Topicalizing psychosocial distress in cancer follow-up consultations: An exploration of the interactional effects of discussion tools

This paper reports on a case study into the effects on doctor–patient interaction of the use of the Distress Thermometer and Problem List (DT+PL) as a tool to further the discussion of psychosocial distress in the follow-up head-and-neck cancer consultation. The follow-up head-and-neck cancer consultation is a well-defined, goal-oriented, institutional speech event. Its aims include checking patients for recurrence and monitoring patients for after-effects of the malignity and its treatment, and psychosocial distress. The discussion of psychosocial issues, however, is not as well-integrated in the follow-up consultation as is deemed desirable. To remedy this, instruments have been developed to facilitate the discussion of patients’ quality of life. This paper uses the conceptual framework of the Ethnography of Communication and insights from Discourse Analysis and Pragmatics to analyse the impact of one of these instruments on doctor–patient interaction. Fine-grained analysis of the contextual parameters of the follow-up cancer consultation and of interactional data and meta-data suggests that, although the tool is successful in creating affordances for the discussion of psychosocial problems, it may simultaneously—and paradoxically—also put constraints on the range of topics that is discussed during the consultation. Doctors show awareness of this and deploy a variety of strategies to preserve their “normal” anamnesis while strategically integrating the discussion of the DT+PL into their consultations.