title: Patient-physician communication about early stage prostate cancer: analysis of overall visit structure.
abstract: BACKGROUND
  We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer.
  
  
  OBJECTIVE
  To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.
  
  
  METHODS
  Forty veterans and 18 urologists at one VA medical centre.
  
  
  METHODS
  We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities.
  
  
  RESULTS
  We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions.
  
  
  CONCLUSIONS
  Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.
authors.affiliation: Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Henry
authors.affiliation: Department of Sociology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Czarnecki
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Valerie C
authors.initials: VC
authors.lastname: Kahn
authors.affiliation: Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Wen-Ying Sylvia
authors.initials: WY
authors.lastname: Chou
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.|Ann Arbor VA HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.|Departments of Internal Medicine and Psychology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: Fuqua School of Business, Duke University, Durham, NC, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.affiliation: College of Human Medicine, Michigan State University, East Lansing, MI, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Rovner
authors.affiliation: Department of Medicine, Duke University, Durham, NC, USA.|Durham VA Medical Center, Durham, NC, USA.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.affiliation: VA Health Services Research & Development, Office of Research and Development, Veterans Health Administration, Washington, DC, USA.|San Francisco VA Medical Center, San Francisco, CA, USA.|Departments of Psychiatry and Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.affiliation: Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D017430:Prostate-Specific Antigen
keywords: discourse analysis; patient-centred communication; prostate cancer; qualitative research; structure; transitions; veterans