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The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate.

ABSTRACT: When interacting with people with aphasia, communication partners use a range of subtle strategies to scaffold, or facilitate, expression and comprehension. The present article analyses the unintended effects of these ostensibly helpful acts. Twenty people with aphasia and their main communication partners (n = 40) living in the UK were video recorded engaging in a joint task. Three analyses reveal that: (1) scaffolding is widespread and mostly effective, (2) the conversations are dominated by communication partners, and (3) people with aphasia both request and resist help. We propose that scaffolding is inherently paradoxical because it has contradictory effects. While helping facilitates performing an action, and is thus enabling, it simultaneously implies an inability to perform the action independently, and thus it can simultaneously mark the recipient as disabled. Data are in British English.

SUBMITTER: Gillespie A

PROVIDER: S-EPMC5555562 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate.

Gillespie Alex A Hald Julie J

PloS one 20170814 8

When interacting with people with aphasia, communication partners use a range of subtle strategies to scaffold, or facilitate, expression and comprehension. The present article analyses the unintended effects of these ostensibly helpful acts. Twenty people with aphasia and their main communication partners (n = 40) living in the UK were video recorded engaging in a joint task. Three analyses reveal that: (1) scaffolding is widespread and mostly effective, (2) the conversations are dominated by c ...[more]

PMID: 28806409

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Project description:PurposeThis study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success.MethodTwenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success.ResultsAll speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success.ConclusionsSpecific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA.Supplemental materialhttps://doi.org/10.23641/asha.17699423.

Project description:BackgroundMost cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help.ObjectiveThis study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM).MethodsA sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals' interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group).ResultsThis study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited.ConclusionsA clinically and culturally tailored QPL is expected to facilitate patients' participation in consultations, improve oncologists' responses to patients' information and support needs, and thus foster patients' psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment.Trial registrationClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062.International registered report identifier (irrid)DERR1-10.2196/26414.

Dataset Information

The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate.

Publications

The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate.

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