Reviewed by Carie S. Tucker King, The University of Texas at Dallas (firstname.lastname@example.org)
Chair: John Misak, Queensborough Community College
Speakers: Ryan Eichberger, University of Minnesota, “Negotiating Crisis in the Magic Land: Blogging, Science Communication, and the Disneyland Measles Outbreak”
Russell Kirkscey, Texas Tech University, “A Rhetorical Framework for the Analysis of Patient Decision Aids”
Kyle Vealey, Purdue University, “Storytelling Failure in the Vale of Leven: How a Bacterial Outbreak at a Rural Hospital Became a Wicked Problem”
The room was small and crowded, with more people coming in as the presenters began. I was fortunate to get a seat near the front. I was excited about this presentation because of the titles and the diversity of the panel.
Ryan Eichberger began by sharing an overview of the anti-vaccination movement and referencing the measles-and-autism hoax. He then introduced the 2015 measles outbreak that began at Disneyland and his research questions:
- How did science communicators use the technological and social affordances of the blogging medium to communicate a pro-science message?
- What narrative(s) of science did these bloggers construct, including audiences, characters, and exigencies?
- What limitations did the blogging medium present, and what does this mean for the blog in 2016?
He sought to investigate what blog posts online by pro-vaccination writers were saying about vaccine refusal. He conducted a content analysis of 50 blogs (individual, aggregate, news, and organization blogs) that addressed the Disney outbreak and the issues related to vaccinations.
Through his research, Eichberger identified four types of blogs:
- Independent blogs written by well-informed or expert writers who wrote voluntarily, most focusing on their perspectives of what he called the “logical fallacies in non-vaccination arguments as well as to rebut the non-vaccination arguments of key public figures”;
- Aggregate blogs whose authors, qualified paid writers, received more responses or comments than other types of blogs and used at least two times as many tags as well as internal links (to their own posts) but tended to take a critical or sarcastic tone toward the non-vaccination arguments;
- Organizational blogs whose authors, official writers usually for health organizations, used few tags, received few comments, and varied per pro- and anti-vaccination platforms; and
- Mainstream blogs whose authors, also qualified paid writers, used tags and received comments or responses with more references to news and other sources and also included less biased perspectives.
Eichberger found that the blogs did not link as much to external sources (and thus did not interact in the conversation about immunization) but rather existed to tell stories.
In conclusion, Eichberger found that this was a failed conversation with no discussion. He recognized that the blogs created gaps in the conversation, maintained dehumanizing and angry tones, established hybridity (blogs did not fit into specific categories), included comments that made audiences into characters, and constrained the affordances of blogs and community.
Russell Kirkscey presented about patient decision aidstechnical communication documents that biomedical practitioners have createdthat help patients to understand the options and make informed decisions about their care including decisions about asking for testing.
Kirkscey defined patient decision aids (PDAs) as technical communication documents and noted that they may have multi-media components or may be print or online, and may be from healthcare practitioners or in clinical settings. He listed their functions as informational (providing options), persuasive (arguing for and against options), and evaluative (testing knowledge) with numeric values that may be subjective.
He noted that they can have multiple agendas and purposes. (He investigated this in his dissertation, which can be accessed through the Texas Tech Library’s collection of dissertations.) He shared the International Patient Decision Aid Standards Collaboration “Checklist for Users” to provide an example of current assessment of PDAs.
Kirkscey sampled non-commercial decision aids (what he terms “gateway documents”). The aids’ designers were hospital teachers and representatives, patient advocates, and employees of biomedical organizations and government health departments. He quickly shared the framework he used to rhetorically analyze these aids and then shared samples, such as the Kaiser Prenatal Testing Decision Tree (a print process chart for decision making), the Healthwise Alzheimer’s (interactive) Quiz, and the Kaiser Prenatal Testing “Understanding Your Options” web page.
Kirkscey posed questions about balance, bioethics, and design. Specifically, his research questions were
- How do biomedical professionals rhetorically construct patient decision aids?
- Do biomedical practitioners create decision aids that adhere to bioethical standards?
- Do decision aids achieve balanced argumentation for and against treatment?
For his research, he applied deliberative rhetoric, epideictic rhetoric, and Austin S. Babrow’s (1992) Problematic Integration Theory. Kirkscey specifically noted the conflict between the designers, who are the experts on processes, and the patients, who are the experts on their own bodies.
He concluded that the creators had constructed arguments for the visual aids “using veiled paternalism” and that the visual aids were not balanced in their benefits to patients. Russell proposed his own rubrics for models of analysis— to encourage designers to balance the development methods.
Kyle Vealey presented a review of Clostridium difficile associated disease at Vale of Leven Hospital in Scotland. The outbreak occurred December 2007 to June 2008. Vealey addressed public inquires and their importance. Citizens of the United Kingdom can submit petitions for public inquiries by submitting an e-form; those petitions with enough attention will be addressed by the government. He addressed the petition for a public inquiry so individuals in the UK whose family members were and are affected will be better prepared. He defined these as “wicked problems” and provided an excerpt from an official report of Scotland Parliament’s Public Petitions Committee:
- The scale of the outbreak at the Vale of Leven Hospital was unprecedented… I am equally clear about the fact that the issue is not restricted to the Vale of Leven—it affects people, hospitals, and care homes throughout Scotland. The incidence of C diff is rising: year on year, the trend has been upwards. New strains are being diagnosed as we speak. At this point, no one is quite sure about the toxicity of the new 078 strain that has been discovered… A public inquiry would enable us to learn lessons not in a piecemeal way but in a comprehensive way. (Public Petitions Committee, 2009)
Vealey concluded his presentation by suggesting that we can learn how to approach similar technical and public health issues by applying our analysis of the outbreak in the Vale of Leven. He also suggests that we need to continue to analyze situations like this and deliberate the best ways to manage such issues.
This panel provided some interesting, relevant, and diverse issues in medical rhetoric that encouraged me to consider asking more questions about past situations to better prepare for future issue in public health and medical communication. Judging by the size of the crowd at the panel, I was not the only one who anticipated that this was a valuable group of presentations, and the audience was not disappointed.
Babrow, Austin S. (1992). Communication and problematic integration: Understanding and diverging probability and value, ambiguity, ambivalence, and impossibility. Communication Theory, 2(2), 95–130. doi:10.1111/j.1468-2885.1992.tb00031.x
Scotland. Parliament. Public Petitions Committee. (2009, January 27). Public Petitions Committee. 3rd Session. Retrieved from http://www.parliament.scot/parliamentarybusiness/report.aspx?r=3130&mode=pdf