Special section examining risk discussions across clinical specialties using conversation analysis: From information transfer to an interactional perspective.

Abstract

Risk and uncertainty are pervasive in clinical settings, from diagnosis to treatment decision-making and disease management. Accordingly, risk communication has attracted a sustained interest, and is predominantly characterised by information transfer, with a focus on how messages are framed and received. Conversation analysis (CA) provides a different approach to analysing communication, examining the complexities of how risk is broached, is calibrated to individual contexts, and is sensitively negotiated across clinical encounters. This special section showcases original research that significantly advances our insights into risk communication, offering novel and rigorous insights from a spectrum of actual clinical encounters. Seven original papers present analyses of authentic recordings of clinical encounters in the U.K., USA, and Sweden across a range of clinical specialties (primary care, obstetrics, nephrology, paediatrics, and neurology). The nature of the risks varies from immediate and high-stakes situations (such as during labour and delivery), to more distal severe risks (seizure-related unexpected death or fatal anaphylaxis). Other studies examine the likelihood of illness development. Collectively, these studies illustrate the projectability of risk, the collaborative construction of (and resistance to) risk-oriented lifestyle behaviours, and the ways in which patient/carer concerns or worries are invoked. They highlight practices for gathering risk-related information, and the pivotal ways in which risk discussions can facilitate shared decision-making. Studies also show practical ways clinicians sensitively address severe outcomes or morally charged matters of risk-relevant lifestyle behaviours, carefully progressing from establishing a patient's current understanding to providing recommendations. The final paper explores how these types of studies can be translated into training. A guest commentary provides a broad reflection on how CA investigations advance the field of risk communication. Overall, this special section highlights the promise of interactional studies in clinical risk communication, provides recommendations for future research, and calls for the systematic integration of this knowledge into clinical practice.