that an individual patient can provide about his or her experience of the illness. https://dspace.library.uvic.ca/handle/1828/4835
Delivering Bad News
Our first study focused on how physicians solve the dilemma of delivering bad news honesty but as kindly as possible. Earlier experiments on the use of implicit language in difficult situations (Bavelas, Black, Chovil, & Mullett, 1990) led to Del Vento’s analogue experiment that compared physicians’ language when delivering bad versus good news. The good-news condition produced explicit, direct language, while the bad-news condition revealed the use of many subtle conventions for accomplishing a truthful but less harsh version.
- Del Vento, A. (2007) Physicians' use of indirect language to deliver medical bad news: an experimental investigation. Unpublished Master’s Thesis, Department of Psychology, University of Victoria.
Del Vento, A., Bavelas, J. B., Healing, S., MacLean, G., & Kirk, P. (2009). An experimental investigation of the dilemma of delivering bad news.
Del Vento, A., & Kirk, P. (Producers). (2008). How to break bad news. Practical tips for health care providers. DVD available frommediasales@viha.ca (at cost) or individual copies free with self-addressed stamped envelope sent to Dr. Janet Bavelas, Department of Psychology, University of Victoria, P.O. Box 3050, Victoria, BC, V8W 3P5.
Training DVD on evidence-based communication principles
In collaboration with Sara Healing, Christine Tomori, and Vancouver Island Health Authority Multi-media services, Dr. Gerwing has produced a three-module training DVD about communication for health care professionals. The modules are:
- Evidence-based Communication: Dispelling the myths”
- “Using questions effectively”
- “Achieving mutual understanding: Grounding in Communication”
Patient-Centered Assessment of Symptoms and Activities (P-CASA)
Christine Tomori has developed an open-ended assessment, the P-CASA, which examines each individual patient’s symptoms within the context of his or her daily life. P-CASA obtains information about the activities most important to the patient, what interferes with these activities, and any coping strategies the patient may have. Based on initial validation with advanced cancer patients at the BCCA/VIC Pain and Symptom Management Clinic, the P-CASA elicits information about symptoms and their severity that is not available with a standardized symptom rating list, such as the Edmonton Symptom Assessment System. The tool and full details are available to practitioners and researchers who wish to collaborate on further validation. Contact ctomori [at] uvic [dot] ca or bavelas [at] uvic [dot] ca.