Dissertation Information for Myra Shoub NelsonNAME:
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SCHOOL: ADVISORS: COMMITTEE MEMBERS: MPACT Status: Fully Complete Title: The diagnostic moment and the development of patterns of communication: Retrospective accounts of interactions between persons with chronic illness and their healthcare Abstract: Interpersonal interaction within the framework of care for persons with chronic illness provides a site for study differing from previously researched patterns of diagnosis in treatment discourses of acute or urgent care. The researcher finds that long term relationships between healthcare providers and persons with chronic illness change over time. By the use of narrative analysis, three critical moments in the experience of persons with insulin-dependent diabetes are examined: diagnosis, change of healthcare provider (HCP), and evolution of self in chronic illness. Diagnosis is envisioned as a tri-phasic phenomenon; including a pre-diagnostic phase, provision of the diagnosis, and initiation of treatment. The communicative characteristics of each phase is explicated. Change of HCP is the second critical moment presented. A typology of types of change is derived, as are the five moves toward change of provider. Understanding the primary place of the patient with chronic illness (CI) in the process of change of provider leads to the development by the researcher of a model of communication interaction. This model, the Effective Patient-Provider Communication Difference Model, was designed specifically for this study. When a patient does not find synchrony with the provider, he or she may choose to seek alternative care. This can be seen as the result of a mismatch between patient communication needs and provider presentation. When patient and provider have similar needs, effective patient provider communication is facilitated. The evolution of the person with diabetes over a period of years and multiple changes of healthcare providers is examined through the lens of the effective patient provider communication difference model. Shaping of patient provider relationships through positive and negative relational communication patterns are detailed. Networks of care surrounding patients with CI and the rationale for underlying shifts of these communication patterns with providers are explored. The dynamic nature of these communication patterns are seen as enacted through patient-provider interaction. |
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