title: Physician communication styles in initial consultations for hematological cancer.
abstract: OBJECTIVE
  To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations.
  
  
  METHODS
  Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.
  
  
  RESULTS
  Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation.
  
  
  CONCLUSIONS
  Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation.
  
  
  CONCLUSIONS
  Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, USA. Electronic address: krchhabra@gmail.com.
authors.forename: Karan R
authors.initials: KR
authors.lastname: Chhabra
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D001900:Boston; D003142:Communication; D003657:Decision Making; D005260:Female; D019337:Hematologic Neoplasms; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations; D010820:Physicians; D011379:Prognosis; D012017:Referral and Consultation; D014861:Washington
keywords: Information delivery; Oncology consultations; Patient participation; Physician–patient communication; Physician–patient relationships; Second opinions; Shared decision-making; US
references.citation: Leuk Lymphoma. 2011 Dec;52(12):2342-8
references.pmid: 21851220
references.citation: Breast Cancer Res Treat. 2011 Aug;129(1):79-87
references.pmid: 20945090
references.citation: Sociol Health Illn. 2012 Jan;34(1):95-113
references.pmid: 21812791
references.citation: Ann Intern Med. 2005 Aug 16;143(4):293-300
references.pmid: 16103473
references.citation: Theor Med. 1986 Jun;7(2):165-79
references.pmid: 3526626
references.citation: Sociol Health Illn. 2008 May;30(4):511-30
references.pmid: 18298631
references.citation: Med Care. 2007 Apr;45(4):330-9
references.pmid: 17496717
references.citation: Psychooncology. 2012 Mar;21(3):297-306
references.pmid: 21294221
references.citation: Br J Gen Pract. 2000 Nov;50(460):892-9
references.pmid: 11141876
references.citation: Soc Sci Med. 2011 Oct;73(7):1028-36
references.pmid: 21855192
references.citation: Exp Aging Res. 1996 Oct-Dec;22(4):403-28
references.pmid: 8968711
references.citation: Soc Sci Med. 2005 Nov;61(10):2252-64
references.pmid: 15922501
references.citation: Patient Educ Couns. 2009 Jul;76(1):44-50
references.pmid: 19135824
references.citation: Med Educ. 2005 Jun;39(6):632-40
references.pmid: 15910440
references.citation: Crit Care Med. 2004 Jul;32(7):1484-8
references.pmid: 15241092
references.citation: Patient Educ Couns. 2012 Jan;86(1):127-33
references.pmid: 21890301
references.citation: Health Aff (Millwood). 2012 May;31(5):1030-8
references.pmid: 22566443
references.citation: Health Commun. 2001;13(3):241-60
references.pmid: 11550850
references.citation: J Surg Oncol. 2012 Jul 1;106(1):101-6
references.pmid: 22258736