Skip to main content
SpringerLink
Log in

Beyond Interpreting: The Companions’ Role in Bridging Patient-Doctor Understanding in Intercultural Oncological Visits

  • Chapter
  • First Online:
Interculturality in Institutions

  • 135 Accesses

Abstract

Health contexts are culturally and organizational rich environments, often difficult to be navigated also by “indigenous” participants, i.e., those, who are native speakers of the context and, thus, share with the health practitioners a common ground of cultural knowledge.

This chapter investigates the construction of nonnative patients’ communicative competence in oncological visits, including also a companion. Particularly, the study examines whether and how companions of patients, who are nonnative of Italian, help patients to travel communication with their Italian oncologist and particularly, what is their contribution to the accomplishment of the patient’s telling and responses in the course of the visit. Previous analyses have revealed how the oncological visit—as a complex institutional event [Drew & Heritage (Talk at work. Interaction in institutional settings. Cambridge University Press, 1992)]—requires sophisticated cultural and interactional skills from patients, in order for them to accomplish all different activities (e.g., reporting, asking questions, displaying understanding, engaging in decision making, etc) that unfold stepwise, from the beginning to the end of this event. To this task, companions, present in half of the visits, play a relevant and highly specialized role [Fatigante et al. (Frontiers in Psychology 12:664747, 2021b).

The study relies on a set of data constituted by 10 videorecorded oncological visits with patients, who have an ethnic and linguistic background different from the doctor: visits include both first meetings with newly diagnosed patients and follow up visits, and they were collected in three different hospitals of Rome.

The chapter draws on video-observation and Conversation Analysis, a methodological approach that dedicates a particular focus on the close and detailed examination of the sequence of conversational-turns, considered in their multimodal construction, i.e., including gaze, posture, facial expressions, hand movements, gestures etc., co-occurring with talk.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • AIOM (Italian Association of Medical Oncology). (2019). Linee guida assistenza psicosociale dei malati oncologici (Guidelines for the Psychosocial Assistance of Oncological Patients).

    Google Scholar 

  • Alby, F., Fatigante, M., & Zucchermaglio, C. (2017). Managing risk and patient involvement in choosing treatment for cancer: An analysis of two communication practices. Sociology of Health and Illness, 39, 1427–1447. https://doi.org/10.1111/1467-9566.12598

    Article  Google Scholar 

  • Alby, F., Lauriola, M., Marino, F., Fatigante, M., & Zucchermaglio, C. (2021). A coding system for doctor-patient communication in oncological consultations (Oncode) TPM, Testing, Psychometrics, Methodology. Applied Psychology, 28(3), 287–311. https://doi.org/10.4473/tpm28.3.2

    Article  Google Scholar 

  • Annunziata, M. A., & Muzzatti, B. (2012). Psychological distress in oncology. In M. A. Annunziata & B. Muzzatti (Eds.), Psychological distress. Symptoms, causes and coping. Novapublisher.

    Google Scholar 

  • Bischoff, A., & Wanner, P. (2008). The self-reported health of immigrant groups in Switzerland. Journal of Immigrant Minority Health, 10, 325–335. https://doi.org/10.1007/s10903-007-9089-z

    Article  Google Scholar 

  • Blommaert, J., & Verschueuren, J. (Eds.). (1991). The pragmatics of international and intercultural communication. John Benjamins.

    Google Scholar 

  • Bruce, K. H., Schwei, R. J., Park, L. S., & Jacobs, E. A. (2014). Barriers and facilitators to preventive cancer screening in limited English proficient (LEP) patients: Physicians’ perspectives. Communication and Medicine, 11(3), 235. https://doi.org/10.1558/cam.v11i3.24051

    Article  Google Scholar 

  • Bührig, K., & Meyer, B. (2004). Ad-hoc-interpreting and the achievement of communicative purposes in doctor-patient-communication. In J. House & J. Rehbein (Eds.), Multilingual Communication (pp. 43–62). John Benjamins.

    Chapter  Google Scholar 

  • Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., et al. (1999). Race, gender, and partnership in the patient-physician relationship. JAMA, 282(6), 583–589. https://doi.org/10.1001/jama.282.6.583

    Article  Google Scholar 

  • Del Piccolo, L., Goss, C., Bottacini, A., Rigoni, V., Mazzi, M. A., Deledda, G., et al. (2014). Asking questions during breast cancer consultations: Does being alone or being accompanied make a difference? European Journal of Oncological Nursing, 18, 299–304. https://doi.org/10.1016/j.ejon.2014.02.001

    Article  Google Scholar 

  • DeSantis, C. E., Lin, C. C., Mariotto, A. B., Siegel, R. L., Stein, K. D., Kramer, J. L., et al. (2014). Cancer treatment and survivorship statistics. Cancer Journal for Clinicians, 64(4), 252–271. https://doi.org/10.3322/caac.21235

