Physician-dominated conversations: An analysis of illness understanding discussions among patients with advanced cancer

Brigitte N Durieux; Samuel R Zverev; Nicole D Agaronnik; Joshua Davis; Kathryn I Pollak; James A Tulsky; Elise Tarbi; Charlotta Lindvall

doi:10.1016/j.pec.2024.108633

Physician-dominated conversations: An analysis of illness understanding discussions among patients with advanced cancer

Patient Educ Couns. 2025 Apr:133:108633. doi: 10.1016/j.pec.2024.108633. Epub 2025 Jan 2.

Authors

Brigitte N Durieux¹, Samuel R Zverev², Nicole D Agaronnik³, Joshua Davis⁴, Kathryn I Pollak⁵, James A Tulsky⁶, Elise Tarbi⁷, Charlotta Lindvall⁸

Affiliations

¹ Dana-Farber Cancer Institute, Boston, MA, USA.
² Dana-Farber Cancer Institute, Boston, MA, USA; New York University Long Island School of Medicine, New York, NY, USA.
³ Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁴ Dana-Farber Cancer Institute, Boston, MA, USA; Albany Medical College, Albany, NY, USA.
⁵ Duke University School of Medicine, Duke University, Durham, NC, USA; Cancer Prevention and Control Program, Duke Cancer Institute, Duke University, Durham, NC, USA.
⁶ Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA.
⁷ Dana-Farber Cancer Institute, Boston, MA, USA; University of Vermont, Burlington, VT, USA.
⁸ Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA. Electronic address: Charlotta_lindvall@dfci.harvard.edu.

PMID: 39793420
DOI: 10.1016/j.pec.2024.108633

Abstract

Context: Effective communication between patients and oncologists is crucial, particularly around illness understanding. When this communication is asymmetric or imbalanced, it can hinder shared decision-making and lead to suboptimal clinical outcomes.

Objectives: We sought to describe physician-patient speech imbalances ("asymmetry") in illness understanding portions of discussions between oncologists and advanced cancer patients and explore potential trends related to patient characteristics.

Methods: Our study included 285 audio recordings of outpatient encounters between 40 oncologists and 139 patients with advanced cancer. We identified illness understanding communication via manual data annotation and analyzed clinician-patient speech ratios. For this project, a communication outcome of "asymmetry" was defined as taking place when one party spoke more than 60 % of all spoken characters related to illness understanding in the conversation. We used descriptive statistics to report frequency of asymmetric conversations by patient characteristics. We then examined whether certain patient characteristics were associated with presence of at least one asymmetric illness understanding discussion as a categorical variable.

Results: At the conversation level, 77 % of all illness understanding discussions were asymmetric and clinician-dominated. At the patient level, 89 % experienced asymmetric illness understanding communication. We found that non-Hispanic white patients experienced a lower rate of asymmetry across their conversations compared to patients from other racial and ethnic backgrounds (73 % of conversations vs. 82 %).

Conclusions: Asymmetric, clinician-dominated communication was prevalent in illness understanding discussions.

Practice implications: Communication balances may be a relevant factor driving disparities in cancer care. Strategies are needed to address communication imbalances in serious illness conversations and enhance communication education.

Keywords: Asymmetry; Communication; Goals of care (up to 7); Illness understanding.

MeSH terms

Adult
Aged
Communication*
Comprehension*
Decision Making
Decision Making, Shared*
Female
Humans
Male
Middle Aged
Neoplasms* / psychology
Oncologists
Physician-Patient Relations*
Tape Recording