Objective: This study used qualitative methods to explore patients' beliefs about control of ... more Objective: This study used qualitative methods to explore patients' beliefs about control of their end-of-life health and health care. Method: The authors recruited 30 elderly patients from a large, urban Veterans Administration medical center in the United States and engaged them in semistructured interviews about end-of-life care concepts. Using grounded theory methods, they coded, categorized, and compared responses. Results: The authors discovered that patients' decisions about using life sustaining treatment were interconnected with their beliefs about their degree of control over circumstances and the role of external factors, including a higher power; institutions and individuals; medical interventions; medical conditions; and luck, chance, or fate. Discussion: The results shed light on why patients do or do not take active roles in advance decisions concerning the use of life-sustaining treatment.
In this article we examine the discourse of four focus groups we conducted at a pediatric researc... more In this article we examine the discourse of four focus groups we conducted at a pediatric research hospital in which we queried teenage patients, parents, nurses, and physicians about their perceptions of the informed consent process in research. Autonomy, as the goal of informed consent, is a murky concept, with some ethicists questioning the possibility that it can ever be attained. We argue that it might be more productive to consider agency, which we define as language and action that are constructed, negotiated, and maintained through effective communication. Our goal was to understand how individuals rhetorically constructed agency in discussions of informed consent experiences. After transcribing and coding the focus group interviews, we identified six aspects of agency in participants' discourse: (a) defining roles, (b) seeking information, (c) providing information, (d) supporting others, (e) making decisions, and (f) claiming agency for self. Examining these aspects of...
Page 1. Keeping Users at the Center: Developing a Multimedia Interface for Informed Consent Loel ... more Page 1. Keeping Users at the Center: Developing a Multimedia Interface for Informed Consent Loel Kim, Amanda J. Young, and Robert A. Neimeyer The University of Memphis Justin N. Baker and Raymond C. Barfield St. Jude Children's Research Hospital ...
Http Dx Doi Org 10 1089 Jpm 2005 8 534, Jun 1, 2005
To explore patients&a... more To explore patients' perspectives concerning communication with medical providers about end-of-life (EOL) care. Cross-sectional survey involving semistructured interviews. Outpatient primary care clinic of a large, urban Veterans Affairs (VA) Medical Center. Male and female veterans who were 60 years or older, ambulatory, able to speak and read English, residing in the community, receiving outpatient care from the VA, not acutely ill (i.e., not hospitalized or in obvious distress), and not cognitively impaired. During audiotaped interviews to assess understanding of advance directive concepts, all 30 participants were asked what advice they would give medical students or trainees about how to discuss EOL care with patients. The audiotapes of their open-ended responses were transcribed, coded, and examined using qualitative content analysis, a systematic and replicable technique to uncover meaning by detecting commonalities and regularities of speech. Seven essential elements of advice for medical providers emerged: engage in strategies to ensure patient understanding (mentioned by 30% of participants), communicate honestly and truthfully (27%), develop a compassionate bedside manner (27%), treat others as you would want to be treated (20%), provide empathic care (20%), take the time needed to communicate (20%), and determine patient information and decision-making preferences (17%). Effective EOL discussions with patients require attention to the content, process, and perception of patient-provider communication.
Http Dx Doi Org 10 1207 S15327027hc1401_4, Dec 10, 2009
ABSTRACT This article reports our ongoing work in developing a model of health care communication... more ABSTRACT This article reports our ongoing work in developing a model of health care communication called collaborative interpretation, which we define as a rhetorical practice that generates building blocks for a more complete and coherent diagnostic story and for a collaborative treatment plan. It does this by situating patients as problem-solvers. Our study begins with an analysis of provider-patient interactions in a specific setting-the emergency department (ED) of an urban trauma-level hospital- where we observed patients and providers miscommunicating in at least 3 distinct areas: over the meaning of key terms, in the framing of the immediate problem, and over the perceived role of the ED in serving the individual and the community. From our observations, we argue that all of these miscommunications and missed opportunities are rooted in mismatched expectations on the part of both provider and patient and the lack of explicit comparison and negotiation of expectations-in other words, a failure to see the patient-provider interaction as a rhetorical, knowledge-building event. In the process of observing interactions, conversing with patients and providers, and working with a team of providers and patients, we have developed an operational model of communication that could narrow the gap between the lay public and the medical profession-a gap that is especially critical in intercultural settings like the one we have studied. This model of collaborative interpretation (CI) provides strategies to help patients to represent their medical problems in the context of their life experiences and to share the logic behind their health care decisions. In addition, CI helps both patient and provider identify their goals and expectations in treatment, the obstacles that each party perceives, and the available options. It is adaptableto various settings, including short, structured conversations in the emergency room, extended dialogue between a health educator and a patient in a clinical setting, and group discussions in support groups, community groups, or health education classrooms.
