Practitioners’ dilemmas and strategies in decision-making conversations where patients and companions take divergent positions on a healthcare measure An observational study using conversation analysis

Funded by

The Health Foundation Logo

22 September 2020

Published journal: Health Communication


The presence of companions adds complexity to healthcare interactions. Few studies have characterized challenges arising when interactions involve healthcare professionals (HCPs), patients, and companions, or how those challenges are managed. Using conversation analysis, we examined recorded episodes where patients and companions adopt divergent positions on healthcare measures (for example walking aids, homecare, medications). We found nine such episodes within a dataset of 37 palliative care consultations with 37 patients, their companions, and ten healthcare practitioners (HCPs) – doctors, physiotherapists and occupational therapists. Palliative care is one of several healthcare domains where companions substantially contribute to care, consultations, and decision making. We propose that, when patients and companions adopt divergent positions, HCPs face a ‘dilemma of affiliation’ wherein taking a position on the healthcare measure (for example recommending it) entails siding with one party, against the other. By examining what happens in the face of patient-companion divergence, we characterize HCPs’ strategies and substantiate our proposal that these reflect an underlying dilemma. We show that: HCPs do not immediately take a position on the healthcare measure after patient-companion divergence emerges; and when HCPs take a position later in the consultation, they do so without ostensibly siding with the party who previously supported the healthcare measure. Further, once an HCP takes a position, the party who supports the measure can treat the HCP as an ally. We offer insights and propose implications for: palliative care; the interactional complexities of healthcare decision-making; and consultations in which companions participate.


Marco Pino, Ann Doehring & Ruth Parry (2020) Practitioners’ Dilemmas and Strategies in Decision-making Conversations Where Patients and Companions Take Divergent Positions on a Healthcare Measure: An Observational Study Using Conversation Analysis, Health Communication, DOI: 10.1080/10410236.2020.1813952

You might also like...

Press release

Government must be honest about consequences of not introducing new COVID-19 measures for the NHS

Press release

Health Foundation response to the latest NHS performance statistics.

Press release

Landmark international study highlights need to reduce time that hip fracture patients spend in hospital in England

Press release

Innovative international study uses electronic medical records to compare the cost and quality of...

Press release

Kjell-bubble-diagramArtboard 101 copy

Get social

RT @theQCommunity: 💭 What role can improvement play in supporting NHS productivity? @AnitaMehay, Improvement Fellow at the @HealthFdn, exp…

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more