Investigating the Role of Web-Based Writing in Interdisciplinary Decision-
Christa B. Teston, PhD :: Rowan University
My research interests lie in the productive tensions between deliberative rhetoric, visual
communication, and technical writing. A recent product of those interests includes a long-range
case study of real time, interdisciplinary, cancer-care decision-making in one medical workplace
setting. Over the course of this longitudinal study, I observed the ways that a group of medical
professionals from various disciplines met during weekly Tumor Board meetings and drew on a
wide range of kinds, forms, and displays of evidence in order to make difficult decisions about
One of the kinds and forms of evidence consistently invoked during Tumor Board meetings—not
only for its authoritative, charter-like purpose (McCarthy, 1991; McCarthy and Gerring, 1994), but
also because it provides care-related algorithms—is the National Cancer Care Network’s (NCCN)
Standard of Care document. This particular kind of document may qualify as what Geisler, et al.
(2001) characterize as an “IText” in that it is interactive (p. 278, 279, 282), electronically mediated
(p. 274), shapes interactions (p. 273), and is a technological artifact (p. 278).
The Standard of Care document is more than a mere “IText,” or textual document that provides
information for cancer care providers, however. It includes a set of national cancer care guidelines
that have been established, but undergo continual revision by a panel of experts. It includes
evidence-based guidelines that exist as a set of algorithmic pathways reflecting “major step-by-
step management decisions” (NCCN, p. 1). Moreover, Standard of Care documents are presented
for interactive use either online or downloaded as a PDF; users make their way through the
document by clicking on hyperlinks and following both linguistic and non-linguistic visual cues (see
Geisler, et al. (2001) argue that “we need more concrete studies and careful analyses of meaning-
making, meaning-making practices, and situated use of meaning in ITexts” (p. 282). Toward those
ends, in order to better understand how this specific document functions in real time deliberative
practices engaged in by an interdisciplinary group of medical professionals, I employed a
Grounded Theory approach (Glaser and Strauss, 1967) to the contextual and temporal analysis of
the ways in which the document was used during deliberations. Codes and categories, therefore,
were not only inductively derived, but underwent a process of constant comparison. I also
employed a modified Toulminian (2003) analysis of the ways data, claims, and warrants were
invoked (see Teston, 2009 for findings).
This research suggests that “IText” is an inadequate construct in that it fails to encompass the
complexity of web-based writing and its role in complex (Law and Mol, 2002) deliberative
practices. Current collaborative investigations (with Brian McNely, Ball State University) move us
toward more holistic, in situ, grounded research (Glaser and Strauss, 1967) of the ways web-
based writing (like the kind deployed by Standards of Care writers) mediates complex,
interdisciplinary deliberative practices.
Figure 1. Sample screen of bladder cancer Standard of Care Document (note hyperlinks and
various linguistic and nonlinguistic visual cues).