Article published in:
Communicating Certainty and Uncertainty in Medical, Supportive and Scientific Contexts
Edited by Andrzej Zuczkowski, Ramona Bongelli, Ilaria Riccioni and Carla Canestrari
[Dialogue Studies 25] 2014
► pp. 183–200

Diagnostic news delivery

A microanalysis of the use of shields

| University of Calabria, Italy
| University of Calabria, Italy
This paper focuses on the issue of diagnostic news delivery by addressing the research questions of how doctors shield language when breaking bad news to patients and how shields are positioned within the sequential order of these interactions. Empirical research was conducted on a collected corpus of authentic interactions through microanalysis of their epistemic organisation. Findings showed that when doctors were uncomfortable in giving bad news they mainly used verbs and verb phrases to shield the seriousness of the news. Different categories of shields were also used according to varying levels of distress. Following the biomedical SPIKES Protocol, different degrees of certainty were found in the step of Knowledge, whereas mitigating devices occurred in the steps of Empathy and Strategy.
Published online: 26 November 2014
https://doi.org/10.1075/ds.25.09pla
References

References

Adisa, Adeyinka Charles, and Ausy Mbanasu
2004 “Breaking Bad News to Patients.” Journal of Medical Investigation and Practice 4: 49–54.Google Scholar
Andersen, Gisle
2001 Pragmatic Markers and Sociolinguistic Variation: A Relevant-Theoretic Approach to the Language of Adolescents. Amsterdam: John Benjamins. CrossrefGoogle Scholar
Austin, John
1975 How to Do Things with Words (2nd ed.). Oxford: Oxford University Press. CrossrefGoogle Scholar
Baile, Walter F., Robert Buckman, Renato Lenzi, Gary Glober, Estela A. Beale, and Andrzej P. Kudelka
2000 “SPIKES-a Six-step Protocol for Delivering Bad News: Application to the Patient with Cancer.” Oncologist 5: 302–311. CrossrefGoogle Scholar
Barton, Ellen L., and Gail Stygall
2002 Discourse Studies in Composition. Cresskill, NJ: Hampton Press.Google Scholar
Blanch, Danielle, Judith Hall, Debra Roter, and Richard Frankel
2009 “Is it Good to Express Uncertainty to a Patient? Correlates and Consequences for Medical Students in a Standardized Patient Visit.” Patient Education & Counseling 76: 300–306. CrossrefGoogle Scholar
Buckman, Robert
1984 “Breaking Bad News: Why is it Still so Difficult?” British Medical Journal 288: 1597–1599. CrossrefGoogle Scholar
1992 Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press.Google Scholar
2005 “Breaking Bad News: The S-P-I-K-E-S Strategy.” Community Oncology 2 (2): 138–142. CrossrefGoogle Scholar
Caffi, Claudia
2007 Mitigation. New York: Elsevier.Google Scholar
Costello, John
2004 “Is it Always Ethical for Health Professionals to Tell the Truth about Cancer?” Cancer Nursing Practice 3 (8): 25–30. CrossrefGoogle Scholar
Dwamena, Francesca, Churlsun Han, and Robert Smith
2008 “Breaking Bad News: A Patient-centered Approach to Delivering an Unexpected Cancer Diagnosis.” Seminars in Medical Practice 11: 11–20.Google Scholar
Fogarty, Linda
1999 “Can 40 Seconds of Compassion Reduce Patient Anxiety?” Journal of Clinical Oncology 17 (1): 371–379.Google Scholar
Goffmann, Erving
1978 “Response Cries.” Language 54: 787–815. CrossrefGoogle Scholar
1983 “The Interaction Order.” American Sociological Review 48: 1–17. CrossrefGoogle Scholar
Hamilton, Heidi E.
2004 “Symptoms and Signs in Particular. The Influence of the Medical Concern on the Shape of Physician-Patient Talk.” Communication and Medicine 1 (2): 59–70. CrossrefGoogle Scholar
Hayes, Isaac
1995 “Code of Ethics.” In The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries, ed. by Robert Baker, 75–88. Dordrecht: Kluwer Academic Publishers.Google Scholar
Heritage, John, and Steven Clayman
2010 Talk in Action: Interactions, Identities, and Institutions. Chichester: Wiley-Blackwell. CrossrefGoogle Scholar
Higgins, Donna
2002 “Breaking Bad News in Cancer Care. Part 2: Practical Skills.” Professional Nurse 17 (11): 670–671.Google Scholar
