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Diverse prospettive di oncologo e paziente: la co-costruzione di una comprensione condivisa nella fase di anamnesi
Titolo Rivista: SALUTE E SOCIETÀ 
Autori/Curatori: Francesca Alby, Mattia Baruzzo, Marilena Fatigante, Cristina Zucchermaglio 
Anno di pubblicazione:  2015 Fascicolo: 2 Vivere il cancro. Rappresentazioni sociali, scelte, percorsi. Donatella Cavanna, Laura Migliorini (a cura di) Lingua: Italiano 
Numero pagine:  23 P. 37-59 Dimensione file:  106 KB
DOI:  10.3280/SES2015-002004
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più:  clicca qui   qui 

This article analyzes instances of misunderstanding between doctor, patient and accompanying person during the history taking of ‘first time’ oncology visits. History taking is a fundamental activity in these visits since it targets useful information for the oncologist to determine the patients’ current and general health status and then arrange the treatment plan most suitable for their cancer. The authors show how this activity involves all participants in the interaction: the oncologist, the patients and their care-givers. The management of this activity is not plain and straightforward: it requires complex negotiations between participants in order for them to find a shared understanding of what information is relevant to the medical history, and what is the purpose of the activity in progress. The analyses help to identify, on one hand, the characteristics of the diseases that patients do not recognize as relevant, and on the other hand, the investigative strategies and communication skills that the doctor uses to track the information. These strategies are discussed as resources to socialize patients to effectively contribute to the present visit and the future ones.

Keywords: Interazione medico-paziente, patient education, anamnesi, ricerca qualitativa, video registrazione, oncologia

  1. Schegloff E.A., Jefferson G., Sacks H. (1977). The Preference for Self-Correction in the Organization of Repair in Conversation. Language, 53(2): 361-382., DOI: 10.2307/41310
  2. Scribner S. (1984). Studying working intelligence. In: Rogoff B. e Lave J., a cura di, Everyday Cognition: Its Development in Social Context (pp. 9-40). Cambridge, MA: Harvard University Press
  3. Sidnell J., Stivers T., a cura di (2012). The Handbook of Conversation Analysis. Malden, MA: Wiley-Blackwell.
  4. Sorjonen M.-L., Raevaara L., Haakana M., Tammi T.T., Peräkylä A. (2006).
  5. Life-style discussions in medical interviews. In: Heritage J. e Maynard D.W., a cura di, Communication in Medical Care: Interactions between Primary Care Physicians and Patients (pp. 340-378). Cambridge: Cambridge University Press
  6. Stark D.P., House A. (2000). Anxiety in cancer patients. British Journal of Cancer, 83(10): 1261-1267., DOI: 10.1054/bjoc.2000.140
  7. Antaki C., a cura di (2011). Applied Conversation Analysis: Intervention and Change in Institutional Talk. Basingstoke, UK: Palgrave Macmillan
  8. Baile W.F., Aaron J. (2005). Patient-physician communication in oncology: past, present, and future. Current Opinion in Oncology, 17(4): 331-335
  9. Roter D., Hall J.A. (2006). Doctors Talking with Patients/patients Talking with Doctors: Improving Communication in Medical Visits. Westport, CT: Greenwood Publishing Group
  10. Baile W.F., Kudelka A.P., Beale E.A., Glober G.A., Myers E.G., Greisinger A.J., Bast R.C., Goldstein M.G., Novack D., Lenzi R. (1999). Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer, 86(5): 887-897., DOI: 10.1002/(sici)1097-0142(19990901)86:5<887::aid-cncr27>;2-
  11. Balint M. (1957). The Doctor, His Patient and the Illness. Londra: Pitman (trad. it.: Medico, paziente e malattia. Milano: Feltrinelli, 1990)
