Physician communication styles in initial consultations for hematological cancer |
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Institution: | 1. Department of Respiratory Medicine, The Children''s Hospital at Westmead, Westmead, Australia;2. Discipline of Paediatrics and Child Health, University of Sydney, Westmead, Australia;3. Respiratory, Critical Care & Anaesthesia section, UCL, Institute of Child Health, London, United Kingdom;4. Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada;5. Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom;6. Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada |
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Abstract: | ObjectiveTo characterize practices in subspecialist physicians’ communication styles, and their potential effects on shared decision-making, in second-opinion consultations.MethodsTheme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.ResultsPhysicians 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.ConclusionsBroadcasting 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 implicationsTechniques 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. |
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Keywords: | US Physician–patient communication Oncology consultations Information delivery Patient participation Shared decision-making Physician–patient relationships Second opinions |
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