Information exchange in oncology outpatient clinics: source, valence and uncertainty

A large literature of doctor-patient communication exists, yet little is known about how symptom information is communicated in cancer care. This qualitative study explores the exchange of symptom and clinical information between cancer patients and oncologists in outpatient clinics of a regional teaching hospital. Verbatim transcripts of consultations between 14 doctors and 43 post-treatment follow-up patients from eight consultants' clinics were subjected to analytic induction and microinteractional analysis techniques. Findings from these analyses indicate that information about patients was accorded varying relevance by doctors depending upon its source, valence and certainty. Doctors' requests for information was contingent upon certainty of clinical information. Symptom information was elicited from patients only when clinical information with high certainty was unavailable. If negative patient information was volunteered, it was not addressed when positive clinical information was present and cancer treatment was not indicated. It appears that information in outpatient oncology consultations is organised according to a hierarchy and is used to make treatment decisions and not primarily for symptom management.