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

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 cliniciandominated. 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.