Identifying, communicating, and de-escalating risk in high-stakes settings: How conversation analysis research can underpin communication training

Objective: Communicating risk in high-stakes settings can prevent avoidable deaths. Communicating, assessing and managing risk is a critical part of many healthcare and related professionals’ roles. However, there is a dearth of empirical research on risk communication in practice. Training is seldom based on empirical evidence, meaning professionals communicating in some of the most urgent circumstances may have little formal knowledge of how to communicate about risk in practice. Focusing on high-stakes settings, we describe three projects involving work with diverse professionals to improve how they communicate to identify, mitigate, and manage risk. We integrate insights for others considering similar projects. Methods: We present three projects where communication training about current or future threat to life in high-stakes settings was developed based on conversation analysis (CA) and its findings. Projects focused on (1) communicating the risks of emergency medical evacuation during infectious disease outbreaks (2) risk communication about suicidality and self-harm (3) crisis negotiation in the context of suicide threats Results: In each project, researchers collaborated with practitioners to understand communication about risk moment-by-moment. They used CA to identify key challenges and develop empirical evidence of (in)effective communication practices. The evidence was used to develop resources for practitioner training. Integrated insights showed that: training is well received, core risk communication practices were often absent from extant training; collaboration with partners is crucial; and resources/funding constraints limited formal evaluation. Conclusion: Conversation analytic research can generate insights on how risk is assessed and managed moment-by-moment in practice. These insights can underpin training based on evidence from real communication. Practice implications: Developing training from empirical CA can equip professionals working in urgent and high-stakes circumstances to meet and address challenges in practice. Future work is likely to include systematic evaluation of the impact on interactions and patient outcomes.