{ "paper_id": "W02-0225", "header": { "generated_with": "S2ORC 1.0.0", "date_generated": "2023-01-19T05:12:05.238071Z" }, "title": "Rare Dialogue Acts Common in Oncology Consultations", "authors": [ { "first": "Mary", "middle": [], "last": "Mcgee Wood", "suffix": "", "affiliation": { "laboratory": "", "institution": "University of Manchester", "location": { "postCode": "M13 9PL", "settlement": "Manchester", "country": "U.K" } }, "email": "" }, { "first": "Richard", "middle": [], "last": "Craggs", "suffix": "", "affiliation": { "laboratory": "", "institution": "University of Manchester", "location": { "postCode": "M13 9PL", "settlement": "Manchester", "country": "U.K" } }, "email": "richard.craggs@cs.man.ac.uk" }, { "first": "Ian", "middle": [], "last": "Fletcher", "suffix": "", "affiliation": { "laboratory": "", "institution": "University of Manchester Stanley House", "location": { "postCode": "M20 4BX", "settlement": "Manchester", "country": "U.K" } }, "email": "" }, { "first": "Peter", "middle": [], "last": "Maguire", "suffix": "", "affiliation": { "laboratory": "", "institution": "University of Manchester Stanley House", "location": { "postCode": "M20 4BX", "settlement": "Manchester", "country": "U.K" } }, "email": "peter.maguire@cs.man.ac.uk" } ], "year": "", "venue": null, "identifiers": {}, "abstract": "Dialogue Acts (DAs) which explicitly ensure mutual understanding are frequent in dialogues between cancer patients and health professionals. We present examples, and argue that this arises from the health-critical nature of these dialogues.", "pdf_parse": { "paper_id": "W02-0225", "_pdf_hash": "", "abstract": [ { "text": "Dialogue Acts (DAs) which explicitly ensure mutual understanding are frequent in dialogues between cancer patients and health professionals. We present examples, and argue that this arises from the health-critical nature of these dialogues.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Abstract", "sec_num": null } ], "body_text": [ { "text": "We have described elsewhere (Wood, 2001; Wood and Craggs, 2002) the use of dialogue analysis in communication skills training for health professionals working with cancer patients. Our initial corpus arises from a study of Macmillan Cancer Care nurses undertaken by the Psychological Medicine Group, University of Manchester, funded by the Cancer Research Campaign. It consists of 37 dialogues between nurses and patients, each comprising 200-1200 utterances (mostly 300-600). The nurses' goal is to learn as much as possible about the patients' condition, both physical and mental, and to inform the patients about their condition and treatment. The dialogues are thus genuine, naturally occurring conversations, but occurring in an unusual, highly significant and emotionally charged situation.", "cite_spans": [ { "start": 28, "end": 40, "text": "(Wood, 2001;", "ref_id": "BIBREF1" }, { "start": 41, "end": 63, "text": "Wood and Craggs, 2002)", "ref_id": "BIBREF2" } ], "ref_spans": [], "eq_spans": [], "section": "Background", "sec_num": "1" }, { "text": "We have not yet fully annotated a statistically significant sample, but it is clear even from reading through the corpus that a group of thematically related DAs occur frequently which are rare in previously studied corpora such as Switchboard. These are DAs which explicitly establish or confirm accurate mutual understanding, either factual or emotional, between the participants (collaborative completions, summaries), or which build rapport through courtesy and appreciation (thanks, apologies). Protracted closing sequences are characteristic, and tend to have elements of both. We interpret these patterns as direct responses to the goal-directed and potentially health-critical nature of these dialogues.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Background", "sec_num": "1" }, { "text": "We take as our point of comparison the corpus of some 200,000+ utterances from the Switchboard corpus tagged with the SWBD-DAMSL tagset (Jurafsky et al, 1998) . Of these, 36% are \"Statements\", 19% \"Continuers\", and 13% \"Opinions\", giving a total of 68% of all utterances in the three most common categories. At the other end of the scale, an original tagset of 220 was reduced to 42 because the rarity of many made statistical analysis impossible. Even of these 42, 32 occur with less than 1% frequency, 25 less than 0.5%. Four of the five DAs we will discuss here are among these last 25.", "cite_spans": [ { "start": 136, "end": 158, "text": "(Jurafsky et al, 1998)", "ref_id": "BIBREF0" } ], "ref_spans": [], "eq_spans": [], "section": "Rare dialogue acts", "sec_num": "2" }, { "text": "The first goal of the nurse in these dialogues is to ascertain the subjectively perceived physical condition of the patient, which reflects the success of previous treatment, and suggests directions for the future. Factual accuracy is clearly essential if future treatment is to be appropriate. It is also seen as important that the patient have accurate knowledge of his / her condition and treatment.