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36 Complaint implicative sequences in palliative care consultations – an exploratory observational study using conversation analysis
  1. Ruth England
  1. Loughborough University, University Hospitals of Derby and Burton


Background ‘Patient safety’ is often seen as attainable through the application of and compliance with evidence-based guidelines and protocols. However, there is a difference between being safe and feeling safe. ‘Feeling safe’ in healthcare depends on the ongoing interactions of people with one another and their surroundings. This project, undertaken as part of MSc study, explores moments of clinician-patient interaction that are potentially ‘unsafe’ – where conversational activity can be described as complaint-implicative; that is, where there is some expression of discontent about some state of affairs for which responsibility can be attributed to ‘someone’.

Method Ethical permission was granted for access to a corpus of audiovisual recordings of naturally occurring clinical consultations between therapists (physiotherapists, occupational therapists), patients and carers in a hospice. Conversation Analysis (CA) was used to examine these interactions. A collection of episodes that appeared complaint implicative were transcribed according to Jeffersonian conventions and analysed, including in CA data sessions with other experienced scholars.

Results In this context, complaint can be intangible. Most episodes are ‘indirect’ complaints, where the target of the complaint is not the complaint recipient. I also identified a handful of ‘direct’ complaints, where the complaint recipient was made in some way personally accountable for a possible transgression. Therapists responded to direct complaints in ‘mid-range’ ways that were neither affiliating nor disaffiliating. Where such activity was not embedded in problem presentation, it delayed progression to a projected activity; participants worked to re-orient quickly to the clinical project at hand.

Conclusion Further research is required to determine whether these findings are typical in hospice consultation. Results of this initial exploratory project may add to the evidence that underpins communication skills training for clinicians working in palliative care.

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