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In:Dialogues of the Clinic: Encounters across medicine and beyond
Edited by Mariaelena Bartesaghi and Shelby Forbes
[Dialogue Studies 36] 2026
► pp. 175–203

Chapter 7
Patients’ narratives in oncology consultations

How doctors can facilitate dialogue and agency

 | University of Modena and Reggio Emilia
This content is being prepared for publication; it may be subject to changes.
Abstract
Enhanced by “medical dialogue” and increasingly promoted within healthcare systems, patient-centred approaches consider patients as individuals with personal needs, fears, stories, questions, and suggestions for their care. In this chapter, I define dialogue as a particular form of communication usually enhanced by specific actions and expectations, which can facilitate patients’ active participation and agency in interactions with practitioners. Presenting data from 106 consultations video-recorded in five oncological units in hospitals in Northern Italy, this chapter focuses on doctors’ dialogic facilitation of patients’ initiatives, presented in narrative format, within first-time visits. In my analysis of transcribed excerpts of the consultation, I show the communicative actions by which physicians dialogically facilitate and co-construct patient narratives, and detail the effects this has on interaction, particularly in relation to the discovery of the symptoms, the impact the illness has on the patient’s identity and emotional well-being and the potential implications for their care.
Article outline
  • 1.Introduction
  • 2.The medical consultation as a system of interaction:
    Moving away from doctor-centred and monologic approaches
  • 3.Towards patient-centred approaches in medical consultations: Personal expressions and agency
  • 4.From medical dialogue to dialogic facilitation
  • 5.Facilitating and co-constructing narratives
  • 6.Description of the data
  • 7.Data analysis
    • 7.1The discovery of the problem in Radiology and Breast Cancer Unit
    • 7.2The discovery of the problem and patient identity in Radiology
  • 8.Patient identity in the Breast Cancer Surgery department
  • 9.Emotional narratives in the Radiology unit
  • 10.Conclusion
  • Notes
  • References
References (45)
References
Abramovitch, Henry and Eliezer Schwartz. 1996. “Three Stages of Medical Dialogue.” Theoretical Medicine and Bioethics 17(2): 175–187. Google Scholar logo with link to Google Scholar
Baker, Mona. 2006. Translation and Conflict: A Narrative Account. London: Routledge. Google Scholar logo with link to Google Scholar
Bamberg, Michael. 2006. “Stories Big and Small: Why Do We Care?” Narrative Inquiry 16(1): 139–147. Google Scholar logo with link to Google Scholar
Baraldi, Claudio. 2017. “Language Mediation as Communication System.” Communication Theory 27(4): 367–387. Google Scholar logo with link to Google Scholar
. 2022. Facilitating Children’s Agency in the Interaction. Challenges for the Education System. London: Palgrave Macmillan.Google Scholar logo with link to Google Scholar
. 2023. “Agency in and for Mediating in Public Service Interpreting.” In The Routledge Handbook of Public Service Interpreting, ed. by Laura Gavioli and Cecilia Wadensjö, 46–62. London: Routledge. Google Scholar logo with link to Google Scholar
Bohm, David. 1996. On Dialogue. New York: Routledge.Google Scholar logo with link to Google Scholar
Brody, Howard. 1994. “‘My Story is Broken; Can You Help Me Fix It?’ Medical Ethics and the Joint Construction of Narrative.” Literature and Medicine 13: 79–92. Google Scholar logo with link to Google Scholar
Buber, Martin. 1958. I and Thou, 2nd edition. New York: Charles Scribner’s Sons.Google Scholar logo with link to Google Scholar
Buckman, Robert A. 2005. “Breaking Bad News: The S-P-I-K-E-S Strategy.” Community Oncology 2: 183–142. Google Scholar logo with link to Google Scholar
