This is the End: The Role of Death in the Narrative Structure of Popular Movies.

A set of sixty popular movies is analyzed both quantitatively and qualitatively on the role of death in the narrative structure and the portrayal of death. Results of the quantitative analysis show that death events tend to be story-terminating, which implies that death is typically depicted as meaningful in relation to the past. The qualitative thematic analysis reveals that death is also depicted as meaningful in that it can lead to growth, unification and salvation. Furthermore, most movies include explicit death portrayals, thereby inviting viewers to closely approach death and to simulate both their own mortality and the mortality of their loved ones. Finally, it was found that most movie deaths involve violent attacks, indicating that movies tend to paint an unrealistic view of how people die. These findings advance our knowledge of how movies might help people to understand the meaning of death and to cope with existential fears.

Different patterns of persistent somatic symptoms after COVID-19 reported by the Dutch media and the general population.

OBJECTIVE: Post COVID-19 condition is characterized by persistent symptoms after COVID-19 with yet unknown etiology. To explore whether media-related nocebo effects potentially contribute to post COVID-19 condition, we studied in an observational cohort whether frequencies of media coverage of symptoms after COVID-19 corresponded with prevalence rates of these symptoms in participants from a general population cohort diagnosed with COVID-19. METHODS: Prevalence rates and typology of symptoms after COVID-19 in the general population (N = 4231), adjusted for prevalence rates in a matched non-infected control population (n = 8462) were calculated by using data on 23 symptoms from the Lifelines COVID-19 Cohort collected between March 2020 and August 2021. Media coverage of post COVID-19 condition was assessed by coding 1266 Dutch post COVID-19-related news articles (inter-rater-κ ≥ 0.75), published during the corresponding timeframe. Herein, we assessed whether the same 23 symptoms were mentioned as being related to post COVID-19 condition. RESULTS: Core post COVID-19 condition symptoms were mentioned in 390 (30.8%) articles. Five of the ten core symptoms were mentioned by 10 or fewer articles. Ageusia/anosmia was most often persistently increased in COVID-19-positive participants (7.6%), yet was mentioned in 80 (6.3%) articles. General tiredness and breathing difficulties were frequently mentioned, in 23.9% and 17.1% of the articles respectively, while these were not the most frequently increased symptoms reported by participants (4.9% and 2.4%). CONCLUSION: If post COVID-19 condition was predominantly attributable to nocebo effects, its symptom profile would be expected to reflect levels of media coverage for symptoms after COVID-19. However, our findings do not support this.

Interdisciplinary education affects student learning: a focus group study.

BACKGROUND: In order to best prepare medical students for their increasingly complex future career, interdisciplinary higher education is swiftly gaining popularity. However, the implementation of interdisciplinary learning in medical education is challenging. The present study deepens the understanding of the challenges and opportunities inherent to the implementation of an interdisciplinary course. We elucidated the attitudes and beliefs of students participating in a newly developed interdisciplinary minor, in which students of medicine (MS) and communication and information sciences (CISS) were involved. METHODS: We conducted four semi-structured focus group interviews, of which two were held before, and two were held after the course. Seven MS and six CISS participated voluntarily. A pre-arranged interview guide was used. The interviews were recorded and afterwards systematically analyzed with the 'constant comparative analysis' technique. RESULTS: The focus group interviews revealed three differences in epistemics between students in terms of 1) curriculum content, 2) educational formats and 3) student's competence perceptions. These factors influenced the way students evaluated themselves, each other and the interdisciplinary course. CONCLUSIONS: We conclude that factors that influence interdisciplinary learning are personal epistemics, individual learning preferences, and the synergy that is achieved throughout interdisciplinary learning. Organizing the dialogue among students of different disciplines could make students aware of inequalities, implicated biases and assigned status of different student groups. These empirical results are crucial to tailor interdisciplinary education to each specific discipline and to take interdisciplinary learning to a higher level of maturity.

Can we distinguish mixed from ambiguous emotions and morality?

The neurocognitive model of Mixed and Ambiguous Emotions and Morality (MA-EM) makes a relevant case for putting non-unidimensional emotions and morality more prominently on the research agenda. However, existing research challenges its assumptions about the distinction between mixed and ambiguous emotions and morality, and how they relate to reflective versus simulative processing routes, in three respects. First, the emotional state of being moved is generally conceptualized as a non-ambiguous rather than an ambiguous emotion. Second, mixed emotions have been found to elicit reflection rather than simulation. Third, the morality of narrative characters is typically perceived as mixed rather than ambiguous.