  12. Stivers T., Heritage J. (2001). Breaking the sequential mould: Answering “more than the question” during comprehensive history taking. Text-Interdisciplinary Journal for the Study of Discourse, 21(1-2): 151-185 Zimmermann C., Del Piccolo L., Finset A. (2007). Cues and concerns by patients in medical consultations: a literature review. Psychological Bulletin, 133(3): 438-463., DOI: 10.1037/0033-2909.133.3.43
  13. Zucchermaglio C., Alby F. (2014). Reasoning in medical work: An analysis of cognition-in-practice and its potential for organizational interventions. Paper presentato a 30th EGOS Colloquium, Rotterdam, luglio 3-5
  14. Zucchermaglio C., Alby F., Fatigante M., Saglietti M. (2013). Fare ricerca situata in psicologia sociale. Bologna: il Mulino
  15. Beach W.A., a cura di (2001). “Lay diagnosis”. Special Issue in honour of the late Robert Hopper. Text – Interdisciplinary Journal for the Study of Discourse, 21(1-2)
  16. Boyd E., Heritage J. (2006). Taking the Patient’s Medical History: Questioning During Comprehensive History Taking. In: Heritage J. e Maynard D.W., a cura di, Communication in Medical Care: Interactions between Primary Care Physicians and Patients (pp. 151-184). Cambridge: Cambridge University Press
  17. Brown R.F., Butow P.N., Juraskova I., Ribi K., Gerber D., Bernhard J., Tattersall M.H.N. (2011). Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 14(1): 29-37., DOI: 10.1111/j.1369-7625.2010.00613.
  18. Byrne P.S., Long B.E.L. (1976). Doctors talking to patients: a study of the verbal behaviour of general practitioners consulting in their surgeries. Londra: H.M.S.O
  19. Cassell E.J. (1985). Talking with Patients. Vol. 2, Clinical Technique. Cambridge, MA: MIT Press
  20. Cavallo Perin P. (2000). Diabete e ipertensione. Presentazione. GIDM Forum, 20: 143-148. Testo disponibile al sito:, consultato il 20/12/2014
  21. Charles C., Gafni A., Whelan T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science & Medicine (1982), 44(5): 681-692., DOI: 10.1016/s0277-9536(96)00221-
  22. Costantini A., Baile W.F., Lenzi R., Costantini M., Ziparo V., Marchetti P., Grassi L. (2009). Overcoming cultural barriers to giving bad news: Feasibility of training to promote truth-telling to cancer patients. Journal of Cancer Education, 24(3): 180-185., DOI: 10.1080/0885819090287626
  23. Costantini M., Morasso G., Montella M., Borgia P., Cecioni R., Beccaro M., Sguazzotti E., Bruzzi P., ISDOC Study Group (2006). Diagnosis and prognosis disclosure among cancer patients. Results from an Italian mortality followback survey. Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO, 17(5): 853-859., DOI: 10.1093/annonc/mdl028DelPiccoloL.,deHaesH.,HeavenC.,JansenJ.,VerheulW.,FinsetA.(2009)
  24. Verona coding definitions of emotional sequences (VR-CoDES). Provider responses manual. Testo disponibile al sito:, consultato il 20/12/2014
  25. Del Piccolo L., de Haes H., Heaven C., Jansen J., Verheul W., Bensing J., Bergvik S., Deveugele M., Eide H., Fletcher I., Goss C., Humphris G., Kim Y.M., Langewitz W., Mazzi M.A., Mjaaland T., Moretti F., Nübling M., Rimondini M., Salmon P., Sibbern T., Skre I., van Dulmen S., Wissow L.,
  26. Young B., Zandbelt L., Zimmermann C., Finset A. (2011). Development of the Verona coding definitions of emotional sequences to code health providers’ responses (VR-CoDES-P) to patient cues and concerns. Patient Education and Counseling, 82(2): 149-155., DOI: 10.1016/j.pec.2010.02.02
  27. Drew P. (1991). Asymmetries of Knowledge in Conversational Interactions. In: Markova I. e Klaus F., a cura di, Asymmetries in Dialogue (pp. 29-48). Hemel Hempstead: Harvester Wheatsheaf
  28. Fatigante M. (2013). Presupposti culturali nella formulazione delle domande di medici ginecologi a pazienti migranti. Salute e Società, 12(1): 44-60., DOI: 10.3280/SES2013-00100
