Da impossibilidade de certezas na fala-em-intera????o em consultas de c??ncer de mama

Esta tese prov??m de uma pesquisa de doutorado em Lingu??stica Aplicada que visa a entender como se d??o as intera????es entre oncologistas e mulheres com c??ncer de mama em consultas de acompanhamento ao longo de seus tratamentos ou de revis??o. O foco do estudo foi em atendimentos que n??o consistiam em comunica????o de m??s not??cias (uma vez que as pacientes j?? haviam passado pelo diagn??stico de c??ncer) nem em tratamento de pacientes terminais. A literatura a respeito da rela????o m??dico-paciente no c??ncer tem englobado largamente esses dois pontos. Entretanto, a preocupa????o com a intera????o em consultas mais rotineiras, durante os tratamentos e nas revis??es peri??dicas, em que nenhum diagn??stico ou progn??stico negativo ?? de fato entregue pelo m??dico, ainda ?? escassa. A metodologia utilizada adv??m da abordagem te??rico-metodol??gica da An??lise da Conversa ou Fala-em-Intera????o (SACKS, 1992; OSTERMANN; MENEGHEL, 2012). Seu foco ?? a observa????o, grava????o em ??udio (podendo ser tamb??m em v??deo) e posterior descri????o das intera????es, das caracter??sticas das a????es que os participantes ali produzem e de como as a????es de um interagente afetam o outro, que ir?? produzir suas a????es em resposta. Os dados (24 consultas gravadas em ??udio) foram coletados em um hospital da regi??o sul do Brasil que possui um centro para tratamento de c??ncer, transcritos segundo conven????es pr??prias da ??rea (JEFFERSON, 1984) e ent??o analisados. A partir das an??lises, s??o descritas a????es recorrentes realizadas por oncologistas e pacientes, tais como solicita????es de avalia????o; avalia????es do pr??prio estado emocional; avalia????es de estado f??sico; recomenda????es e avalia????es progn??sticas com justificativas e argumenta????o; accounts. Essas a????es interacionais revelam que os participantes est??o a lidar com a impossibilidade da certeza em v??rios aspectos nas consultas; por exemplo: a impossibilidade de uma avalia????o progn??stica absolutamente certa, a impossibilidade de certeza sobre estar-se livre de recidivas, a impossibilidade de certeza de que determinados testes realmente servir??o de base para as tomadas de decis??o necess??rias, etc. Al??m disso, algumas a????es dos m??dicos (avalia????es positivas, recomenda????es e avalia????es progn??sticas com justificativas e argumenta????o e accounts) possuem um potencial de tranquiliza????o da paciente ao poderem diminuir incertezas por meio da constru????o de uma maior assertividade. Ao final, a contribui????o do estudo pode consistir no aprimoramento de um dos eixos b??sicos da rela????o m??dico-paciente: como humanizar a rela????o oncologista-paciente de c??ncer de mama por meio de um aparato comunicacional ??? as pr??ticas interacionais de gerenciamento da certeza.The present dissertation derives from doctoral research in Applied Linguistics that aims at understanding how interactions between oncologists and women with breast cancer play out in long-term treatment consultations and/or follow-up ones. The focus of the study was neither on consultations where bad news was delivered (since the patients had already been diagnosed with the illness) nor on those with terminally ill patients. Literature on the doctor-patient relationship in cancer has largely covered these issues. However, concern about verbal interaction in routine consultations during treatment and in periodic revisions, during which no diagnosis or negative prognosis is actually delivered by the doctor, has been scarce. The methodology used originates in the theoretical-methodological approach of Conversation Analysis or talk-in-interaction (SACKS, 1992; OSTERMANN; MENEGHEL, 2012). Its goal is the observation, audio (or video) recording and latter description of the interactions, the characteristics of the actions the participants produce therein and how one party???s actions affect the other, who will, in turn, produce his/her action in response. The data (24 audio recordings) were collected in a hospital in southern Brazil which is equipped with a cancer treatment center, then transcribed in accordance with conventions used in the field (JEFFERSON, 1984), then analyzed. From the analyses, recurring actions performed by doctors and their patients are described, such as requests for assessments; self-assessments of a patient???s emotional state; physical assessments; recommendations and prognostic evaluations with justifications and argumentation; accounts. These interactional actions show that the participants are dealing with a situation in which certainty is impossible in various aspects of the consultations, for instance: the impossibility of an absolutely certain prognostic evaluation, the impossibility of being sure about not having a relapse, the impossibility of certainty with regard to whether certain tests will actually serve as a basis for making necessary decisions, etc. Furthermore, some of these actions by the doctor (positive assessments, recommendations and prognostic assessments with justifications and argumentation, and accounts) have the potential to reassure the patient as they can reduce uncertainty by means of the construction of assertiveness. Ultimately, the contribution of this study may lie in the improvement of one of the basic axes of the relationship between doctors and their patients: how to humanize the oncologist-breast cancer patient relationship by means of a communicational apparatus ??? the interactional practices of certainty management