Limited health literacy in primary care physiotherapy: Does a physiotherapist use techniques to improve communication?

OBJECTIVES: Research shows that health professionals should adapt their communication when addressing patients with limited health literacy (HL). However, the extent to which physiotherapists apply recommended communication techniques is unclear. METHODS: We conducted a two phase mixed-method study, first holding focus group interviews among patients and experts on communication to explore the need for adjusted communication in physiotherapist-patient interaction. Second, we manually coded audio recordings of primary care physiotherapy consultations to investigate the extent to which physiotherapists applied these recommended communication techniques, and adjusted their communication towards patients with lower education. RESULTS: Focus group interviews identified four categories of communication elements: the teach-back method, medical jargon explanation, summarizing patient's narratives, and checking patient's understanding. In 50 audio recordings we identified 2670 clauses. We report limited use of the recommended communication techniques; the teach-back method was used in 2% of consultations (95%CI: 0.4%-10.5%) while medical jargon explanation was used in 84% (95%CI: 71.5%-91.7%). Mixed effects logistic regression models showed no association between lower education and communication techniques. CONCLUSION: Although physiotherapists need to adjust their communication to patients with lower education, they rarely apply the recommended communication techniques. PRACTICE IMPLICATIONS: Knowledge about limited HL among physiotherapists needs to be increased.

Physicians' and Patients' Interruptions in Clinical Practice: A Quantitative Analysis.

PURPOSE: Physicians' interruptions have long been considered intrusive, masculine actions that inhibit patient participation, but a systematic analysis of interruptions in clinical interaction is lacking. This study aimed to examine when and how primary care physicians and patients interrupt each other during consultations. METHODS: We coded and quantitatively analyzed interruption type (cooperative vs intrusive) in 84 natural interactions between 17 primary care physicians and 84 patients with common somatic symptoms. Data were analyzed using a mixed-effects logistic regression model, with role, gender, and consultation phase as predictors. RESULTS: Of the 2,405 interruptions observed, 82.9% were cooperative. Among physicians, men were more likely to make an intrusive interruption than women (ß = 0.43; SE, 0.21; odds ratio [OR] = 1.54; 95% CI, 1.03-2.31), whereas among patients, men were less likely to make an intrusive interruption than women (ß = -0.35; SE, 0.17; OR = 0.70; 95% CI, 0.50-0.98). Patients' interruptions were more likely to be intrusive than physicians' interruptions in the phase of problem presentation (ß = 0.71; SE, 0.23; OR = 2.03; 95% CI, 1.30-3.20), but not in the phase of diagnosis and/or treatment plan discussion (ß = -0.17; SE, 0.15; OR = 0.85; 95% CI, 0.63-1.15). CONCLUSIONS: Most interruptions in clinical interaction are cooperative and may enhance the interaction. The nature of physicians' and patients' interruptions is the result of an interplay between role, gender, and consultation phase.

Gender stereotyping in medical interaction: A Membership Categorization Analysis.

OBJECTIVE: Gender can be a valuable resource in communication but also a problem, perpetuating gender stereotypes. So far, there has been little attention for how healthcare professionals and patients make gender relevant in medical interactions. The approach of Membership Categorization Analysis (MCA) is particularly pertinent to meticulously analyze gender in medical communication. Applying MCA, this study analyzes how activity descriptions implicitly associated with gender stereotypes, e.g., "carrying a laundry basket up the stairs", feature in the course of GPs' explanations of a question or diagnosis. The aim is to provide a new perspective on the relationship between gender and medical interaction, and to increase our understanding of how gender stereotypes are reproduced in the medical setting. METHOD: Two cases of GPs using gendered explanations in Dutch general practice interactions are analyzed turn-by-turn using MCA. RESULTS: The findings show how GPs' descriptions of gendered activities serve the exemplification of technical terms, designed for the specific patient, while also casting the patient in a traditional gender role. CONCLUSION: Invoking gender in medical interaction may serve a communicative goal while also perpetuating stereotypes. PRACTICE IMPLICATIONS: Insight in the subtleties of gender construction in medical interactions could enhance gender awareness and sensitivity in healthcare.

Coding linguistic elements in clinical interactions: a step-by-step guide for analyzing communication form.