    Article  Google Scholar 

  • Dovidio, J. F., Eggly, S., Albrecht, T. L., Hagiwara, N., & Penner, L. (2016). Racial biases in medicine and healthcare disparities. Testing, Psychometrics, Methodology in Applied Psychology, 23(4), 489–510. https://doi.org/10.4473/TPM23.4.5

    Article  Google Scholar 

  • Eggly, S., Penner, L. A., Greene, M., Harper, F. W. K., Ruckdeschel, J. C., & Albrecht, T. L. (2006). Information seeking during “bad news” oncology interactions: Question asking by patients and their companions. Social Science & Medicine, 63(11), 2974–2985. https://doi.org/10.1016/j.socscimed.2006.07.012

    Article  Google Scholar 

  • Eggly, S., Harper, F. W. K., Penner, L. A., Gleason, M. J., Foster, T., & Albrecht, T. L. (2011). Variation in question asking during cancer clinical interactions: A potential source of disparities in access to information. Patient Education and Counseling, 82(1), 63–68. https://doi.org/10.1016/j.pec.2010.04.008

    Article  Google Scholar 

  • Eggly, S., Penner, L., Hagiwara, N., Gonzalez, R., Harper, F., Heath, E., et al. (2013). Patient, companion, and oncologist agreement regarding information discussed during triadic oncology clinical interactions. Psycho Oncology, 22, 637–645. https://doi.org/10.1002/pon.3045

    Article  Google Scholar 

  • Ellingson, L. L. (2002). The roles of companions in geriatric patient–interdisciplinary oncology team interactions. Journal of Aging Studies, 16, 361–382. https://doi.org/10.1016/S0890-4065(02)00071-3

    Article  Google Scholar 

  • European Council. (2002). Common European framework for the languages: Learning, teaching and assessment. La Nuova Italia.

    Google Scholar 

  • Fantasia, V., Zucchermaglio, C., Fatigante, M., & Alby, F. (2021). We will take care of you: Identity categorisation markers in intercultural medical encounters. Discourse Studies, 23(4), 451–473. https://doi.org/10.1177/14614456211009060

    Article  Google Scholar 

  • Fatigante, M. (2013). Presupposti culturali nella formulazione delle domande di medici ginecologi a pazienti migranti. (Cultural presuppositions in the formulation of questions addressed by gynecologists to migrant patients). Salute e Società, XII(1), 44–60. ISSN 1723-9427.

    Article  Google Scholar 

  • Fatigante, M., Alby, F., Zucchermaglio, C., & Baruzzo, M. (2016). Formulating treatment recommendation as a logical consequence of the diagnosis in post-surgical oncological visits. Patient Education and Counselling, 99(6), 878–887. https://doi.org/10.1016/j.pec.2016.02.007

    Article  Google Scholar 

  • Fatigante, M., Zucchermaglio, C., Alby, F., & Nutricato, M. C. (2021a). La struttura della prima visita oncologica: uno studio conversazionale. Psicologia della Salute, 1, 53–77. https://doi.org/10.3280/PDS2021-001005

    Article  Google Scholar 

  • Fatigante, M., Zucchermaglio, C., & Alby, F. (2021b). Being in place: A multimodal analysis of the contribution of the patient’s companion to ‘first time’ oncological visits. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.664747

  • Glenn, P. (2003). Laughter in interaction. Cambridge University Press.

    Book  Google Scholar 

  • Goffman, E. (1979). Footing. Semiotica, 25(1–2), 1–30. https://doi.org/10.1515/semi.1979.25.1-2.1

    Article  Google Scholar 

  • Goldberg, J. A. (1975). A system for the transfer of instructions in natural settings. Semiotica, 14, 269–296.

    Article  Google Scholar 

  • Goodwin, C. (1979). The interactive construction of a sentence in natural conversation. In G. Psathas (Ed.), Everyday Language: Studies in Ethnomethodology (pp. 97–121). Irvington Publishers.

    Google Scholar 

  • Goodwin, C. (1980). Restarts, pauses, and the achievement of a state of mutual gaze at turn-beginning. Sociological Inquiry, 50, 272–302. https://doi.org/10.1111/j.1475-682X.1980.tb00023.x

    Article  Google Scholar 

  • Goodwin, C. (1981). Conversational organization: Interaction between speakers and hearers. Academic.

    Google Scholar 

  • Goodwin, C., & Goodwin, M. H. (1992). Assessments and the construction of context. In A. Duranti & C. Goodwin (Eds.), Context: Language as an interactive phenomenon (pp. 147–190). Cambridge University Press.

