An examination of the initial cancer consultation of medical and radiation oncologists using the Cancode interaction analysis system

Abstract

This study provides an analysis of the structure of the initial cancer consultation, the consultation styles of medical and radiation oncologists, and their effect on patient outcomes. One hundred and fifty-five cancer patients attending their first consultation with either a medical or radiation oncologist were audiotaped and the transcripts were analysed using the Cancode computer interaction analysis system. Findings revealed that medical oncologists allowed patients and their families more input into the consultation and were rated as warmer and more patient-centred compared with radiation oncologists. However, radiation oncologists spent a longer period discussing, and were more likely to bring up, social support issues with patients. Both medical and radiation oncologists varied their consultation style according to the patient's gender, age, anxiety levels, prognosis, and education. Patients seeing an oncologist who was rated as warmer and discussed a greater number of psychosocial issues had better psychological adjustment and reduced anxiety after consultation. These findings provide current evidence that may be used to inform improvements of communication skills training for oncologists and highlight the need for future communication research to separately consider oncologists from different disciplines. The most widely recommended model of medical interactions in clinical practise is patient-centred care. A patient-centred approach is one in which the doctor listens to patients attentively and sympathetically, talks about psychosocial and non-medical issues (Arora, 2003), appears warm and caring towards the patient rather than hurried, and allows the patient to have input into the consultation (Butow et al, 1995). Researchers have identified the importance of doctors varying their consultation style in response to differing patient characteristics (Butow et al, 1995). For example, researchers suggest that doctors should match their style to patient preferences for involvement in decision-making (Keisler and Auerbach, 2006), and recommend responding flexibly to patients' emotional and informational cues (Butow et al, 2002). Others have found that male and female patients may benefit from different communication strategies (Butow et al, 1997;Parker et al, 2001).Many studies have shown an association between patients receiving patient-centred care in their consultation and subsequent positive patient outcomes (Fogarty et al, 1999). However, previous studies have suggested that patient-centred care and flexibility in consultation style are used inconsistently in medical consultations. Oncologists have been shown to be poor judges of patient preferences for participation, significantly underestimating cancer patients' preference for a shared approach to decision-making (Bruera et al, 2002) and desire for information. They also tend to overestimate the amount of information they believe they have given (Chaitchik et al, 1992) and cancer patients' understanding of this information (Gattellari et al, 1999). O...

Patient satisfaction during radiation therapy

“…It is known that physician-patient discussions of different treatment outcomes are highly correlated with patients' satisfaction with overall medical care regardless of the procedure received [6]. This suggests that the quality of cancer care should include assessment of physician-patient communication as well as specialized health professional communication training [2,7,27]. These measures might for the sake of both sides improve patient as well as physician job satisfaction [31].…”

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

“…108–111 Active participation has been shown to influence the amount of information physicians provide, treatments they recommend, topics discussed, and patient psychosocial and physical health outcomes. 112–116 Question-prompt lists have been developed and tested in several medical settings, and, given the research showing that racially discordant interactions are often characterized by poor-quality communication, it is surprising that this type of intervention has not been tested in this context. 98,100,117,118 We have collaborated with community members, African American patients and their families, and oncologists to develop a question-prompt list for use in the context of racially discordant oncology treatment interactions.…”

Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

“…One way to do this is by increasing patient active participation. Patient active participation plays an important role in short-, intermediate-, and long-term outcomes[27, 28] due to its association with the amount of information physicians provide[29–31], treatments physicians recommend[11], topics patients and physicians discuss[32], and patient psychosocial and physical health outcomes[33, 34]. …”