Impact of Physician Sitting Versus Standing During Inpatient Oncology Consultations: Patients' Preference and Perception of Compassion and Duration. A Randomized Controlled Trial

Abstract

The purpose of this study was to determine the impact of physician sitting versus standing on the patient's preference of physician communication style, and perception of compassion and consult duration. Sixty-nine patients were randomized to watch one of two videos in which the physician was standing and then sitting (video A) or sitting and then standing (video B) during an inpatient consultation. Both video sequences lasted 9.5 minutes. Thirty-five patients (51%) blindly preferred the sitting physician, 16 (23%) preferred the standing, and 18 (26%) had no preference. Patients perceived that their preferred physician was more compassionate and spent more time with the patient when compared with the other physician. There was a strong period effect favoring the second sequence within the video. The patients blinded choice of preference (P = 0.003), perception of compassion (P = 0.0016), and other attributes favored the second sequence seen in the video. The significant period effect suggests that patients prefer the second option presented, notwithstanding a stated preference for a sitting posture (55/68, 81%). Physicians should ask patients for their preference regarding physician sitting or standing as a way to enhance communication.

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…The vast majority of oncology patients prefer face-to-face communication, 9 and randomized controlled trials of physicians' posture whilst breaking bad news have shown patients prefer physicians to sit rather than stand, and perceive those that do so as more compassionate. 92,93 Patients with advanced cancer perceive physician behaviors such as making eye contact (if culturally appropriate) and not taking phone calls to convey a sense of being present and not hurried. This is felt to be more important than the actual amount of time spent.…”

Clinician-patient communication: a systematic review

“…Only two trials of modest quality [5,28] provided appropriate descriptions of the sequence of randomization and dropouts, unlike trials of lower quality [3, 4, 7-9, 25, 30]. Blinding was not possible in most trials because of the nature of the interventions and the focus on self-report outcomes; however, two trials that analyzed consult tapes blinded the tape coders [3,5], and one trial blinded participants to the study purpose but not the intervention [25].…”

“…Three randomized trials that explored different aspects of provider communication style are summarized in Table 5 [8,9,25]. In these three studies, most patients were white (80-84%) [9,25], married (66-68%) [8,9,25], and had post-secondary education (65%; had a mean of 15 years of education) [9,25] or a minimum of grade 12 (68%) [8].…”

“…In these three studies, most patients were white (80-84%) [9,25], married (66-68%) [8,9,25], and had post-secondary education (65%; had a mean of 15 years of education) [9,25] or a minimum of grade 12 (68%) [8]. Videotapes of the interviews were evaluated by patients in two of the trials and were considered by them to be realistic [9,25].…”

“…In a small, randomized crossover study, Strasser et al [25] presented a video to patients with the physician first sitting, then standing, during the consult and then showed another with this order reversed. Overall, patients did not show a preference for the physician to be sitting during the consultation (51%).…”