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) |
|---|---|
| Pages (from-to) | 1757-1768 |
| Number of pages | 12 |
| Journal | Health Expectations |
| Volume | 18 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2015 |
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Keywords
- Discourse analysis
- Patient-centred communication
- Prostate cancer
- Qualitative research
- Structure
- Transitions
- Veterans
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
Cite this
Patient-physician communication about early stage prostate cancer : Analysis of overall visit structure. / Henry, Stephen G; Czarnecki, Danielle; Kahn, Valerie C.; Chou, Wen Ying Sylvia; Fagerlin, Angela; Ubel, Peter A.; Rovner, David R.; Alexander, Stewart C.; Knight, Sara J.; Holmes-Rovner, Margaret.
In: Health Expectations, Vol. 18, No. 5, 01.10.2015, p. 1757-1768.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Patient-physician communication about early stage prostate cancer
T2 - Analysis of overall visit structure
AU - Henry, Stephen G
AU - Czarnecki, Danielle
AU - Kahn, Valerie C.
AU - Chou, Wen Ying Sylvia
AU - Fagerlin, Angela
AU - Ubel, Peter A.
AU - Rovner, David R.
AU - Alexander, Stewart C.
AU - Knight, Sara J.
AU - Holmes-Rovner, Margaret
PY - 2015/10/1
Y1 - 2015/10/1
N2 - 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.
AB - 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.
KW - Discourse analysis
KW - Patient-centred communication
KW - Prostate cancer
KW - Qualitative research
KW - Structure
KW - Transitions
KW - Veterans
UR - http://www.scopus.com/inward/record.url?scp=84942295059&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942295059&partnerID=8YFLogxK
U2 - 10.1111/hex.12168
DO - 10.1111/hex.12168
M3 - Article
VL - 18
SP - 1757
EP - 1768
JO - Health Expectations
JF - Health Expectations
SN - 1369-6513
IS - 5
ER -