BACKGROUND: The quality of communication between healthcare professionals (HCPs) and patients affects health outcomes. Different coding systems have been developed to unravel the interaction. Most schemes consist of predefined categories that quantify the content of communication (the what). Though the form (the how) of the interaction is equally important, protocols that systematically code variations in form are lacking. Patterns of form and how they may differ between groups therefore remain unnoticed. To fill this gap, we present CLECI, Coding Linguistic Elements in Clinical Interactions, a protocol for the development of a quantitative codebook analyzing communication form in medical interactions. METHODS: Analyzing with a CLECI codebook is a four-step process, i.e. preparation, codebook development, (double-)coding, and analysis and report. Core activities within these phases are research question formulation, data collection, selection of utterances, iterative deductive and inductive category refinement, reliability testing, coding, analysis, and reporting. RESULTS AND CONCLUSION: We present step-by-step instructions for a CLECI analysis and illustrate this process in a case study. We highlight theoretical and practical issues as well as the iterative codebook development which combines theory-based and data-driven coding. Theory-based codes assess how relevant linguistic elements occur in natural interactions, whereas codes derived from the data accommodate linguistic elements to real-life interactions and contribute to theory-building. This combined approach increases research validity, enhances theory, and adjusts to fit naturally occurring data. CLECI will facilitate the study of communication form in clinical interactions and other institutional settings.

The Effects of Being Informed About Chemotherapy-Related Cognitive Symptoms With And Without Self-Affirmation on Perceived Cognitive Symptoms of Breast Cancer Patients: A Randomized Prospective, Longitudinal Study.

BACKGROUND: Informing patients about chemotherapy-related cognitive symptoms (CRCS) may increase perceived cognitive symptoms. This longitudinal randomized study evaluated this Adverse Information Effect (AIE) in breast cancer patients and examined whether self-affirmation (SA) can reduce AIEs (ClinicalTrials.gov identifier: NCT04813965). PATIENTS AND METHODS: Before (neo) adjuvant chemotherapy, 160 newly diagnosed breast cancer patients were randomly allocated to receive: standard information on side-effects (control), standard information with additional information about CRCS (information), or standard and additional information with a subsequent self-affirmative text (information+SA). Online-questionnaires assessed the perceived frequency (MOS-cog) and severity (MDASI-cog) of cognitive symptoms before chemotherapy (baseline, T0), and 2.5-months (T1) and 6.5-months (T2) post-chemotherapy. Higher scores indicate less frequent, and more severe symptoms, respectively. Baseline-to-follow-up analyses using a mixed-effects modeling approach compared groups over time. RESULTS: At T0-T2, 148, 140 and 133 patients responded, respectively (attrition rates: 8%, 5%, 5%). Frequency (ES = -0.36, P =.003) and severity (ES = 0.54, P <.001) of symptoms worsened from baseline to T1, without differences between groups. At T2, symptom frequency remained stable for informed (ES=-0.3, P =.021) and self-affirmed (ES=-0.3, P =.019) patients, but returned to baseline levels for controls. At T2, symptom severity remained increased for informed patients (ES = 0.3, P =.006), but normalized for self-affirmed patients (ES = 0.2, P =.178) and controls. CONCLUSION: No AIEs occurred until T2. The initial overall increase in perceived cognitive symptoms recovered at T2 for controls, but not for patients who received additional information about CRCS. Self-affirmation attenuated these longer-term AIEs for the perceived severity but not the frequency of symptoms.

"They don't do anything" contextual factors influencing Turkish-Dutch individuals' perceptions of general practitioners and medical specialists in the Netherlands and Turkey.

OBJECTIVE: Intercultural difficulties between GPs and patients are important contributors to health disparities. Framed in an interpretivist paradigm, this paper's thematic analysis examined how Turkish-Dutch patients' expectations of Dutch GPs may result in intercultural communication difficulties. METHODS: Five focus group discussions were conducted with 21 participants of Turkish-Dutch background. Participants were asked to discuss perceived differences between GP-patient encounters in the Netherlands and Turkey. RESULTS: Our study revealed that Turkish-Dutch patients regularly expect Dutch GPs to show other behavior than they perceive to obtain on two themes, 1) dealing with patients' symptoms and 2) communication. In general, Turkish-Dutch patients expect Dutch GPs to show faster, more decisive and informative behavior in diagnostics and treatment. These expectations seem based on their experiences with practitioners in Turkey and on differences between health care systems. CONCLUSIONS: GP-patient difficulties appear primarily the result of underlying frustrations rather than clashes resulting from differences in explanatory models of illness or cultural values. PRACTICE IMPLICATIONS: Whereas systemic differences are more difficult to alter, difficulties in the communication are more readily amenable to change. Patient-centered communication and information about the reasons for being restrictive in diagnosing and treating on symptoms could alleviate these frustrations.