Physician communication styles in initial consultations for hematological cancer

PATIENT EDUCATION AND COUNSELING

卷:93

Article

Chhabra, Karan R.¹  Pollak, Kathryn I.^2,3  Lee, Stephanie J.⁴  Back, Anthony L.⁴  Goldman, Roberta E.^5,6  Tulsky, James A.^2,7,8 

[1] Rutgers Robert Wood Johnson Med Sch, New Brunswick, NJ USA

[2] Duke Canc Inst, Canc Prevent Detect & Control Res Program, Durham, NC USA

[3] Duke Univ, Med Ctr, Dept Community & Family Med, Durham, NC 27706 USA

[4] Univ Washington, Fred Hutchinson Canc Res Ctr, Seattle, WA 98195 USA

[5] Brown Univ, Alpert Med Sch, Dept Family Med, Providence, RI 02912 USA

[6] Harvard Univ, Sch Publ Hlth, Dept Social & Behav Sci, Boston, MA 02115 USA

[7] Duke Univ, Med Ctr, Dept Med, Duke Palliat Care, Durham, NC 27706 USA

[8] Durham VA Med Ctr, Hlth Serv Res & Dev Serv, Durham, NC USA

关键词: US;    Physician-patient communication;    Oncology consultations;    Information delivery;    Patient participation;    Shared decision-making;    Physician-patient relationships;    Second opinions;   

DOI  :  10.1016/j.pec.2013.08.023

来源: Elsevier

【 摘 要 】

Objective: To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. Methods: Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. Results: Physicians frequently broadcasted information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation. Conclusions: Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation. Practice implications: Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free