Busch, Isolde, Francesca Moretti, Giulia Travaini, Albert W. Wu, and Michela Rimondini. 2019. “Humanization of Care: Key Elements identified by Patients, Caregivers, and Healthcare Providers. A Systematic Review.” Patient 12(5): 461–474. Google Scholar logo with link to Google Scholar
Charon, Rita. 2001. “The Patient-Physician Relationship. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust.” JAMA 286(15): 1897–1902. Google Scholar logo with link to Google Scholar
. 2006. Narrative Medicine: Honouring the Stories of Illness. Oxford: Oxford Academic. Google Scholar logo with link to Google Scholar
Chatwin, John, Sarah Collins, Ian S. Watt, and Rowena Field. 2007. “A Feeling of Equality: Some Interactional Features that Build Rapport and Mutuality in a Therapeutic Encounter.” In Patient Participation in Health Care Consultations: Qualitative Perspectives, ed. by Sarah Collins, Nicky Britten, Johanna Ruusuvuori, and Andrew Thompson, 83–103. Maidenhead, UK: Open University Press.Google Scholar logo with link to Google Scholar
Davies, Brown and Rom Harré. 1999. “Positioning and Personhood.” In Positioning Theory, ed. by Rom Harré and Luk van Langenhove, 32–52. Oxford: Blackwell.Google Scholar logo with link to Google Scholar
Epstein, Ronald M., Peter Franks, Kevin Fiscella, Cleveland G. Shields, Sean C. Meldrum, Richard L. Kravitz, and Paul R. Duberstein. 2005. “Measuring Patient-Centered Communication in Patient-Physician Consultations: Theoretical and Practical Issues. Social Science & Medicine 61(7): 1516–1528. Google Scholar logo with link to Google Scholar
Epstein, Ronald M., and Richard L. Street Jr. 2007. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda, MD: National Cancer Institute.Google Scholar logo with link to Google Scholar
Georgakopoulou, Alexandra. 2007. Small Stories, Interaction, and Identities. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
Gergen, Kenneth J., Sheila McNamee, and Frank J. Barrett. 2001. “Towards Transformative Dialogue.” International Journal of Public Administration 24(7/8): 697–707. Google Scholar logo with link to Google Scholar
Halkowski, Timothy. 2006. “Realizing the Illness: Patients’ Narrative of Symptoms Discovery.” In Communication in Medical Care: Interaction between Primary Care Physicians and Patients, ed. by John Heritage and Douglas W. Maynard, 86–114. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Heritage, John and Douglas W. Maynard. 2006. “Introduction: Analysing interaction between doctors and patients in primary care encounters.” In Communication in Medical Care: Interaction between Primary Care Physicians and Patients, ed. by John Heritage and Douglas W. Maynard, 1–21. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Heritage, John and Geoffrey T. Raymond. 2005. “The Terms of Agreement: Indexing Epistemic Authority and Subordination in Talk-in-Interaction.” Social Psychology Quarterly 68(1): 15–38. Google Scholar logo with link to Google Scholar
Heritage, John and Jeffrey D. Robinson. 2006. “The Structure of Patients’ Presenting Concerns: Physicians’ Opening Questions.” Health Communication 19(2): 89–102. Google Scholar logo with link to Google Scholar
Jefferson, Gayle. 2004. “Glossary of Transcript Symbols with an Introduction.” In Conversation Analysis: Studies from the First Generation, ed. by Gene H. Lerner, 43–62. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
Kalitzkus, Vera and Peter F. Matthiessen. 2009. “Narrative-based Medicine: Potential, Pitfalls, and Practice.” The Permanent Journal 13(1): 80–86. Google Scholar logo with link to Google Scholar
Koenig, Cristopher J. 2011. “Patient Resistance as Agency in Treatment Decision.” Social Science & Medicine 72(7): 1105–1114. Google Scholar logo with link to Google Scholar
Littlejohn, Stephen W. 2004. “The Transcendent Communication Project: Searching for a Practice of Dialogue.” Conflict Resolution Quarterly 21(3): 337–359. Google Scholar logo with link to Google Scholar