    Google Scholar 

  • Haakana, M. (2010). Laughter and smiling: Notes on co-occurrences. Journal of Pragmatics, 42(6), 1499–1512. https://doi.org/10.1016/j.pragma.2010.01.010

    Article  Google Scholar 

  • Hagiwara, N., Slatcher, R. B., Eggly, S., & Penner, L. A. (2017). Physician racial bias and word use during racially discordant medical interactions. Health Communication, 32(4), 401–408. https://doi.org/10.1080/10410236.2016.1138389

    Article  Google Scholar 

  • Heritage, J., & Watson, R. (1980). Aspects of the properties of formulations. Semiotica, 30, 245–262.

    Article  Google Scholar 

  • Heritage, J. (1984). Garfinkel and ethnomethodology. Polity Press.

    Google Scholar 

  • Hillen, M. A., de Haes, H. C. J. M., Verdam, M. G. E., et al. (2018). Trust and perceptions of physicians’ nonverbal behavior among women with immigrant backgrounds. Journal of Immigrant and Minority Health, 20, 963–971. https://doi.org/10.1007/s10903-017-0580-x

    Article  Google Scholar 

  • Hymes, D. (1972). On communicative competence. In J. B. Pride & J. Holmes (Eds.), Sociolinguistics (pp. 269–285). Penguin.

    Google Scholar 

  • Jacobs, E. A., Agger-Gupta, N., Hm Chen, A., Piotrowski, A., & Hardt, E. J. (2003). Language barriers in health care settings: An annotated bibliography of the research literature. The California Endowment.

    Google Scholar 

  • Jefferson, G. (1979). A technique for inviting laughter and its subsequent acceptance/declination. In G. Psathas (Ed.), Everyday language: Studies in ethnomethodology (pp. 79–96). Irvington.

    Google Scholar 

  • Jefferson, G. (1987). On exposed and embedded correction in conversation. In G. Button & J. R. E. Lee (Eds.), Talk and social organization (pp. 86–100). Multilingual Matters.

    Google Scholar 

  • Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G. H. Lerner (Ed.), Conversation analysis: Studies from the first generation (pp. 13–31). John Benjamins.

    Chapter  Google Scholar 

  • Jefferson, G., Sacks, H., & Schegloff, E. A. (1987). Notes on laughter in pursuit of intimacy. In G. Button & J. R. E. Lee (Eds.), Talk and social organization (pp. 152–120). Multilingual Matters.

    Google Scholar 

  • Johnson, R. L., Roter, D., Powe, N. R., & Cooper, L. A. (2004). Patient race/ethnicity and quality of patient–physician communication during medical visits. American Journal of Public Health, 94(12), 2084–2090. https://doi.org/10.2105/ajph.94.12.2084

    Article  Google Scholar 

  • Luzi, A. M., Pasqualino, G. M., Pugliese, L., Schwarz, M., & Suligoi, B. (2015). L’accesso alle cure della persona straniera: indicazioni operative (Seconda edizione). Istituto Superiore di Sanità, Ministero della Salute [Access to treatment for immigrant: practical indications (2nded.)].

    Google Scholar 

  • Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A., & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science and Medicine, 199, 219–229. https://doi.org/10.1016/j.socscimed.2017.05.009

    Article  Google Scholar 

  • Mazer, B. L., Cameron, R. A., DeLuca, J. M., Mohile, S. G., & Epstein, R. M. (2014). “Speaking-for” and “speaking-as”: Pseudo-surrogacy in physician–patient–companion medical encounters about advanced cancer. Patient Education and Counselling, 96, 36–42. https://doi.org/10.1016/j.pec.2014.05.001

    Article  Google Scholar 

  • McGarry, O., Hannigan, A., De Almeida, M. E., Severoni, S., Puthoopparambil, S. J., & MacFarlane, A. (2018). What strategies to address communication barriers for refugees and migrants in health care settings have been implemented and evaluated across the WHO European Region? Health Evidence Network synthesis report 62. WHO Regional Office for Europe.

    Google Scholar 

  • Menke, R., Streich, W., Rossler, G., & Brand, H. (2003). Report on Socio-economic differences in health indicators in Europe: Health inequalities in Europe and the situation of disadvantaged groups. National Institute for Public Health and the Environment (RIVM).

    Google Scholar 

  • Montgomery, K. K., & Harris-Braun, E. K. (2000). Information is not enough: The place of statistics in the doctor-patient relationship. Cancer Treatment Research, 102, 13–21. https://doi.org/10.1007/978-1-4757-3044-9_2

    Article  Google Scholar 

  • Norrick, N. (1987). Functions of repetition in conversation. Text & Talk, 7(3), 245–264. https://doi.org/10.1515/text.1.1987.7.3.245

    Article  Google Scholar 

  • Oliver, M. N., Goodwin, M. A., Gotler, R. S., Gregory, P. M., & Stange, K. C. (2001). Time use in clinical encounters: Are African American patients treated differently? Journal of the National Medical Association, 93, 380–385. PMCID: PMC2594073.

