3 Conversation analysis of authentic care decision conversations 49 physician-patient conversations in acute primary care visits [21], as this institutional context is most closely related to our data. We first identified the phases in our data using a similar bottom-up approach. We identified moments in which the physician and patient themselves make a new phase relevant in the interaction. Two of the authors (SB & TvC) identified these phases independently and then discussed their findings. To analyze how the topic of care decisions was introduced, we analyzed the parts of the consultation involving a discussion of care decisions. Here we used Jeffersonian transcription conventions to show phonetic information and pacing (see Appendix A) [22]. We also described notable non-verbal information (e.g., looking at the computer, typing, or handing over forms). We began our analysis at the point when either the physician or the patient introduced the topic of care decisions and then looked at the previous and subsequent turns until the topic was concluded. We focused on the introduction of the topic to gain insight into the interactional implications of certain care decision introductions. To describe the discussion of care decisions in greater detail, we organized a data session, a common practice in conversation analytic studies. Six conversation analysts analyzed specific fragments using the video recordings and transcripts [19]. 3. Results In this section, we show how often care decisions were discussed (section 3.1), when -or in which phase of the consultations- care decisions were discussed (section 3.2) and how the topic of care decisions was introduced (section 3.3). 3.1 How often are care decisions discussed? Care decisions were discussed in 21 of these consultations, conducted by six different physicians. Figure 1 shows the distribution of these conversations over the four groups and who initiated the topic. Physicians initiated the topic of care decisions in two of the 65 (3.1%) consultations before their training and 15 of the 85 (17.6%) consultations after their training. Of the 85 patients who had not received patient education, none introduced the topic, whilst four of the 65 (6.2%) patients who had received the patient education did.
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