Singh-etal2017

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Singh-etal2017
BibType ARTICLE
Key Singh-etal2017
Author(s) Sarguni Singh, Dagoberto Cortez, Douglas Maynard, James F. Cleary, Lori DuBenske, Toby C. Campbell
Title Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis
Editor(s)
Tag(s) EMCA, Cancer, Medical, Medical EMCA
Publisher
Year 2017
Language
City
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Journal Journal of Oncology Practice
Volume 13
Number 3
Pages 231-239
URL Link
DOI 10.1200/JOP.2016.014621
ISBN
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Institution
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Abstract

Introduction: Patients with incurable cancer have poor prognostic awareness. We present a detailed analysis of the dialogue between oncologists and patients in conversations with prognostic implications.

Methods: A total of 128 audio-recorded encounters from a large multisite trial were obtained, and 64 involved scan results. We used conversation analysis, a qualitative method for studying human interaction, to analyze typical patterns and conversational devices.

Results: Four components consistently occurred in sequential order: symptom-talk, scan-talk, treatment-talk, and logistic-talk. Six of the encounters (19%) were identified as good news, 15 (45%) as stable news, and 12 (36%) as bad news. The visit duration varied by the type of news: good, 15 minutes (07:00-29:00); stable, 17 minutes (07:00-41:00); and bad, 20 minutes (07:00-28:00). Conversational devices were common, appearing in half of recordings. Treatment-talk occupied 50% of bad-news encounters, 31% of good-news encounters, and 19% of stable-news encounters. Scan-talk occupied less than 10% of all conversations. There were only four instances of frank prognosis discussion.

Conclusion: Oncologists and patients are complicit in constructing the typical encounter. Oncologists spend little time discussing scan results and the prognostic implications in favor of treatment-related talk. Conversational devices routinely help transition from scan-talk to detailed discussions about treatment options. We observed an opportunity to create prognosis-talk after scan-talk with a new conversational device, the question “Would you like to talk about what this means?” as the oncologist seeks permission to disclose prognostic information while ceding control to the patient.

Notes