Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

Kimball, Brittany; James, Katherine M.; Yost, Kathleen J.; Fernandez, Cara; Kumbamu, Ashok; Leppin, Aaron L.; Robinson, Marguerite; Geller, Gail; Roter, Debra; Larson, Susan; Lenz, Heinz Josef; García, Agustin A.; Braddock, Clarence H.; Jatoi, Aminah; Núñcio, María Luisa Zuniga de; Montori, Víctor M.; Koenig, Barbara A.; Tilburt, Jon C.

doi:10.1186/1471-2407-13-455

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…We conducted a cross‐sectional, audio‐recorded observational study of outpatient medical oncology visits with clinicians and patients from across the cancer continuum, as described elsewhere . For the purposes of this study we defined complementary and alternative medicine based on the contemporary definition when the study was conceptualized (2009) as a “group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine” .…”

Section: Methodsmentioning

confidence: 99%

A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context

et al. 2019

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Background Little is known about how complementary and alternative medicine (CAM) is discussed in cancer care across varied settings in the U.S. Methods In two practices affiliated with one academic medical center in southern California (SoCal), and one in the upper Midwest (UM), we audio‐recorded patient‐clinician interactions in medical oncology outpatient practices. We counted the frequency and duration of CAM‐related conversations. We coded recordings using the Roter Interaction Analysis System. We used chi‐square tests for bivariate analysis of categorical variables and generalized linear models for continuous variables to examine associations between dialogue characteristics, practice setting, and population characteristics with the occurrence of CAM discussion in each setting followed by multivariate models adjusting for clinician clustering. Results Sixty‐one clinicians and 529 patients participated. Sixty‐two of 529 (12%) interactions included CAM discussions, with significantly more observed in the SoCal university practice than in the other settings. Visits that included CAM were on average 6 minutes longer, with CAM content lasting an average of 78 seconds. In bivariate tests of association, conversations containing CAM included more psychosocial statements from both clinicians and patients, higher patient‐centeredness, more positive patient and clinician affect, and greater patient engagement. In a multivariable model including significant bivariate terms, conversations containing CAM were independently associated with higher patient‐centeredness, slightly longer visits, and being at the SoCal university site. Conclusion The frequency of CAM‐related discussion in oncology varied substantially across sites. Visits that included CAM discussion were longer and more patient centered. Implications for Practice The Institute of Medicine and the American Society of Clinical Oncology have called for more open discussions of complementary and alternative medicine (CAM). But little is known about the role population characteristics and care contexts may play in the frequency and nature of those discussions. The present data characterizing actual conversations in practice complements a much larger literature based on patient and clinician self‐report about CAM disclosure and use. It was found that CAM discussions in academic oncology visits varied significantly by practice context, that the majority were initiated by the patient, and that they may occur more when visit time exists for lifestyle, self‐care, and psychosocial concerns.

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Section: Methodsmentioning

confidence: 99%

A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context

et al. 2019

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“…The visits were audio recorded and the patient and clinician completed post-encounter surveys. More detail regarding data collection procedures has been presented elsewhere [22]. …”

Section: Methodsmentioning

confidence: 99%

Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits

Roter

Yost

O’Byrne

et al. 2016

Patient Education and Counseling

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Objective Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction. Methods 327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue. Results CAM was discussed in 36 of 327 visits; discussions were brief (< one minute), the majority patient initiated (65%) and more common for patients in early stages of cancer care. Longer visits (35 vs 29 minutes; p<05), greater patient engagement in visit dialogue, lowered clinician verbal dominance and a more patient-centered pattern of visit communication were significantly related to visits with CAM discussions (all p values<01). Both patient and clinician visit satisfaction was higher with CAM discussion (p<05). Conclusions CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction. Practice Implications CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.

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“…The present analysis is part of an on‐going, multicenter parent study assessing cancer communication through the use of audio recordings and paper‐based surveys . Participants include patients, at any stage of treatment for any solid tumour malignancy, and their clinicians (staff oncologists, oncology fellows and nurse practitioners).…”

Section: Methodsmentioning

confidence: 99%

Was a decision made? An assessment of patient–clinician discordance in medical oncology encounters

Leppin

Humeniuk

Fernandez

et al. 2015

Health Expectations

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Background Shared decision making is promoted to improve cancer care quality. Patients and clinicians may have different ideas about what constitutes a cancer care decision, which may limit the validity of self-reported measures of shared decision making. We sought to estimate the extent to which patients and clinicians agree on whether a cancer care decision was made during an outpatient encounter. Methods We surveyed patients and clinicians immediately after an oncology encounter at a large, tertiary medical center and calculated agreement in response to the single-item question, “Was a specific decision about cancer care made during the appointment today?” Answer options were ‘yes’ and ‘no’. Participants were 315 oncology patients with any solid tumor malignancy and at any stage of management and their clinicians (22 staff oncologists, 9 senior fellows, and 5 nurse practitioners) Results Patients and clinicians reported having made a cancer care decision in 184 (58%) and 174 (55%) of encounters, respectively. They agreed on whether a cancer care decision was made in 213 (68%) of encounters (chance-adjusted agreement was 0.34); in 56 of the 102 discordant encounters, the patient reported making a decision while the clinician did not. We found no significant correlates with discordance. Conclusions Patients and clinicians do not always agree on whether a cancer care decision was made. As such, measures that ask patients and/or clinicians to evaluate a decision making process or outcome may be methodologically insufficient when they do not explicitly orient respondents toward the thing they are being asked to assess.

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Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

Cited by 13 publications

References 35 publications

A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context

A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context

Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits

Was a decision made? An assessment of patient–clinician discordance in medical oncology encounters

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