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Doctor-patient interactions in oncology
S Ford1, L Fallowfield, S Lewis
1Department of Oncology, UCL Medical College, London, England.
Social Science & Medicine (1982)
|June 1, 1996
Summary
Cancer consultations are clinician-dominated, with limited psychosocial discussion. Patients rarely initiated topics or asked questions, indicating low patient-centeredness despite the serious nature of the disease.
Area of Science:
- Oncology
- Medical Communication
- Health Services Research
Background:
- Content analysis of cancer consultations is limited.
- Effective communication is crucial in oncology, especially when delivering bad news.
- Previous research suggests clinician dominance and low psychosocial discussion in medical encounters.
Purpose of the Study:
- To examine the structure and content of bad news cancer consultations.
- To test hypotheses regarding clinician dominance, psychosocial discussion levels, and patient characteristics influencing clinician behavior.
Main Methods:
- Descriptive study of 117 new outpatient cancer consultations at a London teaching hospital.
- Audiotaping of two consultations per patient with oncologist consent.
- Content coding using the Roter Interaction Analysis System (RIAS).
Main Results:
- Clinicians predominantly used closed questions, limiting patient initiation and patient-centeredness.
- Psychosocial health discussions were minimal (2.5 times less than medical topics), despite the disease and treatment implications.
- While diagnosis, prognosis, and treatment were discussed, patients' emotional well-being was rarely addressed.
Conclusions:
- Cancer consultations in this setting were clinician-dominated with low patient-centeredness.
- There is a significant lack of psychosocial support and discussion within these consultations.
- Further research is needed to explore clinician behavior variations based on patient characteristics, though initial suggestions were limited by sample size.