Http Dx Doi Org 10 1207 S15327027hc1901_6, Dec 10, 2009
This article reports a qualitative study of elderly veterans&... more This article reports a qualitative study of elderly veterans' perceptions of and preferences for end-of-life care. At a large urban Veterans Affairs (VA) hospital, we asked 30 veterans and 30 health care providers to define 4 terms in the VA form of the advance directive: life-sustaining treatment, terminal condition, state of permanent unconsciousness, and decision-making capacity. The veterans commonly used narratives to construct meaning, and analysis showed that the resulting texts had both a subtext (the values and goals driving the narrative) and a context (life experiences that filter and shape the current interpretation). We found that all 3 components--text, subtext, and context--are crucial to understanding the central theme of an individual's narrative and the decision-making processes associated with it. In this article we examine 1 lengthy narrative using Chafe's (1994) notion of intonation units. We then present a series of short narratives to demonstrate 3 subthemes that emerged from the data: quality of life versus quantity of life, benefit of treatment versus cost of treatment, and, most common, control versus lack of control. Our goal was to demonstrate the centrality and usefulness of storytelling in the patient-provider interaction when listeners are willing to consider the subtext and context of the story and its role in the decision-making process. As demonstrated in this study, deciphering people's stories gives us insight into their values, the mental constructs that drive their decision making, and the goals that they have for their own health care.
With tightened budgets, cuts in federal grants, and a more cautious public, the funding crisis in... more With tightened budgets, cuts in federal grants, and a more cautious public, the funding crisis in public school music programs will require the combined efforts of parents, teachers, and administrators. Executives at MENC, the National Education Association, and the ...
Journal of Health Care for the Poor and Underserved, 2007
To explore perspectives concerning use of a mobile geriatrics unit (MGU) by underserved populatio... more To explore perspectives concerning use of a mobile geriatrics unit (MGU) by underserved populations in low-income urban neighborhoods, we recruited 18 elderly African American patients and engaged them in in-depth semistructured interviews. Using grounded theory techniques of constant comparative analysis, we found that most patients learned about the MGU from community members and initially visited it to determine whether it would be worth using in the future. In describing their MGU experiences, patients tended to focus on three main factors: quality of care, accessibility of services, and ambience of the care setting. They reported that the MGU allowed them to have their health conditions and medications monitored regularly and functioned as a central link to the larger Veterans Affairs health care system. The findings suggest that using MGUs is an acceptable and effective way to help medically underserved populations receive primary medical care and referrals to specialty care.
... Amanda J. Young, PhD, is Assistant Professor, Department of Communication, University of Memp... more ... Amanda J. Young, PhD, is Assistant Professor, Department of Communication, University of Memphis. ... DO, Associate Professor of Pedia-trics, Division of Adolescent Medicine, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA 15213 (E-mail: magold@pitt.edu). ...
Objective: This study used qualitative methods to explore patients' beliefs about control of ... more Objective: This study used qualitative methods to explore patients' beliefs about control of their end-of-life health and health care. Method: The authors recruited 30 elderly patients from a large, urban Veterans Administration medical center in the United States and engaged them in semistructured interviews about end-of-life care concepts. Using grounded theory methods, they coded, categorized, and compared responses. Results: The authors discovered that patients' decisions about using life sustaining treatment were interconnected with their beliefs about their degree of control over circumstances and the role of external factors, including a higher power; institutions and individuals; medical interventions; medical conditions; and luck, chance, or fate. Discussion: The results shed light on why patients do or do not take active roles in advance decisions concerning the use of life-sustaining treatment.
In this article we examine the discourse of four focus groups we conducted at a pediatric researc... more In this article we examine the discourse of four focus groups we conducted at a pediatric research hospital in which we queried teenage patients, parents, nurses, and physicians about their perceptions of the informed consent process in research. Autonomy, as the goal of informed consent, is a murky concept, with some ethicists questioning the possibility that it can ever be attained. We argue that it might be more productive to consider agency, which we define as language and action that are constructed, negotiated, and maintained through effective communication. Our goal was to understand how individuals rhetorically constructed agency in discussions of informed consent experiences. After transcribing and coding the focus group interviews, we identified six aspects of agency in participants' discourse: (a) defining roles, (b) seeking information, (c) providing information, (d) supporting others, (e) making decisions, and (f) claiming agency for self. Examining these aspects of...
Page 1. Keeping Users at the Center: Developing a Multimedia Interface for Informed Consent Loel ... more Page 1. Keeping Users at the Center: Developing a Multimedia Interface for Informed Consent Loel Kim, Amanda J. Young, and Robert A. Neimeyer The University of Memphis Justin N. Baker and Raymond C. Barfield St. Jude Children's Research Hospital ...
Http Dx Doi Org 10 1089 Jpm 2005 8 534, Jun 1, 2005
To explore patients&a... more To explore patients' perspectives concerning communication with medical providers about end-of-life (EOL) care. Cross-sectional survey involving semistructured interviews. Outpatient primary care clinic of a large, urban Veterans Affairs (VA) Medical Center. Male and female veterans who were 60 years or older, ambulatory, able to speak and read English, residing in the community, receiving outpatient care from the VA, not acutely ill (i.e., not hospitalized or in obvious distress), and not cognitively impaired. During audiotaped interviews to assess understanding of advance directive concepts, all 30 participants were asked what advice they would give medical students or trainees about how to discuss EOL care with patients. The audiotapes of their open-ended responses were transcribed, coded, and examined using qualitative content analysis, a systematic and replicable technique to uncover meaning by detecting commonalities and regularities of speech. Seven essential elements of advice for medical providers emerged: engage in strategies to ensure patient understanding (mentioned by 30% of participants), communicate honestly and truthfully (27%), develop a compassionate bedside manner (27%), treat others as you would want to be treated (20%), provide empathic care (20%), take the time needed to communicate (20%), and determine patient information and decision-making preferences (17%). Effective EOL discussions with patients require attention to the content, process, and perception of patient-provider communication.
