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Physician dialogues with advanced cancer patients: mostly patient-friendly but often physician-directed

Elizabeth Edwardsen, Diane Morse, Mary Gale Gurnsey, Adam Taupin, Cleveland Shields, Jennifer Griggs, Susan McDaniel


Objective: To explore patient-physician communication with advanced cancer patients, with particular interest in patient-centered communication and any differences between patient interactions with family physicians and oncologists.

Methods: Design: Unannounced standardized patients (SPs) portrayed cancer patients seeking a first consultation with a new physician. Population: 16 community oncologists and 18 community family physicians with undetected, audio-recorded visits. Analysis and text management: We generated themes and created a coding system with a discourse analysis-informed approach to the transcripts. We then focused analysis of dialogues in context to refine the coding scheme. Finally, we applied simple descriptive statistics to the codes.

Results: Dialogue categories that emerged included: 1) exploring patient perspectives; 2) providing information and 3) engaging patients in decision-making. Ninety-four per cent (32 of 34) encounters contained dialogue with decision-making. About half of these utterances, 48% (n=104), were coded as shared decision-making. Patient-centered utterances comprised 52% of physician speech, while 48% were physician-centered. Physicians utilized predominantly patient-friendly language (no medical jargon) to provide patient education (83%).

Conclusion: Physicians were more patient-friendly in their communication than patient-centered; physician-directed exchanges and unshared decision-making were common. Continued medical education and research are indicated to explore and expand patient-centered communication and shared decision-making.

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