Using conversation analysis to explore communication of cardiovascular disease and cancer risk in primary care
The communication of cardiovascular disease (CVD) risk to patients is incorporated into many clinical guidelines and the NHS Health Checks programme. Similar models predicting risk of cancer have been developed but are much less widely used. Studies in CVD show that healthcare professionals (HCPs) adopt a range of approaches when communicating risk. The aim of this study is to use conversation analytic (CA) methods to explore the range of language and communication techniques used by HCPs when discussing risk of CVD and cancer with patients, and the way these different approaches shaped patient decisions about lifestyle change and medication.
Patients were recruited from 5 GP practices in the East of England. HCPs were trained to give patients their estimated risk of cancer in addition to their CVD risk within NHS Health Checks. Questionnaire data was collected from patients, immediately and 3 months after the consultation, on intention to change behaviour and take prescribed medications. 30 intervention consultations were recorded with patient and healthcare professional consent and transcribed verbatim. Extended sequences of talk immediately preceding and through the communication of CVD and cancer risk were identified and transcribed in further detail according to Jeffersonian conventions.On completion of follow-up data collection in March 2019, potential relationships between the qualitative CA findings and the quantitative questionnaire data will be explored.
CA analysis is currently underway. The analysis is focused on the recurrent practices through which actions are designed, sequences are organized, and activities associated with the intervention are accomplished. Preliminary findings indicate to deliver CVD and cancer risk and recommend lifestyle changes often required delicacy. HCPs were observed to orient to this delicacy using linguistic resources and bodily conduct. HCP engagement in ‘online commentary’ whilst collecting key data or measurements was also observed to shape patient expectations prior to risk communication. We noted that there were distinct activity phases that HCPs needed to jointly achieve with patients, such as information gathering, risk calculation, and advice-giving. Results showed that the ordering of these activities affected the smooth running of the consultation. Advice-giving before risk was calculated often meant that the advice was not tailored to patients’ individual needs [for behaviour change], whilst placing this activity at the end of a consultation provided the means for a clinically effective endpoint.
To our knowledge this will be the first application of CA methods to examine risk communication between HCPs and patients during NHS Health Checks. Through examining different communication practices and their sequential trajectories and their relationship to patient reported behaviour change intentions, more or less ‘successful’ ways of communicating patient risk may be identified. These findings may then be used in evidence-based communication training for HCPs on the delivery of risk information to patients.