title: An exploration of the dynamics and influences upon second medical opinion consultations in cancer care.
abstract: OBJECTIVE
  The aim of this study was to explore the dynamics within second medical opinion consultations in patients with cancer.
  
  
  METHODS
  Semi-structured interviews were held with four oncologists and were subjected to a thematic analysis to define the broad issues. These formed the basis of a survey distributed to Australian medical oncologists.
  
  
  RESULTS
  Overall 65 surveys were returned representing an overall response rate of 30% (10% and 63% electronic and hardcopy response rates, respectively). The dynamics in giving second medical opinions are influenced by the collegiate relationships of the doctors. Nearly two-thirds of oncologists believed that the first doctors' treatment and recommendations influenced the outcome of the second opinion, more than one-third believed the outcome was influenced by the relationship between the two doctors, and 41% believed the public nature of a second opinion was influential. In each case, these figures were more than double their assessments of patients' beliefs of these influences. Care was taken not to criticise the primary doctor.
  
  
  CONCLUSIONS
  Second medical opinions provide an opportunity for oncologists to review medical care and engage in enhanced communication with patients who have additional needs. These consultations do not, however, occur in a vacuum but are influenced by the need to attend to relationships between the patient and their primary doctor and between the doctors themselves. The second medical opinion is embedded within a network of relationships and within the illness journey.
authors.affiliation: Palliative Care Service, St Vincent's Hospital and Centre for Palliative Care, University of Melbourne, Melbourne, Victoria, Australia. jennifer.philip@svhm.org.au
authors.forename: Jennifer
authors.initials: J
authors.lastname: Philip
authors.forename: Michelle
authors.initials: M
authors.lastname: Gold
authors.forename: Max
authors.initials: M
authors.lastname: Schwarz
authors.forename: Paul
authors.initials: P
authors.lastname: Komesaroff
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data