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Mutual understanding", "sec_num": "2.1" }, { "text": "Secondly, the nurse is trying to elicit the mental / emotional state of the patient, and any particular concerns or worries he or she has. Although this is a somewhat different type of mutual understanding, the same DAs -collaborative completions and summaries -can effect both.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Mutual understanding", "sec_num": "2.1" }, { "text": "Collaborative completions are rare in most dialogue types, where they would probably be seen as pre-emptive interruptions. (The SWBD/ DAMSL corpus includes 699/ 205,000, about 0.3%.) Here, however, they are supportive, and relatively common. We have identified recurring patterns of both factual and emotional use. a. Factual completions: commonly, the patient is not sure of the name of (e.g.) a drug or procedure, and hesitates, whereon the nurse provides it: P20 This is the, this is the ones I'm taking there. The same effect is also often achieved through an overt question, more often on the part of the nurse: N133 And the tablets that you take, the capsules that you've just taken now? P134 They're Tylex, they're a painkiller but I don't, I mean I don't take them all the time they're just purely as a little top up. (035-215) b. Emotional completions: the patient may be struggling to find the right words, or reluctant to talk about something. The nurse is showing understanding and empathy with the patient, and encouraging him/her to continue the conversation: ", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Collaborative completions", "sec_num": null }, { "text": "P80 :", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Collaborative completions", "sec_num": null }, { "text": "The SWBD/ DAMSL \"summarize/reformulate\" DA would seem laboured and unnatural in most types of conversation, and indeed their corpus includes only 919/ 205,000, about 0.5%. In our domain, however, it is an entirely natural and useful way of checking correct mutual understanding, factual or emotional. b. Summary / paraphrase: a simple summary asks for confirmation that the speaker has understood the preceding dialogue correctly. Repetition may be used to express the confirmation: N25 : Mmmm. So yesterday you were sick twice. P25 : Twice. For the first and only time. 042-277Summaries can also be used to bring the conversation back on track after a digression. The nurse may initially wish to pursue a digression, in case it leads to the revealing of a concern, but also needs to keep the conversation focussed and ensure its goals are met within an acceptable length of time: P132 : I mean, and the parent, their separated parents, I think it's dreadful. ", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Summaries", "sec_num": null }, { "text": "The dialogues in our corpus are not only more important than most, they also occur in a complex wider context. The nurse is part of an organisation which is trying to save the patient's life, using treatments with painful, embarrassing, and depressing side-effects. Everyone involved has more than usual to be thankful or sorry for. Emotions run high. At the same time, the whole enterprise depends on trust and cooperation. Explicit courtesy, consideration, and appreciation are essential \"social glue\". No wonder that thanks and apologies, both barely represented in SWBD/DAMSL, are common here.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "\"Social glue\"", "sec_num": "2.2" }, { "text": "Thanks occur only 67 times in SWBD/DAMSL, probably not enough to be statistically recognised as a separate tag, but clearly signalled lexically: N115 Alright then. P115 Right. Thank you very much. In our corpus, the nurse thanks the patient with surprising frequency (even ignoring the artificial cases of thanking the patient for allowing the conversation to be recorded). These seem to be part of a general pattern of positive attitude and encouragement: N6 So thanks for doing this Karen ", "cite_spans": [ { "start": 485, "end": 490, "text": "Karen", "ref_id": null } ], "ref_spans": [], "eq_spans": [], "section": "Thanks", "sec_num": null }, { "text": "\"Conventional-closing\" is the tenth most frequent tag in SWBD/DAMSL (although still only 1% (2486/ 205,000)). Our corpus is distinguished not so much by the frequency as the nature of closures. The evidence is incomplete, as in many dialogues the tape runs out or is switched off before the end, but typically the closure of a dialogue is long, and explicitly negotiated. The nurse makes it clear to the patient that the conversation is ending, in a way which does not leave the patient feeling cut off or abandoned (the imminent arrival of lunch is often given as a reason): N131 Alright then. Both participants seem to be taking their last opportunity to check that mutual understanding is complete. Sometimes contact details are given or new topics arise at this point: N558 Oh, I'll finish off now anyway. (023-111) The tape runs out at P604, after some repetition of earlier topics and some new ones.