Research Projects

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Professor Beach’s Current & Ongoing Research Projects

An outline of current and ongoing research projects (including links to publications) are summarized below.

 

Communication & Health – in the Family & Clinic

I. Two Books Nearing Completion:

    A Natural History of Family Cancer:

    Interactional Solutions to Medical Problems

    -Basic Research

    -Educational Dissemination

    -Stage/Theatrical Production

 

Handbook of Patient-Provider Interactions:

Raising and Responding to Concerns About Life, Illness, and Disease

 

II. Moores Cancer Center & the Department of Surgery:

Collaborations with the University of California, San Diego Medical Center

     Moores Cancer Center

    -Emerging Focus on ‘Communication & Ethnic Disparities’

    Department of Surgery

    -Preliminary Intervention

 

III. Additional Studies of Ordinary Conversation & Institutional Interactions

    Acknowledgment Tokens

    Stories & Related Social Activities

    Methodological Positions

    Courtroom Interactions

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I. Two Books Nearing Completion:

Communication & Health – in the Family & Clinic

 

Two related books are scheduled for publication (by Hampton Press, Inc.) in 2006:

 

-A Natural History of Family Cancer:

-Interactional Solutions to Medical Problems

 

Basic Research

 

Readers of A Natural History of Family Cancer will be provided with the first comprehensive analysis of pivotal communication moments comprising one family’s interactional journey through cancer. The corpus is comprised of a collection of 60 local and long distance phone calls over a thirteen month period, involving twenty-six participants and nearly eleven hours of interactions between family members, friends, acquaintances, and service calls (e.g., to the airlines, kennel, and different businesses). This series of conversations – which I have characterized as “the Malignancy corpus” – represent the first natural history of a family’s interactional attempts to understand and deal with cancer and its consequences developmentally, from initial diagnosis to death. Findings reveal how family members, faced with a longitudinal and terminal diagnosis of a mother/wife/sister, employ specific interactional practices when communicating about, making sense of, and essentially “coming to grips” with bad cancer news.

 

A sampling of the basic research questions arising from these rare, but critically important materials, include:

 

More specifically, chapters address single cases and collections of the social activities comprising cancer dilemmas. These communication patterns, and the interactional practices comprising them, include (but are not limited to) how family members collaborate in producing the following:

 

 

Also included is a unique final chapter: A retrospective interview with family members more than 15 years following the recordings of their family phone conversations. This interview reveals meaningful insights about numerous critical issues. For example: Coping with the diagnosis, treatment, and prognosis of terminal cancer; Managing family relationships in the midst of uncertainty, grief, and hope; Life following death of a loved one; and Survivors’ advice for others experiencing cancer. These discussions also reveal marked contrasts between information retrievable from interviews, and empirical findings that can only be generated from close analysis of recorded and transcribed conversations.

 

Beach, WA (2002). Between dad and son: Initiating, delivering, and assimilating bad cancer news. Health Communication, 14, 271-299;

Beach, WA (2002). Managing optimism in talk about cancer. In J Mandelbaum, P Glenn & C LeBaron (Eds.). Studies in language and social interaction: In Honor of Robert Hopper (175-194). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Beach, WA & Andersen, J (2003). Communication and cancer? Part I: The noticeable absence of interactional research. J of Psychosocial Oncology, 21, 1-23;

Beach, WA & Lockwood, A (2003). Making the case for airline compassion fares: The serial organization of problem narratives during a family crisis.  Research on Language and Social Interaction, 36, 351-393;

Beach, WA & Good, JS (2004). Uncertain family trajectories: Interactional consequences of cancer diagnosis, treatment, and prognosis.  Journal of Social and Personal Relationships, 21, 9-35;

Beach, WA & Andersen, J. (2004). Communication and Cancer? Part II: Conversation analysis. Journal of Psychosocial Oncology, 21, 1-22.

Educational Dissemination

Following the publication of basic research findings in Professor Beach’s book on family cancer, he will be collaborating with Professional Resources Group (PRG), a healthcare consulting company in Massachusetts. The purpose of this partnership is to design and develop educational materials – grounded in naturally occurring phone calls and transcriptions – for understanding how patients, family members, and medical professionals communicate about, and through, cancer journeys . . . from diagnosis through death. Innovative learning modules will be disseminated to cancer centers, hospitals, medical groups, and other health consortiums focusing on cancer care. Grounded in findings generated from years of basic research, the vision is to create unique opportunities to assist others (lay and professional alike) who must rely on communication when navigating their ways through cancer journeys.

 

Stage/Theatrical Production

Plans have also been initiated to utilize family conversations about cancer – audio recordings and transcriptions from the Malignancy corpus – to generate a script, design and develop a public theatrical performance. This theatrical event is co-sponsored by the College of Professional Studies & Fine Arts at SDSU, involving colleagues within the School of Communication and Department of Theatre & Film, as well as a number of San Diego associations. The vision is to bring together cancer patients, their families, medical professionals, and all citizens celebrating the importance of communication for quality of life. Scheduled to begin in late spring, 2006, a director for this production has already been selected, and others will soon be enlisted: a producer, playwright, dramaturge, designers, and actors.

 

Handbook of Patient-Provider Interactions:

Raising and Responding to Concerns About Life, Illness, and Disease

Over the last 40 years, research focusing on communication between patients and their providers can be understood as an increasing shift from doctor-centered ® patient-centered ® relationship-centered ® interactionally enacted care. This edited volume of 50 new and previously published research studies brings together, for the first time, influential empirical investigations and theoretical positions on primary social actions during consultations. Interdisciplinary and international researchers utilize methodological innovations to resolve a noticeable absence: An authoritative and unified resource not only for scholars and teachers in the social and medical sciences, but for clinicians and practitioners who rely on medical interviews to solicit medical histories, conduct physical examinations, and deliver diagnoses. Activities involved in offering suggestions for treatment, discussing preventive care, and encouraging healing outcomes are also communicative achievements.  

 

The close examination of video recorded, naturally occurring medical encounters is complimented with alternative approaches for closely examining significant interactional moments: How do patients and providers collaborate when raising, and responding, to both psychosocial and biomedical concerns? What relationships exist among patients’ daily lives, their conceptions of illness, and medical experts’ orientations to diagnosis and treatment?

 

In this handbook, the emphasis on interactional enactments makes clear that it is the identification of specific practices for organizing involvements, the sequential environments in which these exchanges occur, and participants’ orientations to seeking and providing care that are essential prerequisites for transforming basic research into meaningful applications for enhancing care. By anchoring recommendations for refining communication skills in naturally occurring patterns and practices of interaction, shaping new perspectives on competent medical care becomes increasingly probable.


Beginning with studies published in the 1970’s through 2005, chapters are organized thematically and chronologically to provide readers with a grounded sense of historical relevance and application. Early, foundational contributions  clearly portray the importance of not taking patient-provider communication for granted, construct a framework for their investigation, and articulate the inadequacy of traditional approaches to biomedicine for ensuring quality patient care and healing outcomes. Research extending these primary calls for transformation in medical research, education, and training are organized across areas such as the following:

 

            [Preliminary Listing]

Professor Beach’s  publications on communication during medical encounters:

Jones, CM & Beach, WA (in press). Patient’s attempts and doctors’ responses to premature solicitation of diagnostic information. In M. Maxwell (Ed.), Diagnosis as a cultural practice. Mouton de Gruyter.

Beach, WA & Mandelbaum, J. (2005). “My mom had a stroke”: Understanding how patients raise and providers respond to psychosocial concerns. In LH Harter, PM Japp, & CM Beck (Eds), Narratives, health, and healing: Communication theory, research, and practice (343-364). Mahwah, NJ: Lawrence Erlbaum Associates.

Beach, WA, Easter, D.E., Good, JS, & Pigeron, E. (2004). Disclosing and responding to cancer “fears” during oncology interviews. Social Science & Medicine. 60, 893-910.

Easter, DE & Beach, WA (2004). Competent patient care is dependant upon attending to empathic opportunities presented during interview sessions. Current Surgery, 61, 313-318.

Beach, WA & LeBaron, C (2002). Body disclosures: Attending to personal problems and reported sexual abuse during a medical encounter. Journal of Commmunication, 52, 617-639.

Beach, WA & Dixson, C. (2001). Revealing  moments: Formulating understandings of adverse experiences in a Health Appraisal interview. Social Science & Medicine, 52, 25-45.

Beach, WA (1995). Preserving and constraining options: "Okays" and `official' priorities in medical interviews. In GH Morris & RJ Cheneil (Eds). The talk of the clinic: Explorations in the analysis of medical and therapeutic discourse (pp.259-289). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Jones, CM & Beach, WA (1995). Therapists' techniques for responding to unsolicited contributions by family members. In GH Morris & RJ Cheneil (Eds). The talk of the clinic: Explorations in the analysis of medical and therapeutic discourse (pp.49-70). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

 


II. Moores Cancer Center & the Department of Surgery:

Collaborations with the University of California, San Diego Medical Center

 Moores Cancer Center

 

Working with clinical researchers and staff at the Moores Cancer Center, a new phase of data collection is nearly completed. A corpus of approximately 120 video recorded interviews between cancer patients and 15 oncologists (medical, surgical, and radiation) will provide a solid foundation for enhancing understandings of communication and cancer care. Basic research findings on important social activities are emerging, such as how patients exhibit and doctors respond to fears about cancer (insert Beach et al link/2004, here), the delivery and receipt of both good and bad cancer news, how patients expand their answers to doctors’ questions when narrating touched-off life and world experiences, the interplay of talk and gaze throughout the organization of delicate moments, and contrasts between how patients speculate about their illness and doctors’ technical responses and diagnoses. 

 

These and related interactional findings will form the basis for future grant applications, and for ongoing educational opportunities designed to enhance the quality of cancer care (e.g., through video-reviews with doctors, ongoing workshops focusing on emerging collections of key moments shared by cancer patients and doctors, and the identification of alternative practices and styles for addressing patients’ concerns).  

 

Providing compassionate, personalized cancer care in an environment of world-class scientific research – “to advance discovery and treatment for each patient entering our doors in the hope of cure” – is a commitment promoting the highest standards of excellence for advancing healing. The emerging studies on communication during oncology interviews seek to gradually build a science of compassion, facilitating the development of trusting and technologically sophisticated relationships between cancer patients, their families, doctors, and staff.

 

Emerging Focus on ‘Communication & Ethnic Disparities’

 

We are in the initial stages of seeking to understand how cancer patients, from ethnically diverse backgrounds, present their concerns (problems, confusions, worries, anxieties, fears) to doctors and respond to doctors’ questions about their illness. For example, how “submissive and/or assertive” are patients throughout history-taking – and by what interactional critieria might such assessments be made? We are also interested in how ethnically diverse oncologists (surgical, medical, radiation, and resident) respond to patients’ concerns. For example, how do doctors attend to what patients treat as important, and/or disattend their concerns? What variations exist, if any, across ethnically diverse patients and doctors? Further, we are envisioning analysis medical records for 3 months following patient’s recorded visitation to determine possible ethnic variations in diagnosis and treatment regimens. Questionnaires, generated from findings about patient-doctor interactions, will also be utilized to assess both patients’ and doctors’ evaluations of key communication moments occurring within oncology encounters. Analysis will reveal similarities and possible discrepancies between actual “real time” communication between patients and doctors at the Moores Cancer Center, and post-hoc moments reported as significant through questionnaires provided to patients following oncology visitations (and mailed back to clinic). The larger vision is to integrate and disseminate these multi-methodological findings in an educational DVD made available to UCSD cancer center staff. Additional information emerging from this study will then be available for seeking additional external funding for a broader investigation, designing curricular and training materials for intervention and evaluation of ways to enhance cultural sensitivity and intercultural communication competence in cancer clinics.

Department of Surgery

Working with colleagues in the Department of Surgery at UCSD (e.g., David Easter, M.D. & Carol Runge, Program Coordinator, UCSD General Surgery Residency Program), we have begun to develop a ‘Communication Mentoring Program for Surgeons’.  Efforts have been initiated with surgical residents, since the residency program populates its resident ranks with graduates from some of the most desirable medical schools in the country.  It is committed to meeting the educational needs of the individual trainee, whether or not a resident wants to be productive in scientific research, clinical care, or teaching in their future careers.  For these and other reasons, the surgery program at UCSD is considered very desirable, and it typically matches its top choices into residency training. 

Recently, medical schools, residency programs and continuing educational programs have all focused on core curriculum requirements – many of which are rooted in communication skills.  The six core competencies as they apply to surgical residency training are: Patient Care, Medical Knowledge, Practice Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice. 

An additional recent stressor in surgical education is the imposition of strict working-hours regulations.  Residents are required to be in-hospital for no more than 80 hours/week, averaged over 4-weeks, and must not be in-hospital for more than 30 consecutive hours.  “Work” is functionally defined as being in the workplace, regardless of activity, e.g., sleeping in call rooms or active patient care.  These pressures have led to more “shift work” styles of resident interactions with patients, including many hand-offs and cross-covering of patients.  It is in this new educational environment that clear communication is more essential than ever. 

Preliminary Intervention

In an effort to better understand the core elements and difficulties occurring during routine surgical interactions with patients, including during residency education, we have presented to two Grand Rounds involving surgeons, and begun a series of observational studies of residents in training.  A 2 month seminar was conducted for 6 surgical residents. Anchored in reviews of video recordings and transcriptions of medical interviews, participants were also provided with selected reprints and a bibliography of conversation analytic studies of medical encounters. Residents were then required to video record their own interviews with patients, review their interactions, and identify “good and bad” moments for subsequent (often extended) review and discussion.  An anonymous 2—item questionnaire was administered to the six mentoring participants prior to and following the completion of the mentoring program. The main outcome measure was 9 opinions regarding medical interviews and patient-physician interactions.

 

Results

Of the 20 opinion measures, nine showed meaningful shifts (eta squared > .10) from pretest to posttest measures, perhaps as a result of the mentoring program. Five of the nine changes in opinion are clearly consistent with the mentoring intervention. Four of the nine changes seem counter to the mentoring intervention upon first inspection. However, when analyzed in the context of the consistent opinion shifts, these changes also seem consistent with the intervention, although in unexpected ways.

 

Clearly consistent with the intervention, participants 1) increased their awareness of the importance of verbal and nonverbal communication, 2) increased their desire to listen to lay diagnoses, 3) decreased their emphasis on strictly “medical” purposes of interviews, 4) increased their willingness to listen to patients’ personal stories, and 5) increased perceived value of reassurance and hope as interview outcomes.

 

In addition, participants 1) treated communication as less of an “important issue” for them after the mentoring (perhaps as a consequence of the communication skills they acquired), 2) increased their agreement that time constraints required tight focus on diagnosis and treatment (perhaps because “lay diagnosis” and “personal stories” were added to participants’ expanding understanding of diagnosis and treatment), 3) increased their agreement that “medical concerns” are more important than patients’ “personal concerns” (perhaps because “medical concerns” include “lay diagnosis” and “personal stories” as a result of mentoring), and 4) decreased comfort with patient expressions of anxiety and fear (perhaps because the shield of biomedical detachment was lowered as a result of mentoring).

 

As a case study of only six participants, changes in opinions from pretest to posttest must be regarded as strictly heuristic. Further, instrumentation was constructed for this specific mentoring program, so no indices or reliability coefficients were generated from the limited data available. Nevertheless, the possible effect size of the mentoring intervention is impressive (eta squared = .12 to .37), assuming that the mentoring program was the primary causal agent in the shift in pretest-posttest measures. The mentoring program seemed to increase participant acceptance of patient-initiated communication, such as lay diagnosis and “personal stories.” Mentoring also seemed to increase the willingness of participants to regard reassurance and hope as desirable outcomes of medical interviews. Interestingly, participants still regarded medical interviews as constrained by time, requiring tight focus on the diagnosis and treatment. However, the very meaning of “diagnosis and treatment” may very well have been transformed by their mentoring experiences.

 

 

Plans to continue communication monitoring for surgical residents are underway, and to possibly extend such training to other surgeons. Research focusing on close analysis of communication during actual video recorded  surgeries is also being envisioned.

 

III. Additional Studies of Ordinary Conversation & Institutional Interactions

A variety of additional studies have been pursued, and continue to emerge in unison with the projects summarized above. A brief listing of additional areas of my research follows, categorized (roughly) into the following areas of emphasis:

 

-Acknowledgment Tokens

-Stories & Related Social Activities

-Methodological Positions

-Courtroom Interactions

 

Acknowledgment Tokens

Earlier work on such acknowledgment tokens as “Okay” – contrasted with, for example, “mm”, “mm hmm”, “uh huh”, or “yeah” –  or brief utterances such as “I don’t know”, created an empirical foundation for close examination of subsequent observations (e.g., about monitoring and being responsive to patients’ concerns). Ongoing work, such as how speakers employ wide variations in the construction and use of “Okays” (prosaically, through pitch, tone, rate, and emphasis), continues to trigger my interests and, hopefully, promote finer-grained understandings of the amazingly ordered complexities of everyday language use.

Beach, WA & Metzger, TR (1997). Claiming insufficient knowledge. Human Communication Research, 23, 562-588.

Metzger, TR & Beach, WA (1996). Preserving alternative versions: Interactional techniques for organizing courtroom cross-examination.  Communication Research, 23, 749-765.

Beach, WA (1995). Preserving and constraining options: "Okays" and `official' priorities in medical interviews. In GH Morris & RJ Cheneil (Eds). The talk of the clinic: Explorations in the analysis of medical and therapeutic discourse (pp.259-289). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Beach, WA (1995). Conversation analysis: "Okay" as a clue for understanding consequentiality. In SJ Sigman (ed.). The consequentiality of communication (pp.121-162). Hillsdale, NJ: Lawrence Erlbaum Assoc, Inc.

Beach, WA (1993). Transitional regularities for 'casual' "Okay" usages. Journal of Pragmatics, 19, 325‑352

Beach, WA & Lindstrom, AK (1992). Conversational universals and comparative theory: Turning to Swedish and American acknowledgement tokens‑in‑interaction. Communication Theory, 2, 24‑49.

Beach, WA (1991). Searching for universal features of conversation. Research on Language and Social Interaction, 24, 349-366.

Beach, WA (1990). Orienting to the phenomenon. In J.A. Anderson (Ed.), Communication yearbook 13 (pp. 216‑244). Beverly Hills, CA: Sage Publications.

Beach, WA (1990). Language as and in technology: Facilitating topic organization in a videotex focus group meeting. In MJ Medhurst (Ed.), Communication and the culture of technology (pp. 197‑220). Pullman, WA: Washington State University Press.

 

Stories & Related Social Activities (e.g., Blamings, Pursuing & Inviting Action,

Pre-sequences, Poetics, Gender, Birthday Parties, Conversational Universals)

 

Social activities comprising stories and storytelling have been an interest of mine for some time (in ordinary and institutional interactions), and are apparent    throughout my writings. Related interests in how “gender” or “sexism” might be evident in talk-in-interaction are also recognizable. A corpus of video recordings I collected on children’s birthday parties is also beginning to be analyzed.

Good, J.S. & Beach, WA (in press). Opening up gift-opening: Birthday parties as situated activity systems Text.

Beach, WA & Lindstrom, AK (1992). Conversational universals and comparative theory: Turning to Swedish and American acknowledgement tokens‑in‑interaction. Communication Theory, 2, 24‑49.

Beach, WA (2002). Phone openings, ‘gendered’ talk, and conversations about illness. In J Mandelbaum, P Glenn, & C LeBaron (Eds). Studies in language and social interaction: In Honor of Robert Hopper (573-588). Lawrence Erlbaum Associates.

Beach, WA (2000). Inviting collaborations in stories about a woman. Language in Society,29, 379-407.

Beach, WA (1993). The delicacy of preoccupation. Text and Performance Quarterly, 13, 299‑312.

Beach, WA (1991). Avoiding ownership for alleged wrongdoings. Research on Language and Social Interaction, 24, 1-36.

Beach, WA (1991). Searching for universal features of conversation. Research on Language and Social Interaction, 24, 349‑366.

Beach, WA & Japp, PM (1983). Storifying as time‑traveling: The knowledgeable use of temporally structured discourse. In Robert N. Bostrom (Ed.), Communication yearbook  7 (pp. 867‑888). Beverly Hills, CA: Sage Publications.

Beach, WA & Dunning, DG (1982). Pre‑indexing and conversational organization. Quarterly Journal of          Speech, 68, 170‑185.

 

Methodological Positions

 

At times I have specifically addressed the relationship between conversation analysis and alternative methodological positions (i.e., in terms of ‘units of analysis’, self-reported vs. enacted behaviors, contrasts between verbal/nonverbal/nonvocal actions, conversation analysis and ethnomethodology, and issues of reliability, validity, and generalizability). The following papers address, at least in part, these varied concerns:

Beach, WA & Andersen, J. (2004). Communication and Cancer? Part II: Conversation analysis. Journal of Psychosocial Oncology, 21, 1-22.

Beach, WA & Andersen, J (2003). Communication and cancer? Part I: The noticeable absence of interactional research. J of Psychosocial Oncology, 21, 1-23.

Beach, WA & LeBaron, C (2002). Body disclosures: Attending to personal problems and reported sexual abuse during a medical encounter. Journal of Commmunication, 52, 617-639.

Beach, WA (1995). Maps and diggings. In S.J. Sigman (ed.). The consequentiality of communication (pp. 223-226). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Beach, WA (1990). Orienting to the phenomenon. In J.A. Anderson (Ed.), Communication yearbook 13 (pp. 216‑244). Beverly Hills, CA: Sage Publications. (Revised and reprinted in FL Casmir (Ed). Building communication theories: A socio-cultural approach (pp.133-164). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.).

Beach, WA (1994). Relevance and consequentiality. Western Journal of Communication, 58, 51-57.

Beach, WA (1990). On (not) observing behavior interactionally. Western Journal of Speech Communication, 54, 603‑612.

Beach, WA (1982). Everyday interaction and its practical accomplishment:Progressive developments in ethnomethodological research. Quarterly Journal of Speech, 68, 314‑327.

 

Courtroom Interactions

 

An early and continued interest in how judges, attorneys, and witnesses organize their interactions is summarized below. Particular attention has been given to cross-examination, though much work remains on a large collection of instances addressing how judges ‘regulate court traffic’ by interactionally managing key exchanges across daily court proceedings:

Metzger, TR & Beach, WA (1996). Preserving alternative versions: Interactional techniques for organizing courtroom cross-examination. Communication Research, 23, 749-765.

Beach, WA (1991). Intercultural problems in courtroom interaction. In LA Samovar & RE Porter (Eds), Intercultural communication: A reader,(6th Ed), (pp. 215-221). Belmont CA: Wadsworth Publishing Co.

Beach, WA (1990). Orienting to the phenomenon. In J.A. Anderson (Ed.), Communication yearbook 13 (pp. 216‑244). Beverly Hills, CA: Sage Publications. (Revised and reprinted in FL Casmir (Ed). Building communication theories: A socio-cultural approach (pp.133-164). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.).

Beach, WA (1988). Organizing courtroom contexts: Interactional resolutions to intercultural troubles. In Larry A. Samovar and Richard E. Porter (Eds.), Intercultural communication: A reader (5th Edition), (pp. 200‑206). Belmont, CA: Wadsworth Publishing Co.

Beach, WA (1985). Temporal density in courtroom interaction: Constraints on the recovery of past events in legal discourse. Communication Monographs, 52, 1‑18.