A entrega de notícias em aconselhamentos genéticos: uma investigação interacional sobre como acontece na prática

Abstract

This master’s dissertation consists of a subproject of a larger study (Uma mulher, um feto, e uma má notícia: a entrega de diagnósticos de síndromes e de malformações fetais – em busca de uma melhor compreensão do que está por vir e do que pode ser feito, OSTERMANN, 2013) and aims at describing the news delivery made by a geneticist to pregnant or puerperal women and their companion during audio recorded genetic counselings held in a mother and child hospital of the Sistema Único de Saúde (SUS), located in southern Brazil. After transcribing the 54 audiorecorded genetic counselings, we selected only the 21 counseling sessions which dealt with the communication of tests results. By taking a conversation analytical perspective (SACKS; SCHEGLOFF; JEFFERSON, 1974), the interactions were analyzed so as to describe the actions involved within the phase of the consultations in which the sequence of good and bad news delivery occurs. The data analysis reveals that the delivery of the news follows a didactic sequence composed by the following elements: (1) a news preannouncement, (2) a retake of the previous exams results which indicated the realization of more specialized exams, (3) a/some perspective-display series (MAYNARD, 1992) in case of bad news, (4) a news announcement itself, and when the news consists of a “bad” diagnosis, (5) a display of something potentially “positive” within each case. Another tendency revealed in the data refers to the process of placing the category of spokesperson to the doctor, to the staff of fetal medicine and to the institution itself when the news is good. When the news to be delivered is bad, on the other hand, there is a process of distancing of the person who delivers it and this category is alocated to the exam, which is then put in the position of the “agent” of the verbs that announce the news and, as a consequence, ends up being “the responsible one” for bearing it. This process of agentivization of the exam is linked to the process of “depersonalization of the disease”, which happens due to the lack of nominal and/or pronominal referents that categorize the fetus as the bearer of the disease and the symptoms presented throughout the news delivery sequence. The linguistic-interactional analysis of the news delivery in this research study shows recurring practices in the event genetic counseling. By these recurrences, the geneticist presents ways to deal with the patients and their companions’ distress, and these ways can be spread to the health professionals’ education in areas in which diagnosis delivery is a daily practice.