BACKGROUND: We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer.
OBJECTIVE: To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.
PARTICIPANTS: Forty veterans and 18 urologists at one VA medical centre.
METHODS: We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities.
RESULTS: We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions.
CONCLUSION: Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.
Written by:
Henry SG, Czarnecki D, Kahn VC, Chou WY, Fagerlin A, Ubel PA, Rovner DR, Alexander SC, Knight SJ, Holmes-Rovner M Are you the author?
Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA
Reference: Health Expect. 2013 Dec 22 (Epub ahead of print)
doi: 10.1111/hex.12168
PubMed Abstract
PMID: 24372758
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