Objective To examine using audio-recorded encounters the extent and process of companion participation when discussing treatment choices and prognosis in the context of a life-limiting cancer diagnosis. Methods Qualitative analysis of transcribed outpatient visits between 17 oncologists, 49 patients with advanced cancer, and 34 companions. Results 46 qualifying companion statements were collected from a total of 28 conversations about treatment choices or prognosis. We identified a range of companion positions, from “pseudo-surrogacy” (companion speaking as if the patient were not able to speak for himself), “hearsay”, “conflation of thoughts”, “co-experiencing”, “observation as an outsider”, and “facilitation”. Statements made by companions were infrequently directly validated by the patient. Conclusions Companions often spoke on behalf of patients during discussions of prognosis and treatment choices, even when the patient was present and capable of speaking on his or her own behalf. Practice Implications The conversational role of companions as well as whether the physician checks with the patient can determine whether a companion facilitates or inhibits patient autonomy and involvement. Physicians can reduce ambiguity and encourage patient participation by being aware of the when and how companions may speak on behalf of patients and by corroborating the companion's statement with the patient.

The plant mobility and plant protection of cyantraniliprole is discussed with implications for use in insect resistance management and integrated pest management programs.

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Background Compassion has been extolled as a virtue in the physician-patient relationship as a response to patient suffering. However, there are few studies that systematically document the behavioral features of physician compassion and the ways in which physicians communicate compassion to patients. Objective To develop a taxonomy of compassionate behaviors and statements expressed by the physician that can be discerned by an outside observer. Design Qualitative analysis of audio-recorded office visits between oncologists and patients with advanced cancer. Setting and Participants Oncologists (n=23) and their patients with advanced cancer (n=49) were recruited in the greater Rochester, New York, area. The physicians and patients were surveyed and had office visits audio-recorded. Main Outcome Measures Audio-recordings were listened to for qualitative assessment of communication skills. Results Our sensitizing framework was oriented around three elements of compassion: recognition of the patient’s suffering, emotional resonance, and movement towards addressing suffering. Statements of compassion included direct statements, paralinguistic expressions, and performative comments. Compassion frequently unfolded over the course of a conversation rather than being a single discrete event. Additionally, non-verbal linguistic elements (e.g. silence) were frequently employed to communicate emotional resonance. Discussion and Conclusions This study is the first to systematically catalog instances of compassionate communication in physician-patient dialogues. Further refinement and validation of this preliminary taxonomy can guide future education and training interventions to facilitate compassion in physician-patient interactions.