Abstract
In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of how evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal (making a decision shared by the patient), the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence.
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Notes
We considered only the relationship between the evidence and its immediate purpose. For example, in case of turns characterized by two moves (such as case 6 above), evidence is used primarily for supporting an evaluation, and indirectly for justifying a decision. We code this evidence under the category of an evaluation move.
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Acknowledgements
Fabrizio Macagno would like to thank the Fundação para a Ciência e a Tecnologia for the research Grant No. PTDC/FER‐FIL/28278/2017
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This study was funded by the Fundação para a Ciência e a Tecnologia, research Grant No. PTDC/FER‐FIL/28278/2017.
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FM is responsible for study conception and design, analysis and interpretation, and drafting of manuscript. SB is responsible for study conception and design, acquisition of data, analysis and interpretation, drafting of par. 2, 4.2, 7, and critical revision of manuscript.
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Fabrizio Macagno declares that he has no conflict of interest. Sarah Bigi declares that she has no conflict of interest.
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Macagno, F., Bigi, S. The Role of Evidence in Chronic Care Decision-Making. Topoi 40, 343–358 (2021). https://doi.org/10.1007/s11245-020-09692-4
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DOI: https://doi.org/10.1007/s11245-020-09692-4