Applying a multidimensional approach to understanding clinical conversations: A deprescribing case study in primary care

• Published in: Patient education and counseling 2022-07, Vol.105 (7), p.2590-2598
• Main Authors: Richard, Claude, Lussier, Marie-Thérèse, Roberge, Denis, Lavoie, Marie-Ève, Turner, Justin
• Format: Article
• Language: English
• Subjects: Coding methods; Communication; Deprescribing; Deprescriptions; Doctor-patient communication; Female; Humans; Medication discussions; Primary Health Care; Tape Recording
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2022.02.003

To describe and evaluate the contribution of multiple coding approaches applied to a clinical conversation on deprescribing in primary care (PC). Seven distinct coding approaches were applied to one audiotaped consultation. Only exchanges related to deprescribing a benzodiazepine (BZD) were coded for: content, interaction, arguments, connectors, transitions, orientation towards deprescribing and concordance with a deprescribing algorithm. A discursive map presents the unfolding of the exchanges. The deprescribing conversation was broken down into 31 utterances divided into three segments: opening (n = 6), development (n = 16) and closing (n = 9). The family physician dominated the last two segments and most of her utterances were favorable to BZD deprescribing while the patient’s utterances were generally unfavorable in the first two segments. The number of distinct codes assigned to utterances varied according to the coding approach. The map illustrates how each utterance can be viewed through different lenses revealing the dynamics and complexity of the deprescribing conversation. This multidimensional methodological approach with its proposed way of presenting results, either quantitatively or qualitatively, and its map offer a comprehensive evaluation of the deprescribing process in this PC setting. This novel multidimensional coding approach has potential to be applied to a range of other topics in clinical communications. •Multidimensional analysis offers a comprehensive portrait of a clinical conversation.•Each coding system tells a story in a different but complementary way.•Different codes enhance each other while also illustrating their specific features.•Providing a “map” is an innovative representation of a clinical conversation that enables deeper understanding.