Computer-based interaction analysis of the cancer consultation

Abstract

S_ry There are few data available on which to base recommendations for effective communication in the cancer consultation. This paper describes a computerised interaction analysis system designed specifically for the cancer consultation and its application in a study investigating the relationship between doctor-patient behaviour and patient outcomes. One hundred and forty-two cancer patients attending their first consultation with a cancer specialist were audio taped and a copy of the tape was retained for interaction analysis. Before the consultation patient anxiety and information and involvement preferences were measured. Outcomes included recall of information, patient satisfaction with the consultation and psychological adjustment to cancer. Doctor behaviour was shown to vary significantly according to the age, sex, involvement preferences and in/out-patient status of the patient. The ratio of doctor to patient talk was related to satisfaction with communication, while patients whose questions were answered showed better psychological adjustment at follow-up. The results suggest that patient-centred consultations lead to improved satisfaction and psychological adjustment. These data provide precise information about consultation behaviour which can be used in the documentation of current practice and the evaluation of new interventions to improve communication.Keywords: doctor-patient communication; satisfaction; interaction analysis; computers; psychological adjustment Effective and clear communication is essential to the physician-patient relationship (Morrow et al., 1983). It is particularly important in the care of cancer patients because of their wish to be informed and involved in medical decision-making (Cassileth et al., 1980;Sutherland et al., 1989;Tattersall et al., 1994) and the legal requirements now in place for informed consent. Furthermore, interactions between cancer patients and their doctors generally concern issues of vital importance to the patient and which may be emotionally laden and can lead to psychiatric disturbance in a proportion of patients (Chiatchik et al., 1992; Derogatis et al., 1983). The possible costs of poor communication include increased anxiety, distress and coping difficulties (Cohen and lazarus, 1979), non-compliance with treatment (Cartwright, 1964), loss of confidence in staff and dissatisfaction with medical care, leading to medicolegal complaints (NSW Department of Health, 1991.There are few data on which to base recommendations for effective communication. There have been no attempts to obtain accurate descriptions of doctor-patient encounters in the cancer consultation and their relationship to patient outcomes. Analysis of interactions in the general practice of medicine has provided a window into doctor-patient communication and useful guidelines for practice in general medicine (e.g. Bales, 1950;Bain, 1977;Inui et al., 1982;Roter, 1984 Our group has developed a cancer-specific interaction analysis system (CN-LOGIT) which offers the opportunity to describ...

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

“…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). On the other hand, in one of our earlier studies, an interaction analysis of 142 consultations of cancer patients seeing a male medical oncologist, we found evidence of flexibility (Butow et al, 1995). The oncologist was more affiliative with anxious patients and females, spent more time answering the questions of patients who asked more questions, and spoke for a longer period with younger patients about prognostic and treatment issues.…”

“…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).…”

“…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).…”

Communication in cancer genetic counselling: does it reflect counselees' previsit needs and preferences?

“…Low patient question-asking behaviour was noted by various authors in other medical settings (Beisecker and Beisecker, 1990;Street, 1991;Ford et al, 1996). As patient question-asking was found to be strongly related to physicians' provision of medical information (Street, 1991;Butow et al, 1995), counselees might moreover elicit more effective responses from counsellors if they would make more use of this directing tool. Low question-asking may be related to counselee concession to expert authority, or to unfamiliarity with the content and process of cancer genetic counselling (Collins et al, 2000), or the exact role of counsellors in the provision of health care (Bernhardt et al, 2000).…”

The development of a structured rating schedule (the BAS) to assess skills in breaking bad news

“…Patients who ask questions and have them answered also demonstrate better adjustment (Butow et al, 1995). Coping theory (Lazarus, 1993) has been offered as an explanation of these phenomena (Parle et al, 1996, Ptacek andEberhardt, 1996).…”