Cues and concerns by patients in medical consultations: a literature review.

The aim of the current article is to review the peer-reviewed research literature on cues and concerns published between 1975 and 2006. To be included, articles had to report observational studies based on patient-physician consultations and report findings on patient expressions of cues and/or concerns. Quantitative and qualitative studies from different medical settings were considered. Fifty-eight original articles based on the analysis of audio- or videotaped medical consultations were tracked down. Definition of cues and concerns and methodological approaches differed widely. Physicians missed most cues and concerns and adopted behaviors that discouraged disclosure. Communication training improved the detection of cues and concerns. Future research progress would require different methodological approaches more appropriate for studying verbal interactions and the complexity of the various levels that influence interactions.