Luhmann, Niklas. 1995. Social Systems. Stanford: Stanford University Press.Google Scholar logo with link to Google Scholar
Norrick, Neal R. 2007. “Conversational Storytelling.” In The Cambridge Companion to Narrative, ed. by David Herman, 127–141. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Ochs, Elinor and Lisa Capps. 2001. Living Narrative. Creating Lives in Everyday Storytelling. Cambridge, MA: Harvard University Press.Google Scholar logo with link to Google Scholar
Pearce, Barnett W. 1989. Communication and the Human Condition. Carbondale, Southern Illinois: University Press.Google Scholar logo with link to Google Scholar
Pearce, Barnett W. and Kimberly A. Pearce. 2003. “Taking a Communication Perspective on Dialogue.” In Dialogue: Theorizing Difference in Communication Studies, ed. by Rob Anderson, Leslie A. Baxter, and Kenneth N. Cissna, 39–56. Thousand Oaks: Sage.Google Scholar logo with link to Google Scholar
Robinson, Jeffrey D. 2003. “An Interactional Structure of Medical Activities during Acute Visits and its Implications for Patients’ Participation.” Health Communication 15(1): 27–57. Google Scholar logo with link to Google Scholar
2006. “Soliciting Patients’ Presenting Concerns.” In Communication in Medical Care: Interactions between Primary Care Physicians and Patients, ed. by John Heritage and Douglas W. Maynard, 22–47. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Robinson, Jeffrey D., Donald R. Hoover, Maria K. Venetis, Thomas J. Kearney, and Richard L. Street Jr. 2013. “Consultations between Patients with Breast Cancer and Surgeons: A Pathway from Patient-Centered Communication to Reduced Hopelessness.” Journal of Clinical Oncology 31(3): 351–358. Google Scholar logo with link to Google Scholar
Rossi, Elisa. 2021. “The Social Construction of Gender in Medical Interactions: A Case for the Perpetuation of Stereotypes?” Health Communication 36(9): 1125–1135. Google Scholar logo with link to Google Scholar
. 2022. “Il dialogo medico nelle interazioni pediatriche. Azioni comunicative per promuovere la partecipazione attiva e l’approccio centrato sul paziente.” Salute e Società XXI (2): 165–179. Google Scholar logo with link to Google Scholar
Roter, Debra L. and Judith A. Hall. 2006. Doctors Talking with Patients/Patients Talking with Doctors. Improving Communication in Medical Visits. London: Bloomsbury Academic. Google Scholar logo with link to Google Scholar
Sarangi, Srikant. 2001. “Editorial on Demarcating the Space between ‘Lay Expertise’ and ‘Expert Laity.’” Text & Talk 21(1/2): 3–11. Google Scholar logo with link to Google Scholar
Somers, Margaret R. 1994. “The Narrative Constitution of Identity: A Relational and Network Approach.” Theory and Society 23: 605–649. Google Scholar logo with link to Google Scholar
Stivers, Tanya and John Heritage. 2001. “Breaking the Sequential Mould: Narrative and Other Methods of Answering ‘More Than the Question’ during Comprehensive History Taking.” Text & Talk 21(1): 151–185.Google Scholar logo with link to Google Scholar
Street, Richard L. Jr. and Bradford Millay. 2001. “Analyzing Patient Participation in Medical Encounters.” Health Communication 13(1): 61–73. Google Scholar logo with link to Google Scholar
Ten Have, Paul. 2001. “Lay Diagnosis in Interaction.” Text & Talk 21(1/2): 251–260.Google Scholar logo with link to Google Scholar
Waring, Justin J. 2009. “Constructing and Re-constructing Narratives of Patient Safety.” Social Science and Medicine 69(12): 1722–1731. Google Scholar logo with link to Google Scholar
Zandbelt, Linda C., Ellen M. A. Smets, Frans J. Oort and Hanneke C. J. M. de Haes. 2005. “Coding Patient-Centred Behaviour in the Medical Encounter.” Social Science & Medicine 61(3): 661–671. Google Scholar logo with link to Google Scholar
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