Http Dx Doi Org 10 1207 S15327027hc1401_4, Dec 10, 2009
ABSTRACT This article reports our ongoing work in developing a model of health care communication... more ABSTRACT This article reports our ongoing work in developing a model of health care communication called collaborative interpretation, which we define as a rhetorical practice that generates building blocks for a more complete and coherent diagnostic story and for a collaborative treatment plan. It does this by situating patients as problem-solvers. Our study begins with an analysis of provider-patient interactions in a specific setting-the emergency department (ED) of an urban trauma-level hospital- where we observed patients and providers miscommunicating in at least 3 distinct areas: over the meaning of key terms, in the framing of the immediate problem, and over the perceived role of the ED in serving the individual and the community. From our observations, we argue that all of these miscommunications and missed opportunities are rooted in mismatched expectations on the part of both provider and patient and the lack of explicit comparison and negotiation of expectations-in other words, a failure to see the patient-provider interaction as a rhetorical, knowledge-building event. In the process of observing interactions, conversing with patients and providers, and working with a team of providers and patients, we have developed an operational model of communication that could narrow the gap between the lay public and the medical profession-a gap that is especially critical in intercultural settings like the one we have studied. This model of collaborative interpretation (CI) provides strategies to help patients to represent their medical problems in the context of their life experiences and to share the logic behind their health care decisions. In addition, CI helps both patient and provider identify their goals and expectations in treatment, the obstacles that each party perceives, and the available options. It is adaptableto various settings, including short, structured conversations in the emergency room, extended dialogue between a health educator and a patient in a clinical setting, and group discussions in support groups, community groups, or health education classrooms.
Http Dx Doi Org 10 1207 S15327027hc1901_6, Dec 10, 2009
This article reports a qualitative study of elderly veterans&... more This article reports a qualitative study of elderly veterans' perceptions of and preferences for end-of-life care. At a large urban Veterans Affairs (VA) hospital, we asked 30 veterans and 30 health care providers to define 4 terms in the VA form of the advance directive: life-sustaining treatment, terminal condition, state of permanent unconsciousness, and decision-making capacity. The veterans commonly used narratives to construct meaning, and analysis showed that the resulting texts had both a subtext (the values and goals driving the narrative) and a context (life experiences that filter and shape the current interpretation). We found that all 3 components--text, subtext, and context--are crucial to understanding the central theme of an individual's narrative and the decision-making processes associated with it. In this article we examine 1 lengthy narrative using Chafe's (1994) notion of intonation units. We then present a series of short narratives to demonstrate 3 subthemes that emerged from the data: quality of life versus quantity of life, benefit of treatment versus cost of treatment, and, most common, control versus lack of control. Our goal was to demonstrate the centrality and usefulness of storytelling in the patient-provider interaction when listeners are willing to consider the subtext and context of the story and its role in the decision-making process. As demonstrated in this study, deciphering people's stories gives us insight into their values, the mental constructs that drive their decision making, and the goals that they have for their own health care.
With tightened budgets, cuts in federal grants, and a more cautious public, the funding crisis in... more With tightened budgets, cuts in federal grants, and a more cautious public, the funding crisis in public school music programs will require the combined efforts of parents, teachers, and administrators. Executives at MENC, the National Education Association, and the ...
Journal of Health Care for the Poor and Underserved, 2007
To explore perspectives concerning use of a mobile geriatrics unit (MGU) by underserved populatio... more To explore perspectives concerning use of a mobile geriatrics unit (MGU) by underserved populations in low-income urban neighborhoods, we recruited 18 elderly African American patients and engaged them in in-depth semistructured interviews. Using grounded theory techniques of constant comparative analysis, we found that most patients learned about the MGU from community members and initially visited it to determine whether it would be worth using in the future. In describing their MGU experiences, patients tended to focus on three main factors: quality of care, accessibility of services, and ambience of the care setting. They reported that the MGU allowed them to have their health conditions and medications monitored regularly and functioned as a central link to the larger Veterans Affairs health care system. The findings suggest that using MGUs is an acceptable and effective way to help medically underserved populations receive primary medical care and referrals to specialty care.
... Amanda J. Young, PhD, is Assistant Professor, Department of Communication, University of Memp... more ... Amanda J. Young, PhD, is Assistant Professor, Department of Communication, University of Memphis. ... DO, Associate Professor of Pedia-trics, Division of Adolescent Medicine, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA 15213 (E-mail: magold@pitt.edu). ...
Uploads
Papers by Amanda Young