    Google Scholar 

  • Orletti, F. (2013). L’emergere e la costruzione delle identità nell’interazione medico-paziente in contesti multiculturali. (The emergence and the construction of identity in the doctor-patient interaction in multicultural contexts). Salute e Società, XII(1), 61–75. ISSN 1723-9427.

    Article  Google Scholar 

  • Pandey, M., Maina, R. G., Amoyaw, J., et al. (2021). Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: A qualitative study. BMC Health Services Research, 21, 741. https://doi.org/10.1186/s12913-021-06750-4

    Article  Google Scholar 

  • Penner, L. A., Dovidio, J. F., Gonzalez, R., Albrecht, T. L., Chapman, R., Foster, T., Harper, F. W., Hagiwara, N., Hamel, L. M., Shields, A. F., Gadgeel, S., Simon, M. S., Griggs, J. J., & Eggly, S. (2016). The effects of oncologist implicit racial bias in racially discordant oncology interactions. Journal of Clinical Oncology, 34(24), 2874–2880. https://doi.org/10.1200/JCO.2015.66.3658

    Article  Google Scholar 

  • Pino, M., Fatigante, M., Alby, F., & Zucchermaglio, C. (2022). Sources of miscommunication in oncology history taking. Applied Linguistics, 43(2), 249–270. https://doi.org/10.1093/applin/amab036

    Article  Google Scholar 

  • Sacks, H., Schegloff, E. A., & Jefferson, G. A. (1974). A simplest systematics for the organization of turn-taking in conversation. Language, 50, 696–735. https://doi.org/10.1353/lan.1974.0010

    Article  Google Scholar 

  • Schegloff, E., Jefferson, G., & Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53, 361–382. https://doi.org/10.2307/413107

    Article  Google Scholar 

  • Schegloff, E. A. (2007). Sequence Organization in Interaction: A Primer in Conversation Analysis I. Cambridge University Press.

    Book  Google Scholar 

  • Schouten, B. C., & Meeuwesen, L. (2006). Cultural differences in medical communication: A review of the literature. Patient Education and Counseling, 64(1-3), 21–34. https://doi.org/10.1016/j.pec.2005.11.014

    Article  Google Scholar 

  • Spolsky, B. (1989). Communicative competence, language proficiency, and beyond. Applied Linguistics, 10(2), 138–156. https://doi.org/10.1093/applin/10.2.138

    Article  Google Scholar 

  • Street, R. L., & Gordon, H. S. (2008). Companion participation in cancer consultations. Psychooncology, 17, 244–251. https://doi.org/10.1002/pon.1225

    Article  Google Scholar 

  • Tehranifar, P., Neugut, A. I., Phelan, J. C., et al. (2009). Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiology, Biomarkers & Prevention, 18, 2701–2708. https://doi.org/10.1158/1055-9965.EPI-09-0305

    Article  Google Scholar 

  • van Wieringen, J. C., Harmsen, J. A., & Bruijnzeels, M. A. (2002). Intercultural communication in general practice. European Journal of Public Health, 12, 63–68. https://doi.org/10.1093/eurpub/12.1.63

    Article  Google Scholar 

  • Williams, S., Dexter, E., & Potter, J. L. (2018). The NHS and migrant patients with cancer. The Lancet Oncology, 19(4), 444–445. https://doi.org/10.1016/S1470-2045(18)30152-9

    Article  Google Scholar 

  • Zucchermaglio, C., & Alby., & Fatigante, M. (2016). What counts as illness? Anamnesis as a collaborative activity, Testing, Psychometrics, Methodology in Applied Psychology, 23(4), 471–487. https://doi.org/10.4473/TPM23.4.4

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy

    Marilena Fatigante, Cristina Zucchermaglio & Francesca Alby

Authors
  1. Marilena Fatigante
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Zucchermaglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Alby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marilena Fatigante .

Editor information

Editors and Affiliations

  1. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy

    Marilena Fatigante

  2. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy

    Cristina Zucchermaglio

  3. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy

    Francesca Alby

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fatigante, M., Zucchermaglio, C., Alby, F. (2022). Beyond Interpreting: The Companions’ Role in Bridging Patient-Doctor Understanding in Intercultural Oncological Visits. In: Fatigante, M., Zucchermaglio, C., Alby, F. (eds) Interculturality in Institutions. Culture in Policy Making: The Symbolic Universes of Social Action. Springer, Cham. https://doi.org/10.1007/978-3-031-12626-0_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-12626-0_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-12625-3

  • Online ISBN: 978-3-031-12626-0

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation