Palliative care, a health specialty concerned with ‘dying, life-limiting prognosis, and end-of-life planning’ (10), is gaining public and institutional awareness worldwide. As conversations in palliative care serve therapeutic functions to long-suffering patients, this setting is of particular interest to applied linguists and linguistic anthropologists. In Palliative care conversations, David Gramling & Robert Gramling integrate their clinical and linguistic insights to characterize the ‘texts’ and ‘contexts’ of palliative care consultations in the US with conversation analysis and theme-oriented discourse analysis. The book reflects on the meanings of ‘patient-oriented practice’.
The book is divided into three parts according to prominent themes, or ‘projects’ (36), in palliative care conversations identified by the authors. The first part discusses the genre of ‘presenting palliative care’. Towards the beginning of consultations, clinicans’ (re)presentation of palliative care is subject to patients’ epistemic stance/status, inclination, and physical difficulty (chapter 2). The patients and family members, in turn, make sense of this field through informational, sociointeractional, and philosophical queries (chapter 3). Patients’ lay/expert knowledge, previous experiences with illnesses, self-identities, and facework (chapter 4) reflect their positions and intents in the institutional context, which are often utilized by clinicians to explore patients’ present needs.
The second part centres on the salient discourses and linguistic features in palliative care conversations. Seemingly inappropriate irony and dark humour can act as mediators in rapport-building, while rapport-resisting can result from misaligned usages of interactional resource and mutually presumed positions between clinicians and patients (chapter 5). The phenomena of code-mixing and translanguaging are prevalent, as participants creatively employ idiolectal, historical/sociopolitical, and multimodal resources, given speech disabilities of patients and discursive boundaries of the activity (chapter 6). Patients and family members also draw on and recount the voices of absent medical professionals in the consultations, mirroring their (mis)alignments with various information and the ‘symbolic, interactional, and infrastructural relationship’ (162) of palliative care with different specialties (chapter 7).
The exploration of communicative goals in palliative care is discussed in the third part. With the metaphors of ‘setting the table’ and ‘sitting down’ to describe the design of an interactional space to discuss issues concerning patients, the authors demonstrate that patient-centredness requires ‘a complex discursive combination of authority and receptivity’ (184; chapter 8). In the discussion of medical history, clinicians, who usually possess lower epistemic status than what patients expect, tend to take an affective, holistic, and conservative stance to acknowledge patients’ long health journeys for effective rapport-building (chapter 9). Finally, century-long issues of avoiding prognostic talks with terminally ill patients in other medical specialties receive new perspectives in the youthful field of palliative care, and prognostication constitutes a key feature of palliative care conversations which necessitates further interactional studies (chapter 10).
Palliative care conversations profoundly captures the interactional dynamics and situated intricacy of clinician-patient communication in palliative care, which renders the book suitable for not only linguists but also clinical practitioners and policymakers in healthcare. The authors’ work, therefore, represents a comprehensive entryway to the impending qualitative research in this emergent field surrounded by the interactional, political, and ethicomoral issues related to death and dying.