  29. Fele G. (2007). L’analisi della conversazione. Bologna: il Mulino.
  30. Frankel R.M. (1990). Talking in interviews: A dispreference for patient initiated questions in physician-patient encounters. In: Psathas G., a cura di, Interactional Competence (pp. 231-262). Lanham, MD: University Press of America Galatolo R., Pallotti G., a cura di (1999). La conversazione: Un’introduzione allo studio dell’interazione verbale. Milano: Raffaello Cortina Gill V.T. (1998). Doing Attributions in Medical Interaction: Patients’ Explanations for Illness and Doctors’ Responses. Social Psychology Quarterly, 61(4): 342., DOI: 10.2307/278703
  31. Gill V.T., Halkowski T., Roberts F. (2001). Accomplishing a request without making one: A single case analysis of a primary care visit. Text – Interdisciplinary Journal for the Study of Discourse, 21(1-2)., DOI: 10.1515/text.1.21.1-2.5
  32. Gill V.T., Pomerantz A., Denvir P. (2010). Pre-emptive resistance: patients’ participation in diagnostic sense-making activities. Sociology of Health & Illness, 32(1): 1-20., DOI: 10.1111/j.1467-9566.2009.01208.
  33. Grice P. (1975). Logic and Conversation. In: Davidson D. e Harman G., a cura di, The Logic of Grammar (pp. 64-75). Encino, CA: Dickenson
  34. Grossman E., Messerli F.H. (1996). Diabetic and Hypertensive Heart Disease. Annals of Internal Medicine, 125(4): 304-310., DOI: 10.7326/0003-4819-125-4-199608150-0000
  35. Haakana M. (2001). Laughter as a patient’s resource: Dealing with delicate aspects of medical interaction. Text – Interdisciplinary Journal for the Study of Discourse, 21(1-2): 187-219., DOI: 10.1515/text.1.21.1-2.18
  36. Halkowski T. (2006). Realizing the illness: Patients’ reports of symptom discovery in primary care visits. In: Heritage J. e Maynard D.W., a cura di, Communication in Medical Care: Interactions between Primary Care Physicians and Patients (pp. 86-114). Cambridge: Cambridge University Press
  37. Halkowski T., Gill V.T. (2010). Conversation Analysis & Ethnomethodology: The Centrality Of Interaction. In: Bourgeault I., Dingwall R. e de Vries R., a cura di, The SAGE Handbook of Qualitative Methods in Health Research (pp. 212-228). Londra: Sage Publications (trad. it.: Analisi della Conversazione ed Etnometodologia: la centralità dell’Interazione. Salute e Società, 12(1): 183-198, 2013)
  38. Have P. ten. (1999). Doing conversation analysis: a practical guide. Londra: Sage Publications Heritage J. (2010). Questioning in Medicine. In: Freed A. e Ehrlich S., a cura di, “Why Do You Ask?”: The Function of Questions in Institutional Discourse (pp. 42-68). New York: Oxford University Press
  39. Heritage J. (2011). The interaction order and clinical practice: Some observations on dysfunctions and action steps. Patient Education and Counseling, 84(3), 338.343., DOI: 10.1016/j.pec.2011.05.02
  40. Heritage J., Clayman S. (2010). Talk in Action: Interactions, Identities, and Institutions (1 edition). Malden, MA: Wiley-Blackwell
  41. Heritage J., Maynard D.W., a cura di (2006). Communication in Medical Care: Interaction Between Primary Care Physicians And Patients. Cambridge, UK; New York: Cambridge University Press
  42. Sacks H., Schegloff E.A., Jefferson G. (1974). A Simplest Systematics for the Organization of Turn-Taking for Conversation. Language, 50(4): 696-735., DOI: 10.2307/41224
