22. Video-recording conversations in a hospice: The PallComm pilot study

Andrea Bruun
Jul 3
4 min read

I am really into how we communicate with each other. So much that I have specialised in analysing communication. My background is in Linguistics (a fancy word for language science), and on my course I had a module on a research method called Conversation Analysis. I instantly fell in love with this method and found my niche within Linguistics. Why am I rambling on about this in a DAPPLE blog? Let me tell you more!

Conversation Analysis

Let me quickly explain what on earth Conversation Analysis is. It is a qualitative research method, but it is not your typical qualitative research method. Conversation Analysis first of all involves recordings of real-life conversations. These can be video- or audio-recordings. A Conversation Analyst explores conversations ‘in the wild’ rather than in the lab or through reports about conversations found in interviews or surveys. The method involves creating very detailed transcripts of the recordings. They are so nerdy and detailed that we even measure the pauses and mark the stress and intonation of an utterance as well as annotating what people are doing with their bodies when they talk to each other. We do this as we know all of these things matter when we talk to each other. For example, think about the difference between these three utterances where the word in capital letters is stressed:

a) HAVE you done it?

b) Have YOU done it?

c) Have you done IT?

In a), the word ‘HAVE’ is stressed, which would probably be the typical way of asking someone if they have done something. If we then look at b), the ’YOU’ is stressed, and now the utterance is slightly different, isn’t it? Now a specific someone is singled out, maybe adding a layer of accountability. The last one, c), is completely different where the ‘IT’ is now stressed. The utterance now highlights a specific activity – where a stressed ‘IT’ could be interpreted as a sexual one. The stress changes how we may understand the utterance and therefore also our response. So, it really matters where the stress is, doesn’t it? Isn’t’ it fascinating!

We do more than looking at stress though. We look at our recordings and nerdy transcripts, and then we try and make sense of how people get ‘stuff’ done in the conversation. For example, how do they ask and answer questions? How do they make requests or give instructions? How do they make complaints? How do they handle problems with understanding? Then we look at their utterances, how they are designed, and how the conversation unfolds between parties. If you want to know more about Conversation Analysis, you can read this blog by Prof Liz Stokoe.

The Cambridge Handbook of Methods in Conversation Analysis (Edited by Jeffrey D. Robinson, Rebecca Clift, Kobin H. Kendrick, and Chase Wesley Raymond) — *The Cambridge Handbook of Methods in Conversation Analysis* (Edited by Jeffrey D. Robinson, Rebecca Clift, Kobin H. Kendrick, and Chase Wesley Raymond)

Conversation Analysis and palliative care

When it comes to palliative care and learning disabilities, the Conversation Analysis field has looked at these areas separately – but never together. This means that there are no studies on conversations involving people with a learning disability from palliative care settings. This is quite mad if you think about it. Especially, when you think about how important communication is.

On DAPPLE, I am one of the researchers who will get to know the stories of people with a learning disability with a palliative care need, as part of the ethnography strand. We will probably hear and get to know more about communication and how important it is, and how there may be challenges. But DAPPLE will not zoom in on communication in that detailed and nerdy Conversation Analysis way.

I really want to investigate these types of conversations, and I am hoping to do a big project on this. But funders may worry if that is even possible as no one has done it before. So, I applied for a small grant at Kingston University to do a pilot study (a fancy word for a test study) to see if I could actually go into a hospice and record some conversations. I also wanted to look at the recordings to get an idea about what would be interesting to focus on in a big project.

I got the money, and the pilot study is called The PallComm Project. You can see the study plan for the project in our protocol paper here. Let me tell you more about where I’m at so far!

The protocol (plan) for the PallComm pilot study

Early PallComm pilot study findings

I recorded three conversations between patients with a learning disability and hospice staff, as planned. People were interested in taking part in the study, and they were fine with being recorded too. I learned more about how the bigger project should allow for people who lack capacity to take part and for recordings to take place in patients’ home and not only in the hospice.

Setting up and getting ready to record the first conversation

Now, I am looking at the recordings to see what would be interesting to investigate further. I already have some ideas! For example, discussion of illness progression and the end-of-life, pain assessment, how companions speak on behalf of the patient with a learning disability, and how to deal with undecipherable talk. I will discuss my findings with groups of people with a learning disability and palliative care staff to get a better sense of which parts of the communication they think need and deserve some attention and TLC. The stories and observations from DAPPLE may also guide me – and the DAPPLE ‘Better care before death’ co-production group may also help me with making sense of the recordings.