安宁家庭会议中医生及团队互动的多模态分析

Interactions of a Palliative(Hospice) Care Medical Team in a Family Meeting: A Multimodal Analysis

安宁疗护家庭会议在我国情境中是“死亡话语”的一个新语类(高一虹2019)。本研究以一场安宁疗护家庭会议的全程录像为语料,采用多模态话语分析的方法(Norris 2004,2019),考察家庭会议中医生及团队与家属的互动,研究了医生及团队通过哪些“高层活动”,使用了怎样的模态配置,与家属达成了怎样的照护决策,建构了怎样的身份认同。结果显示,医生采用医学影像资料、布局、语言、目光交流、副语言、手势、身势语等,实现了充分告知、深度聆听、积极建构的功能。最后经过集体努力,“病房婚礼”的方案得以实现,生死两安。充分告知、深度聆听、积极建构,也是安宁疗护团队“死亡话语素养”的构成要素,具有重要的实践启示。

Adopting the multimodal analysis framework of Norris( 2004, 2019), this study examines a palliative( hospice) care medical team in their interaction with a patient’s family members. It explores what higher-level mediated actions and modal configurations are adopted,and what identities are constructed during the communication process. Results showed that the physician and her team perform the functions of fully informing facts,deeply listening to feelings,and actively facilitating the family’s decision making. The modal resources adopted include the setting layout,digital image,language,eye contact,paralanguage,and body language. The perlocutionary act of the meeting is the implementation of a ward wedding in the ward,both the dying and the living contented. It is suggested that fully informing,deep listening and active facilitation constitute components of “death discourse literacy” of palliative teams.