Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis

Abstract

Introduction: Patients with incurable cancer have poor prognostic awareness. We present a detailed analysis of the dialogue between oncologists and patients in conversations with prognostic implications.

Methods: A total of 128 audio-recorded encounters from a large multisite trial were obtained, and 64 involved scan results. We used conversation analysis, a qualitative method for studying human interaction, to analyze typical patterns and conversational devices.

Results: Four components consistently occurred in sequential order: symptom-talk, scan-talk, treatment-talk, and logistic-talk. Six of the encounters (19%) were identified as good news, 15 (45%) as stable news, and 12 (36%) as bad news. The visit duration varied by the type of news: good, 15 minutes (07:00-29:00); stable, 17 minutes (07:00-41:00); and bad, 20 minutes (07:00-28:00). Conversational devices were common, appearing in half of recordings. Treatment-talk occupied 50% of bad-news encounters, 31% of good-news encounters, and 19% of stable-news encounters. Scan-talk occupied less than 10% of all conversations. There were only four instances of frank prognosis discussion.

Conclusion: Oncologists and patients are complicit in constructing the typical encounter. Oncologists spend little time discussing scan results and the prognostic implications in favor of treatment-related talk. Conversational devices routinely help transition from scan-talk to detailed discussions about treatment options. We observed an opportunity to create prognosis-talk after scan-talk with a new conversational device, the question "Would you like to talk about what this means?" as the oncologist seeks permission to disclose prognostic information while ceding control to the patient.

Figures

FIG 1.

Time management by type of news delivery. The graph shows the amount of time spent in each phase of conversation in relation to the type of news being delivered. The percentages do not add up to 100% because we excluded the small talk that often comes at the end of the clinic visit. Such small talk includes, for example, weekend plans.

FIG 2.

The frequency of laudable event proposals and appreciation sequences by type of news. These devices are most commonly associated with stable news and bad news, and less often seen in good news discussions.

FIG A1.

Examples of communication phenomena. CT, computed tomography; NSCLC, non–small-cell lung cancer.