Can metaphors and analogies improve communication with seriously ill patients?
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.


METHODS
Cross-sectional observational study of audio-recorded conversations between patients and physicians.


METHODS
Three outpatient oncology practices.


METHODS
Ninety-four patients with advanced cancer and 52 physicians.


METHODS
None.


METHODS
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 (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001).


CONCLUSIONS
The use of metaphors and analogies may enhance physicians' ability to communicate.
Casarett
David
D
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Casarett@mail.med.upenn.edu
Pickard
Amy
A
Fishman
Jessica M
JM
Alexander
Stewart C
SC
Arnold
Robert M
RM
Pollak
Kathryn I
KI
Tulsky
James A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D019365:Metaphor; D008875:Middle Aged; D010817:Physician-Patient Relations; D019452:Terminally Ill; D055815:Young Adult