Abstract
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.
Original language | English (US) |
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Pages (from-to) | 1757-1768 |
Number of pages | 12 |
Journal | Health Expectations |
Volume | 18 |
Issue number | 5 |
DOIs | |
State | Published - Oct 1 2015 |
Keywords
- Discourse analysis
- Patient-centred communication
- Prostate cancer
- Qualitative research
- Structure
- Transitions
- Veterans
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health