  43. Heritage J., Raymond G. (2012). Navigating Epistemic Landscapes: Acquiescence, Agency and Resistance in Responses to Polar Questions. In: de Ruiter J.P., a cura di, Questions: Formal, Functional and Interactional Perspectives (pp. 179-192). Cambridge: Cambridge University Press
  44. Heritage J., Robinson J.D. (2011). “Some” vs “Any” Medical Issues: Encouraging Patients to Reveal Their Unmet Concerns. In: Antaki C., a cura di, Applied Conversation Analysis: Changing Institutional Practices (pp. 15-31). Basingstoke, UK: Palgrave Macmillan
  45. Jefferson G. (1989). Preliminary notes on a possible metric which provides for a “standard maximum” silence of approximately one second in conversation. In: Roger D. e Bull P., a cura di, Conversation: An Interdisciplinary Perspective (pp. 166-196). Clevedon, UK: Multilingual Matters
  46. Jefferson G. (2004). Glossary of transcript symbols with an introduction. In: Lerner G.H., a cura di, Conversation Analysis: Studies from the First Generation (pp. 13-23). Philadelphia, PA: John Benjamins Publishing Company
  47. Kessels R.P.C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96(5): 219-222., DOI: 10.1258/jrsm.96.5.21
  48. Maynard D.W. (2003). Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago, IL: University of Chicago Press
  49. Moja E.A., Vegni E. (1998). La medicina centrata sul paziente. Annali italiani di medicina interna, 13(1): 56-64
  50. Ong L.M., de Haes J.C., Hoos A.M., Lammes F.B. (1995). Doctor-patient communication: a review of the literature. Social Science & Medicine (1982), 40(7): 903-918., DOI: 10.1016/0277-9536(94)00155-
  51. Ong L.M., Visser M.R., Lammes F.B., de Haes J.C. (2000). Doctor-patient communication and cancer patients’ quality of life and satisfaction. Patient Education and Counseling, 41(2): 145-156., DOI: 10.1016/s0738-3991(99)00108-
  52. Orletti F. (2000). La conversazione diseguale: potere e interazione. Roma: Carocci Pham A.K., Bauer M.T., Balan S. (2013). Closing the patient-oncologist communication gap: a review of historic and current efforts. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 29(1): 106-113., DOI: 10.1007/s13187-013-0555-
  53. Pollak K.I., Arnold R.M., Jeffreys A.S., Alexander S.C., Olsen M.K., Abernethy A.P., Sugg Skinner C., Rodriguez K.L., Tulsky J.A. (2007). Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 25(36): 5748-5752., DOI: 10.1200/JCO.2007.12.418
  54. Psathas G. (1995). Conversation analysis: The study of talk-in-interaction. Thousand Oaks, CA: Sage Publications
  55. Raymond G. (2003). Grammar and Social Organization: Yes/No Interrogatives and the Structure of Responding. American Sociological Review, 68(6): 939., DOI: 10.2307/151975
  56. Robinson J.D. (2006). Soliciting patients’ presenting concerns. In: Heritage J. e Maynard D.W., a cura di, Communication in medical care: Interaction between primary care physicians and patients (pp. 22-47). Cambridge: Cambridge University Press
  57. Robinson J.D., Heritage J. (2006). Physicians’ opening questions and patients’ satisfaction. Patient Education and Counseling, 60(3): 279-285., DOI: 10.1016/j.pec.2005.11.00
  58. Robinson J.D., Heritage J. (2014). Intervening With Conversation Analysis: The Case of Medicine. Research on Language & Social Interaction, 47(3): 201-218., DOI: 10.1080/08351813.2014.92565

Francesca Alby, Mattia Baruzzo, Marilena Fatigante, Cristina Zucchermaglio, in "SALUTE E SOCIETÀ" 2/2015, pp. 37-59, DOI:10.3280/SES2015-002004


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