Towards a new kind of patient information leaflet? Risk, trust and the value of patient centeredness

The overall aim of this PhD is to examine the discourses of risk and trust in mandatory Patient Information Leaflets (PILs), the leaflets that accompany medication and are available in Britain, in relation to the health communication approach of patient centeredness, “translated” for use in the application-setting of text, in order to investigate how patient centeredness is (or is not) expressed discursively in PILs, and consider the scope for greater patient centeredness in these texts. The reason for examining risk and trust is that patients have described these aspects as particular weaknesses of PILs; the problems in communicating risk and trust have furthermore been conceptualized as a failure to meet patient need, hence the selection of patient centeredness as an evaluative optic.


To pursue my research objectives, I examine (and contrast) the discourses of risk and trust in two corpora of British PILs, Corpus 1 which is more typical of the genre as a whole, and Corpus 2 which is characterized by a higher degree of patient centeredness. Foucauldian (1972) discourse analysis is used to examine the subject position (which relates to the pharmaceutical company’s discursive presence), the discursive construction of risk and trust, and the patient as a discursive construct. These elements are chosen as they relate to the sender, message and receiver elements of communication theory, thereby facilitating an evaluation of these discursive elements from the communicative perspective of patient centeredness.


The dissertation makes the following contributions:


(1)It brings a new focus to mandatory PILs, namely, the discourses of risk and trust, both of which have been associated with problematizing the reception of these texts, but have not been been examined discursively before


(2)It operationalizes Foucault’s (1972) theory of discourse, showing how it can be used, thereby responding to critique that Foucault (1972) does not provide discourse analysts with usable methods


(3)It develops the theory of patient centeredness, normally associated with the clinical situation, by “translating” it to render it usable in relation to written healthcare materials


(4)It illustrates how existing risk and trust theories provide analytical categories that can be used to support the analysis of risk and trust discourses


(5)It contrasts the patient centeredness of two corpora, considering the scope for greater patient centeredness in PILs more generally and addressing the “What next” question, very important for discourse analytic research in health communication