The analysis of verbal interaction sequences in dyadic clinical communication: a review of methods.

OBJECTIVE: To identify methods available for sequential analysis of dyadic verbal clinical communication and to review their methodological and conceptual differences.
METHODS: Critical review, based on literature describing sequential analyses of clinical and other relevant social interaction.
RESULTS: Dominant approaches are based on analysis of communication according to its precise position in the series of utterances that constitute event-coded dialogue. For practical reasons, methods focus on very short-term processes, typically the influence of one party's speech on what the other says next. Studies of longer-term influences are rare. Some analyses have statistical limitations, particularly in disregarding heterogeneity between consultations, patients or practitioners. Additional techniques, including ones that can use information about timing and duration of speech from interval-coding are becoming available.
CONCLUSION: There is a danger that constraints of commonly used methods shape research questions and divert researchers from potentially important communication processes including ones that operate over a longer-term than one or two speech turns. Given that no one method can model the complexity of clinical communication, multiple methods, both quantitative and qualitative, are necessary. PRACTICE IMPLICATIONS: Broadening the range of methods will allow the current emphasis on exploratory studies to be balanced by tests of hypotheses about clinically important communication processes.