Doctor-patient interactions in oncology

https://doi.org/10.1016/0277-9536(95)00265-0Get rights and content

Abstract

Studies which apply content analysis techniques to the cancer consultation are few. This descriptive study examines the structure and content of the bad news cancer consultations of 117 outpatients newly referred to the Medical Oncology Department of a large London teaching hospital. From previous communication research three main hypotheses are formed: (i) the cancer consultation is clinician-dominated rather than patient-centred; (ii) the level of psychosocial discussion between clinicians and patients is low and (iii) patient characteristics such as sex, age and prognostic category influence clinician behaviours. Each patient had two consultations with one of 5 oncologists. Both these were audiotaped with the patients' consent. The tapes were content coded using the Roter Interaction Analysis System. Results showed that clinicians tended to use closed rather than open questions. Patients asked few questions and were seldom given space to initiate discussion. Thus, the level of patient-centredness was low. Despite the fact that consultations concerned life threatening disease and often contained information regarding toxic treatment which is known to provoke psychological dysfunction, the number of questions relating to patients' psychological health were few. The amount of discussion concerning medical topics from both parties was 2.5 times greater than the amount of psychosocial discussion. Although there was a suggestion in the data that 3 clinicians showed variations in behaviour according to patient age and prognostic group, the number of patients for each doctor was small. Patients were well informed about their diagnosis, prognosis and treatment options, but their emotional well-being was rarely probed.

References (29)

  • P. Maguire et al.

    Effect of counselling on the psychiatric morbidity associated with mastectomy

    Br. med. J.

    (1980)
  • A. Cox et al.

    Psychiatric interviewing techniques, VI: experimental study: eliciting feelings

    Br. J. Psychiat.

    (1981)
  • S. Putnam et al.

    Teaching the medical interview: an intervention study

    J. Gen. Intern. Med.

    (1988)
  • M. Stewart

    What is a successful doctor-patient interview?

    A study of interactions and outcomes

    Soc. Sci. Med.

    (1989)
  • Cited by (339)

    • Breaking Bad News in the Mammography Department: A Patient Perspective from Primary Care

      2020, Journal of Medical Imaging and Radiation Sciences
      Citation Excerpt :

      No matter how bad your day and how busy your clinic, it is unlikely to be worse than that of the patient receiving a diagnosis of cancer. It is well recognised that how bad news is discussed can affect the patient's comprehension of information,8 level of hopefulness,9 and subsequent psychological adjustment.10 A patient-centred communication style has the most positive outcome for recipients of bad news on a cognitive, evaluative, and emotional level.11

    View all citing articles on Scopus
    View full text