Risk communication in prenatal screening for Down syndrome: a discourse analytic study of patients'risk talk

Abstract

Risk is a crucial concept in healthcare communication. This is attested to by a large

body of research on risk communication in psychology, sociology, and, more recently,

discourse analysis. This previous research has primarily focused on how healthcare

providers manage risk talk, whereas patients’ risk talk has received little attention.

Where it has been researched, it has been presented in an oversimplified way, namely

that the patients have been reported to perceive their risk in a simplified,

‘all-or-nothing manner’. Using theme-oriented discourse analysis (Roberts and

Sarangi, 2005), this study challenges this simplified perception by examining patients’

risk talk in prenatal screening for Down syndrome.

The data for this study comprises 14 video-recorded consultations collected in one

prenatal hospital in Hong Kong. The particular focus of the study is on patients who

have received a ‘positive’ result from the initial screening for Down syndrome that

has put them in a high-risk group by increasing their probability of having a baby with

Down syndrome. In these consultations patients are informed about further testing to

confirm the diagnosis. To examine the patients’ risk talk, the transcripts of the

interactions have been coded along the lines of structural, thematic and interactional

maps (Roberts and Sarangi, 2005) to note down risk talk by patients, what is it

concerned with and the interactional dynamics of how it is managed.

The analysis suggests that patients’ risk talk concerns three types of risks, namely the

“risk of occurrence” (that is the probability of having a child with Down Syndrome)

the “risk of knowing” (that is dealing with the knowledge about having a child with

Down Syndrome) and what has been referred to in this study as the “risk of not

knowing” (that is not finding out about the condition due to the uncertainty

surrounding the tests). In contrast to the findings in the previous studies, the patients

in the data actively initiate risk talk by raising clarification questions and talking

about their concerns. The analysis has revealed the differences in how different types

of risk talk are constructed by the patients. These differences are discussed in regards

to the phases of the consultation in which risk talk occurs and whether risk talk is

aimed at eliciting further information or making a decision about pursuing further

testing. The analysis has also noted that risk communication is a joint activity

involving the patients and the healthcare providers. In addressing patients’ risk talk

the healthcare providers in the data take on an indirect approach, thereby avoiding

influencing the patients’ decision-making and managing the uncertainty surrounding

prenatal screening. The analysis has also pointed out that the patients’ socioeconomic

and cultural backgrounds have a crucial impact on how risk talk is constructed by the

patients.