Physician communication styles in initial consultations for hematological cancer

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. Practice implications: 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. (C) 2013 Elsevier Ireland Ltd. All rights reserved.