title: Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients.
abstract: Silences in doctor-patient communication can be "connectional" and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients.
  
  
  
  Two medical students and a professor of voice screened all 1211 silences over 2s in length from 124 oncology office visits. We developed a "strength of connection" taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm.
  
  
  
  We identified connectional silences with good reliability. Typical dialog rhythms surrounding connectional silences are characterized by relatively equal turn lengths and frequent short vocalizations. We found no pattern of volume and pitch variability around these silences. Connectional silences occurred in a wide variety of lexical contexts.
  
  
  
  Particular patterns of dialog rhythm mark connectional silences. Exploring structures of connectional silence extends our understanding of the audio-linguistic conditions that mark patient-clinician connection.
  
  
  
  Communicating with an awareness of pitch, rhythm, and silence - in addition to lexical content - can facilitate shared understanding and emotional connection.
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Josef_Bartels@URMC.Rochester.edu.
authors.forename: Josef
authors.initials: J
authors.lastname: Bartels
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Rachel_Rodenbach@urmc.rochester.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rodenbach
authors.affiliation: Eastman School of Music, 26 Gibbs St., Rochester, NY 14604, USA. Electronic address: KCiesinski@esm.rochester.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ciesinski
authors.affiliation: Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA. Electronic address: Robert_Gramling@urmc.rochester.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
authors.affiliation: Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA. Electronic address: Kevin_Fiscella@urmc.rochester.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA. Electronic address: Ronald_Epstein@urmc.rochester.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Epstein
mesh_terms: D003142:Communication; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009146:Music; D000072103:Oncologists / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology
keywords: Compassion; Connection; Dialog rhythm; Discourse analysis; Emotion; Empathy; End-of-life; Engagement; Healthcare communication; Interpersonal synchrony; Music; Paralinguistic; Patient-centered; Presence; Silence