Communication styles in the cancer consultation: Preferences for a patient-centred approach

Objective: Although doctor-patient communication has been the focus of nume rous studies, there is a lack of empirical evidence on which to base a curr iculum for teaching effective communication skills for use in an oncology s etting. Research within the general practice area identifies patient-centre d and doctor-centred behaviours as the most important dimensions of doctor- patient communication. This study examined patients and their relatives/fri ends' preferences for and satisfaction with patient-centred and doctor-cent red consulting styles. It was argued that by determining patient preference s for consulting styles, specific recommendations for improving communicati on in the oncology setting could be formulated. Participants and Methods: One hundred and thirteen women who had been treat ed for breast cancer and 48 of their relatives or friends watched videotape d scenarios of an oncology consultation, using professional actors. Viewers were randomly allocated to either a good prognosis or poor prognosis video , in which the oncologist discussed the patient's diagnosis, treatment and prognosis. These segments were presented in both styles to allow viewers to directly compare and contrast the patient-centred and doctor-centred appro ach. Outcomes included style preference and satisfaction. Demographic detai ls, information and involvement preferences, anxiety and depression levels were also obtained. Results: Both patients and their relatives or friends significantly preferr ed a patient-centred consulting style across all aspects of the consultatio n (p < 0.0001), except within the treatment segment of the good prognosis v ideo where there was no significant difference. One third of the viewers pr eferred a doctor-centred style for the treatment and prognosis segments. Pr edictors of a patient-centred style preference in the treatment and prognos is segments included watching a poor prognosis video (OR = 2.45, 95% CI 1.0 4-5.81, p = 0.04; OR = 3.22, 95% CI 1.22-8.50, p = 0.02, respectively), and being employed in a professional occupation (OR = 2.38, 95% CI 1.02-5.53, p = 0.04 for the treatment segment only). Satisfaction ratings varied withi n and across videos. Conclusion: Despite some methodological limitations, this study provides em pirical data indicating that patients and their relatives or friends prefer a patient-centred approach to the consultation, particularly when the pati ent has a poor prognosis. The fact that a substantial minority of patients preferred a doctor-centred style emphasizes the need to enhance physicians' abilities to recognize different patient needs throughout the consultation . Copyright (C) 2000 John Wiley & Sons, Ltd.