Physician communication styles in initial consultations for hematological cancer.
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.
Chhabra, KR; Pollak, KI; Lee, SJ; Back, AL; Goldman, RE; Tulsky, JA
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