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Empathy as a Way of Acknowledging Patients’ Personhood in Palliative Care Interactions

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Psychologies of Ageing

Abstract

The so-called discursive turn in social psychology has provided a framework for understanding psychological processes as interactional phenomena. This chapter considers how doctors actually provide support, focusing particularly on how they empathise with their older patients during end-of-life or palliative care. Using conversation analysis to examine recordings of actual doctor-patient consultations taken from a hospice, this research demonstrates that empathy is an omnipresent feature of palliative care interaction. This means that doctors display it both when responding to patients’ emotional disclosures, and when recognising the concerns that patients might have regarding, for example, difficult-to-follow advice. These findings build upon earlier research showing the end stages of life to be individual and varied, rather than adhering to generic, one-size-fits-all conceptions of what constitutes “good death.” They also have practical implications, as well as illustrating the benefits that an approach grounded in discourse (rather than cognition) can have for research in the psychology of ageing.

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Notes

  1. 1.

    The data for this chapter are taken from 37 recordings of doctor-patient hospice consultations, which were collected as part of the “Video-based communication research and training in decision-making, empathy, and pain management in supportive and palliative care” (VERDIS) Project (see https://tinyurl.com/ybk8t3mz). Researchers on this project obtained full consent from participants for the use of their recordings in research as long as the recordings were appropriately anonymised. With this in mind, pseudonyms are used in place of the patients’ real names in this chapter. It should also be noted that, while the overwhelming majority of patients in the data were indeed older, this was not true in every case.

  2. 2.

    Extracts are presented using the conventions laid out by Jefferson (2004). These conventions were developed specifically for the transcription of talk-in-interaction, and thus render not only what was said, but how it was said (intonation, breathiness, etc.), where it was said (e.g. when two speakers talk in overlap), and any pauses or gaps within the talk. A glossary of the symbols used in this chapter can be seen in the appendix. (See, also, Hepburn and Bolden (2017) for a more detailed discussion.)

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Acknowledgements

I would like to thank the patients and doctors who participated in the study from which the data for this chapter were taken. I would also like to thank Ruth Parry for her helpful comments, Luke Feathers, Christina Faull, and LOROS hospice. Ruth Parry is funded by a National Institute for Health Research Career Development Fellowship CDF-2014-07-046. The data used in this research were collected by the “VERDIS” programme of research and training funded by The Health Foundation Insight Award RU33.

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Authors and Affiliations

  1. University of Exeter, Exeter, UK

    Joseph Ford

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  1. Joseph Ford
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Correspondence to Joseph Ford .

Editor information

Editors and Affiliations

  1. School of Social Sciences, Loughborough University, Loughborough, UK

    Elizabeth Peel

  2. School of Health and Medicine, Lancaster University, Lancaster, UK

    Carol Holland

  3. School of Psychology, Keele University, Newcastle-under-Lyme, UK

    Michael Murray

Appendix: Glossary of Transcription Symbols

Appendix: Glossary of Transcription Symbols

::::

Colons indicate that the immediately preceding sound was elongated, with more colons meaning greater elongation.

___:

Underlining indicates that the underlined sound was emphasised.

( ):

Brackets indicate that the hearing is tenuous or unclear.

=:

Equals sign indicates that two pieces of talk are connected.

.,:

Indicate different forms of ending intonation. A full stop indicates a fall and a comma indicates a partial rise.

[ ]:

Square brackets indicate overlapping talk.

(1.0):

Numbers in brackets indicate pauses, timed to the nearest tenth of a second.

(.):

Indicates a micropause, smaller than 0.2 seconds.

° °:

Degree symbols indicate that talk was noticeably quiet.

.hh hh:

Standalone h’s indicate inbreaths (preceded by full stop) or outbreaths (no full stop).

> <:

Inward-facing carets indicate that talk was noticeably fast.

< >:

Outward facing carets indicate that talk was noticeably slow.

(h):

H inside brackets within a word indicates laughter.

Hhh :

Italicised h within a word indicates breathiness.

Boldface :

Used to draw attention to analytically relevant stretches of talk.

↑↑:

Up and down arrows indicate sudden shifts in pitch.

.shih:

Used to denote a sniff, e.g. when the speaker is crying (see Hepburn and Bolden 2017).

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Ford, J. (2018). Empathy as a Way of Acknowledging Patients’ Personhood in Palliative Care Interactions. In: Peel, E., Holland, C., Murray, M. (eds) Psychologies of Ageing. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-97034-9_4

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