Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?

Abstract

Objective: It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. Design: Cross-sectional observational study of audio-recorded conversations between patients and physicians. Setting: Three outpatient oncology practices. Patients: Ninety-four patients with advanced cancer and 52 physicians. Intervention: None. Main outcome measures: Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. Results: In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65=101, 64% versus 31=101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (r ¼ 0.27; p ¼ 0.006), as did physicians who used more analogies (Spearman r ¼ 0.34; p < 0.001). Conclusions: The use of metaphors and analogies may enhance physicians' ability to communicate.

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…77 The use of metaphors and analogies however (eg, likening a chemotherapy regimen to a marathon) can improve patient understanding and satisfaction with communication, due to the incorporation of everyday concepts that are more familiar to patients than medical terminology. 89 Where language barriers exist, some patients prefer translation to be performed by family members who are trusted and accessible, while others prefer professionals who aren't emotionally invested in the conversation. 54,71 'Cultural interpreters', such as Aboriginal health workers, may also be helpful in providing guidance in cultural norms and facilitating understanding of illness concepts that may be underpinned by completely different worldviews.…”

A Cross-sectional Feasibility Study Testing the Use of Abstract Animations for the Communication and Assessment of Pain (Preprint)

“…Taking into account pain literature that suggests pain is more accurately depicted visually [24] and is better communicated with word pictures, analogies, and metaphors, [25,26] we decided on a highly visual, abstract, and expressive mode of pain communication: animations.…”

Exploring Barriers Among Primary Care Providers in Referring Patients to Hospice

“…17 Improving communication between patients, hospices, and providers is an aspect worthy of further investigation. 21 Provider discussion with the patient and family regarding a terminal illness and resulting sequelae ultimately improves outcomes. 22 Reducing communication barriers will reduce hospice referral barriers by assisting patients and families in making decisions about end-of-life care.…”