Negotiating Conversation and Interaction Through Videoconferencing in Speech Language Therapy

1. Negotiating conversation and interaction through videoconferencing in speech language therapy: a conversation analytic study DAVID Dalley

2. Overview of presentation • Background to the research • The current study • Methodology • Analysis • Findings • Discussion and implications • Questions

3. Background to the research • Health care professional - patient interaction • The practice of medicine and restoration of an individual’s health is intimately associated with the ways in which health care professionals and patients communicate (Heath, 1986). • Speech and language therapy for head and neck cancers • Concerned with the rehabilitation of communication and swallowing abilities resulting from a wide range of health-related problems (Royal College of Speech Language Therapists, n.da) • Telemedicine • Telemedicine represents a valuable resource in order to deliver health-care to individuals and communities in remote locations (Miller, 2003)

4. The current study • The purpose of the study was to develop understanding of how medical tasks are achieved when using telemedicine videoconferencing in speech and language therapy • extended requests were identified as means by which medical tasks were achieved • The aim of the study was to understand how medical tasks are achieved through extended requests in physical examination sequences during speech language therapy consultations delivered via telemedicine videoconferencing. • The study also examined how different participants in the consultation are involved in achieving extended requests when using telemedicine videoconferencing.

5. Methodology • Research carried out with Macmillan speech and language therapy service for head and neck cancer patients. • Main telehealth provider linked with 5 hospitals across rural locations in mid wales • 16 naturally occurring consultations spanning 8 hours and 58 minutes of data with. Consultations ranged in duration from 14mins 52 seconds to 58 mins 35 seconds • The data consisted of audio and video recordings • Data was analysed using Conversation analysis and transcribed using the Jefferson transcription system

6. Conversation analysis • CA is concerned with the systematic analysis of talk • Utterances within interaction can be considered as objects which are drawn upon in order to achieve things, for example a question can be drawn upon to obtain information from a recipient (Hutchby & Wooffitt, 2005) • CA is concerned with the sequential organisation of interaction and turn taking and turn construction

7. Summary of findings • The initial request was initiated by the specialist speech and language therapist (SSLT) (18/20) • Initial requests projected a course of action informing the recipients of what is required to fulfil the request • Initial requests were framed as collaborative endeavours through the plural pronoun “we” • The fulfilment of the request was taken up by the general speech and language therapist (GSLT) and patient (P). • Recipients engaged in actions of incipient fulfilment (preparatory actions) • Responded through acceptance and fulfilment or immediate extended fulfilment • The GSLT played an integral role in facilitating request making and fulfilling requests.

9. Initial request with possible contingency

10. Initial request with possible contingency

11. Switching pronouns

13. Acknowledging the difficulty in fulfilment

15. Formats of responding- Extending through problem presentation

17. Formats of responding- Acceptance and fulfilment

19. Discussion and implications • Telemedicine presents individuals with novel organisational, technological and situational dilemmas, which are argued to be resolved through collaborative interactional work (Pappas & Seale, 2010) • Through adopting “we” the SSLT includes the patient as an equal in the fulfilment of the requested actions, identified as being a crucial aspect in advocating a relationship centred approach between health-care professionals and patients (Ong,DeHaes, Hoos, & Lammes, 1995) • In the context of telemedicine consultations the GSLT becomes a critical intermediary between the patient and SSLT when achieving medical tasks.

20. References • Heath, C. (1986). Body movement and speech in medical interaction. Cambridge University Press. • Hutchby, I., & Wooffitt, R. (2008). Conversation analysis. Polity. • Miller, E. A. (2003). The technical and interpersonal aspects of telemedicine: effects on doctor–patient communication. Journal of telemedicine and telecare, 9(1), 1-7. • Ong, L. M., De Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: a review of the literature. Social science & medicine, 40(7), 903-918. • Pappas, Y., & Seale, C. (2010). The physical examination in telecardiology and televascular consultations: a study using conversation analysis. Patient education and counseling, 81(1), 113-118. • Royal college of speech language therapists (n.daA) What is speech and language therapy? Royal college of speech language therapists. Retrieved from: https://www.rcslt.org/speech_and_language_therapy/docs/factsheets/what_is_slt