Patient-physician communication about early stage prostate cancer: analysis of overall visit structure.


Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Henry, SG; Czarnecki, D; Kahn, VC; Chou, W-YS; Fagerlin, A; Ubel, PA; Rovner, DR; Alexander, SC; Knight, SJ; Holmes-Rovner, M

Published Date

  • October 2015

Published In

Volume / Issue

  • 18 / 5

Start / End Page

  • 1757 - 1768

PubMed ID

  • 24372758

Pubmed Central ID

  • 24372758

Electronic International Standard Serial Number (EISSN)

  • 1369-7625

Digital Object Identifier (DOI)

  • 10.1111/hex.12168


  • eng

Conference Location

  • England