Modes of risk explanation in telephone consultations between nurses and parents for a genetic condition

Abstract

Risk explanations are a crucial part of clinical encounters that concern clients’ genetic risk status. The ways in which risk explanations are delivered may impact on clients’ decision-making and outcomes of these clinical encounters. In this article, we examine risk explanations in telephone consultations in Hong Kong between genetic nurses and parents whose infants have been diagnosed with a mild hereditary disorder, G6PD deficiency, commonly known as favism. Using discourse analytic methods, we focus on 50 audio-recorded telephone consultations. First, we show the distribution of different types of risk explanation in terms of their volume and sequential positioning in the study corpus. The two predominant explanation types – physiological explanations and hereditary explanations – are then discussed in relation to their respective functions in these telephone consultations, namely serving as warrants for advice-giving and providing reassurance. We then examine how the genetic nurses interactionally orient themselves to the parents’ existing knowledge regarding G6PD deficiency while delivering these risk explanations. The differences in explanation trajectories are linked to the presence or absence of prior knowledge of the condition on the part of the parents; and these differences are displayed at the interactional rather than at the substantive level, that is parents with prior knowledge of the condition occupy a different participant status in eliciting and responding to the risk explanations.

Keywords:

• risk
• telephone consultations
• nurse–parent interactions
• Hong Kong
• G6PD deficiency
• risk explanations
• advice-giving
• reassurance

Acknowledgements

The research reported here was fully supported by a grant from the Hong Kong Research Grants Council of the Hong Kong Special Administrative Region, China (project no. HKU 758211 H). Wewish to acknowledge the participants of this project who allowed us to have their interactions audio-recorded; and the members of the research team Dr. Lam Tak Sum Stephen, Dr. Lo Fai Man Ivan, Ms. Fung Shun Mei May and a PhD candidate Yau Hoi Ying Alice for assistance with transcribing the data.

Notes

1. G6PD deficiency (also commonly referred to as favism) is an X-linked recessive disorder. It is an enzyme deficiency that increases the sensitivity of red blood cells to oxidative damage (Farhud and Yazdanpanah 2008). The condition is life-long, although most people who suffer from it do not have any symptoms until they are exposed to certain substances (e.g. fava beans) and certain medications. When exposed to these substances, the red blood cells become haemolysed, which in the worst case scenario can result in fatality.

2. Whether risk explanations are offered in telephone-mediated or face-to-face encounters, such explanations routinely encompass issues such as disease causation, disease management, prognosis and patterns of inheritance regardless of the mode of communication. In particular, the mothers’ understanding of the risks associated with having a child with a G6PD deficiency will have direct ramifications for the child's well-being after discharge from hospital.