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.