Study: Doctor's communication style may sway cancer patients

October 09, 2003

WEST LAFAYETTE, Ind. - The way a doctor explains clinical trial options can affect a cancer patient's decision on whether to participate, says a Purdue University communication professor.

Felicia Roberts, a conversation analyst, studied how physicians communicated treatment options to patients considering breast cancer clinical trials, which are studies that evaluate a new therapy in fighting the disease. About 20,000 patients participate in clinical trials sponsored by the National Cancer Institute, according to the institute.

"This research shows that physicians have extremely different approaches to explaining and recommending clinical trials, and these varying differences may affect clinical trial enrollment," said Roberts, whose research area is health communication. "My work can serve as a mirror for doctors so they can see their communication patterns, which they are often not aware of. Sometimes just raising awareness can improve doctor-patient interactions.

"As more patients take a leading role in their own health care, it is important for cancer patients to understand that their perception of a doctor's medical recommendation can be influenced by the physician's communication style," said Roberts, who authored "Talking About Treatment: Recommendations for Breast Cancer Adjuvant Therapy."

Her paper, "Qualitative Differences Among Cancer Clinical Trial Explanations," appeared in the December issue of Social Science & Medicine.

Roberts said doctors' presentation, structuring and delivery of clinical trial recommendations, as well as how they are perceived by patients, are comparatively new areas of study in health communication.

"Despite fairly extensive surveys, retrospective studies and forensic study of medical records, there has been no detailed linguistic examination of the way physicians actually present clinical trials to patients," Roberts said. "I wanted to know what transpires in physician offices during explanations of the cancer clinical trial treatment option. This is one way to better understand factors affecting enrollments."

Roberts' study examined how patients are recruited for trials and to what extent the physician encourages enrollment. Roberts studied 21 audio recordings of doctor-patient consultations, which were collected as part of another researcher's study concerning breast cancer treatment decisions. She selected two contrasting cases to document extreme differences in the doctors' approaches.

"Doctors walk a fine line when they speak to patients because they can't promise results even though, in my data, they tend to encourage treatment," Roberts said.

One doctor identified the clinical trial as an "institutional endeavor" and the other said the clinical trial is about "finding the best treatments." She also chronicled their word choices and the information they shared.

"Patients will likely never know all of the factors contributing to a physician's recommendation for a particular trial, or the oncologists' stance toward trials in general. All they have in front of them is how the option is presented," Roberts said. "Understanding the way alternatives are presented by doctors is central to improving patient-provider interaction."
-end-
Writer: Amy Patterson-Neubert, 765-494-9723, apatterson@purdue.edu

Source: Felicia Roberts, 765-494-3323, froberts@purdue.edu

Related Web site:

Felicia Roberts: http://web.ics.purdue.edu/~froberts/

ABSTRACT

Qualitative differences among cancer clinical trial explanations

Felicia Roberts

This paper examines how medical oncologists present to breast cancer patients the option of participating in experimental treatment trials. The investigation takes a case study approach, comparing two contrasting presentations of the clinical trial option. One presentation constructs the experimental trial as a locally organized, joint physician-patient effort to determine "best" treatments, and minimizes uncertainty by oversimplification of the randomization process; the second presentation situates the clinical trial within the larger national research effort, underscores the uncertainty created by randomization and casts non-enrollment as a reasonable option. These observations provide initial evidence that physician presentation of the clinical trial varies substantially and provides the first detailed look at actual discourse practices used in the United States to recruit patients to experimental protocols.

Purdue University

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