Managing risk and patient involvement in choosing treatment for cancer: an analysis of two communication practices

Abstract

Drawing on conversation analyses of oncology consultations collected in Italy, the article examines the communication practices used to recommend treatments. We found that the oncologist formulates the treatment recommendation (TR) for high-risk patients in terms of a 'mandatory' choice and for low-risk patients as an 'optional' type of decision. In the first case the doctor presses to reach a decision during the visit while in the second case leaves the decision open-ended. Results show that high-risk patients have less time to decide, are pressured towards choosing an option, but have more opportunities for involvement in TR during the visit. Low-risk patients instead have more time and autonomy to make a choice, but they are also less involved in the decision-making in the visit time. Moreover, we document that TR is organised through sequential activities in which the oncologist informs the patient of alternative therapeutic options while at the same time building a case for the kind of treatment she/he believes to be best for the patient's health. We suggest that in this field risk plays a key role in decision-making which should be better understood with further studies and taken into account in the debate on shared decision-making and patient-centred communication.

‘So just to go through the options…’: patient choice in the telephone delivery of the NHS Improving Access to Psychological Therapies services

“…Building on the growing body of conversation analytic scholarship on patient choice in various medical settings (e.g. Alby et al 2017, Reuber et al 2015, Shaw et al 2020, Stivers et al 2018, Toerien et al 2018, we provide further evidence of variability in and in turn variable consequences forthe ways that patients and practitioners negotiate choice and shared decision-making. In sum, we focus on whether, and how, practitioners offered patients choice between available treatment delivery modes, at the point of entering the service.…”

‘We will take care of you’: Identity categorisation markers in intercultural medical encounters

“…The data analysed in this study are part of a data corpus collected in the oncology department of three Italian public hospitals -two medium-size hospitals and one teaching hospital in Rome (cf. Alby et al, 2017a;Alby et al, 2017b;Sterponi et al, 2019;Sterponi et al, 2020). From this data corpus, a sub-sample of 36 video-recordings was selected, according to the following criteria: (a) intercultural medical encounters with non-native Italian patients; (b) medical encounters with Italian native patients matching those with non-native patients by oncologist and/or type of visit (either 'first time', post-surgical encounters with the oncologist or follow-up visits, see description below).…”

The dialogic construction of patient involvement in patient-centred neurorehabilitation

“…19 There has been a significant amount of studies focusing on patient stories and unravelling the patient position in these encounters. 20,21 These studies are important to understand the relational power that is inherent to the encounter. They often involve a critique of the health professionals' abilities to practice care centred around the patients' wishes and needs.…”

“…They often involve a critique of the health professionals' abilities to practice care centred around the patients' wishes and needs. [20][21][22] In communication studies on patient-centred care, there has been a focus on shared decision making in the relationship between patient and healthcare professionals. 4,21 Several studies analyse the communicative tensions that can arise between patients' and healthcare professionals' priorities in the delivery and decision-making processes in patient-centred healthcare.…”

“…[20][21][22] In communication studies on patient-centred care, there has been a focus on shared decision making in the relationship between patient and healthcare professionals. 4,21 Several studies analyse the communicative tensions that can arise between patients' and healthcare professionals' priorities in the delivery and decision-making processes in patient-centred healthcare. 20,21 In these encounters, slight differences in the communicative practices can distinguish participatory efforts from paternalistic practice.…”