Holmes, Janet
1982 “Expressing Certainty and Doubt in English.” RELC Journal 13 (2): 9–29. CrossrefGoogle Scholar
Hoye, Leo
1997 Adverbs and Modality in English. London, New York: Longman.Google Scholar
Huebler, Axel
1983 Understatements and Hedges in English. Amsterdam: John Benjamins. CrossrefGoogle Scholar
Hyland, Ken
1998 Hedging in Scientific Research Articles. Amsterdam: John Benjamins. CrossrefGoogle Scholar
Jones, William
1923 Hippocrates with an English Translation, Vol. 2. London: Heinemann.Google Scholar
Martinovski, Bilyana, Wenji Mao, Jonathan Gratch, and Stacy Marsella
2005 “Mitigation Theory: An Integrated Approach.” In Proceedings of the Twenty-Seventh Annual Conference of the Cognitive Science Society, ed. by Bruno Bara, Lawrence Barsalou, and Monica Bucciarelli, 1407–1412. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Maynard, Douglas W.
2003 Bad News Good News. Conversational Order in Everyday Talk and Clinical settings. Chicago: The University of Chicago Press.Google Scholar
2004 “On Predicating a Diagnosis as an Attribute of a Person.” Discourse Studies 6 (1): 53–76. CrossrefGoogle Scholar
Maynard, Douglas W., and Richard M. Frankel
2006 “On Diagnostic Rationality: Bad News, Good News, and the Symptom Residue.” In Communication in Medical Care. Interaction Between Primary Care Physicians and Patients, ed. by John Heritage, and Douglas W. 
Maynard, 248–278. Cambridge: Cambridge University Press. CrossrefGoogle Scholar
Murphy, Bróna
2010 Corpus and Sociolinguistics. Amsterdam: John Benjamins. CrossrefGoogle Scholar
Narayanan, Vijayakumar, Bibek Bista, and Cheriyan Koshy
2010 “‘BREAKS’ Protocol for Breaking Bad News.” Indian Journal of Palliative Care, May-Aug; 16 (2): 61–65. CrossrefGoogle Scholar
Nikula, Tarja
1996 Pragmatic Force Modifiers. A Study in Interlanguage Pragmatics. Jyväskylä: University of Jyväskylä.Google Scholar
1997 “Interlanguage View on Hedging.” In Hedging and Discourse: Approaches to the Analysis of a Pragmatic Phenomenon in Academic Texts, ed. by Raija Markkanen, and Harmut Schröder, 188–207. Berlin: Walter de Gruyter.Google Scholar
Odebunmi, Akim
2008 “Pragmatic Strategies of Diagnostic News Delivery in South-western Nigerian Hospitals.” Linguistic Online 36 (4): 21–37.Google Scholar
Prince, Ellen F., Joel Frader, and Charles Bosk
1982 “On Hedging in Physician-physician Discourse.” In Linguistics and the Professions: Proceedings of the Second Annual Delaware Symposium on Language Studies, ed. by Robert J. Di Pietro, 83–97. Norwood, NJ: Ablex.Google Scholar
Rabow, Michael, and Stephen McPhee
1999 “Beyond Breaking Bad News: How to Help Patients Who Suffer.” The Western Journal of Medicine 171: 260–263.Google Scholar
Schneider, Stefan
2010 “Mitigation.” In Interpersonal Pragmatics ed. by Miriam A. Locher, and Sage L. Graham, 253–270. Berlin: Walter de Gruyter.Google Scholar
Sperber, Dan, Fabrice Clément, Christophe Heintz, Olivier Mascaro, Hugo Mercier, Gloria Origgi, and Deirdre Wilson
2010 “Epistemic Vigilance.” Mind & Language 25 (4): 359–393. CrossrefGoogle Scholar
Spicker, Stuart
1992 “Ethics in Diagnosis: Bodily Integrity, Trust-Telling, and the Good Physician.” In The Ethics of Diagnosis, ed. by José Luis Peset, and Diego Gracia, 107–122. 
Dordrecht: Kluwer Academic Publishers. CrossrefGoogle Scholar
Stivers, Tanya, Lorenza Mondada, and Jakob Steensig
(eds.) 2011 The Morality of Knowledge in Conversation. Cambridge: Cambridge University Press. CrossrefGoogle Scholar
Vandekieft, Gregg
2001 “Breaking Bad News.” American Family Physician 64 (12): 1975–1978.Google Scholar
Varttala, Teppo
2001 “Hedging in Scientifically Oriented Discourse. Exploring Variation According to Discipline and Intended Audience.” Acta Electronica Universitatis Tamperensis. Available at: http://​acta​.uta​.fi.Google Scholar
Wodak, Ruth
2006 “Medical Discourse: Doctor Patient Communication.” In Encyclopedia of Language & Linguistics, (vol. 7, 2nd ed.), ed. by Keith Brown, 681–687. Oxford: Elsevier. CrossrefGoogle Scholar