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Closures", "sec_num": "2.3" }, { "text": "Cancer care dialogues are health-critical. Misunderstandings in casual conversation are unlikely to have dire consequences: here, they easily could. Both participants need to be unusually clear, and to ensure that the clarity is mutual. This results in an unusual predominance of DAs which establish and monitor mutual understanding, both factual and emotional. These dialogues are also emotionally charged, and are eased by explicit appreciation and courtesy.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Analysis", "sec_num": "3" }, { "text": "(Formal design of patterns to ensure clarity in dialogues can be found in safety-critical situations such as military command and aviation. The use of repetition to check and confirm understanding is characteristic of Air Traffic Control: Tower: BA117 descend 3,000 feet QNH 1017. Pilot: Descend 3,000 feet QNH 1017, BA117.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Analysis", "sec_num": "3" }, { "text": "Our dialogues are at the other end of the scale for openness and unpredictability: it is interesting to see similar surface devices used for the same purpose in such different environments.)", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Analysis", "sec_num": "3" }, { "text": "These findings are somewhat impressionistic, and taken from a relatively small corpus. As soon as we have analysed a larger sample in more detail, it will be possible to verify and quantify these patterns, and to analyse the linguistic characteristics of DAs which have previously eluded us. Also, further comparisons can then be made with other corpora and previous work on dialogue analyses.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Analysis", "sec_num": "3" } ], "back_matter": [ { "text": "Appreciation for their support of this research goes to Manchester University Computer Science Depart-ment for funding Richard Craggs and Cancer Research UK for funding Ian Fletcher.", "cite_spans": [], "ref_spans": [], "eq_spans": [], "section": "Acknowledgements", "sec_num": null } ], "bib_entries": { "BIBREF0": { "ref_id": "b0", "title": "Lexical, Prosodic, and Syntactic Cues for Dialog Acts. ACL/COLING", "authors": [ { "first": "Daniel", "middle": [], "last": "Jurafsky", "suffix": "" }, { "first": "Elizabeth", "middle": [], "last": "Shriberg", "suffix": "" }, { "first": "Barbara", "middle": [], "last": "Fox", "suffix": "" }, { "first": "Traci", "middle": [], "last": "Curl", "suffix": "" } ], "year": 1998, "venue": "", "volume": "", "issue": "", "pages": "", "other_ids": {}, "num": null, "urls": [], "raw_text": "Daniel Jurafsky, Elizabeth Shriberg, Barbara Fox and Traci Curl. 1998. Lexical, Prosodic, and Syntactic Cues for Dialog Acts. ACL/COLING.", "links": null }, "BIBREF1": { "ref_id": "b1", "title": "Dialogue Tagsets in Oncology", "authors": [ { "first": "Mary Mcgee", "middle": [], "last": "Wood", "suffix": "" } ], "year": 2001, "venue": "Proceedings of SIGdial2", "volume": "", "issue": "", "pages": "", "other_ids": {}, "num": null, "urls": [], "raw_text": "Mary McGee Wood 2001. Dialogue Tagsets in Oncology. Proceedings of SIGdial2.", "links": null }, "BIBREF2": { "ref_id": "b2", "title": "Language Engineering meets Oncology Training. Paper submitted to the Edilog workshop on Semantics and Pragmatics of Dialogue", "authors": [ { "first": "Mary", "middle": [ "Mcgee" ], "last": "Wood", "suffix": "" }, { "first": "Richard", "middle": [], "last": "Craggs", "suffix": "" } ], "year": 2002, "venue": "", "volume": "", "issue": "", "pages": "", "other_ids": {}, "num": null, "urls": [], "raw_text": "Mary McGee Wood and Richard Craggs. 2002. Language Engineering meets Oncology Training. Paper submitted to the Edilog workshop on Seman- tics and Pragmatics of Dialogue, Sept 2002.", "links": null } }, "ref_entries": { "FIGREF0": { "uris": null, "type_str": "figure", "text": "N21", "num": null }, "TABREF1": { "content": "
P162 I could feel the panic coming in me and before
the operation definitely but I'm,
N163 You're okay. (057-356)
", "html": null, "type_str": "table", "text": "But that's the sort of feeling I get a, N81 : A tiredness. (042-277) P328b But it's not until it happens to you that, N329 That sudden impact of gosh.", "num": null }, "TABREF2": { "content": "
R158 The dizziness. (016-128)
this example):
P56 : 0 to 10, it went down then to about three.
...
N59 : So it went down to,
P59 : It went down to three. (042-277)
This sequence shows both patterns:
R128 Well she's on 50mg of,
P129 Durogesic.
N129 Fifty?
R129 Durogesic, fifty yes.
N130 Fifty right. (035-215)
Where there is no apparent problem over informa-
tion, repetition suggests encouragement to continue
the conversation on that topic:
157 And you get very dizzy don't you.
N158 That's been an additional problem hasn't it
that dizziness.
", "html": null, "type_str": "table", "text": "repetition signals to the first speaker that the second has heard and understood: N297 I would have no problem in recommending that you go from the 50 to the 75. P298 Yes to the 75. (035-215)The first speaker, on the other hand, may repeat information if the second appears not to have understood (note the use of a collaborative completion in", "num": null } } } }