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COMMUNICATION BETWEEN PHYSICIAN AND CANCER PATIENT

D. Cella, PhD, Rush Cancer Institute, Rush University, Chicago, found that cancer patients perceived spoken messages more positively than intended by oncologists. Thirty-one patients, on average, showed a 0.74 unit disagreement with 5 oncologists during a first visit consultation.

Measuring Communication Each physician-patient interview lasted 15 minutes divided into ten 90-second units. Both participants assigned a score (Likert scale) of 1=very negative to 7=very positive with 4= neutral for the tone of the conversation that took place over the previous 90 seconds. A hand-held communication box allowed secret entry of scores and transmission of data to a lap-top computer. Later, outside observers (psychology graduate students) viewed a videotape of the dialogue and rated each segment using the same 7 point scale.
Patient Demographics Nineteen males and 12 females participated in this pilot study. Age ranged from 25 to 82 years and averaged 48. Six of 31 patients presented AIDS-related cancer; the others included breast, 5; colon, 2; lung, 3; prostate, 2; renal, 2; testicular, 2; unknown primary, 2; and other, 7. Stage of illness consisted of: I-1, II-6, III-4, IV-14, and AIDS related-6.
Communication Ratings Physicians were less positive than patients based on the average scores for the 15-minute sessions. Physicians averaged 4.65 and patients 5.39; the mean discrepancy between them was 0.74 (p<0.001). Observers were also less positive than patients but did not differ significantly from physicians (p>0.05). In this pilot study, patient scoring did not differ by gender or stage of illness.
Overall Satisfaction Each patient/physician pair received two questions about one another's intentions during the 15-minute session. The first question focussed on perceived intentions, "Overall, I believe my patient/doctor intended the content of his/her comments to be ..." asked for a Likert scale rating using 1=very negative to 5=very positive. The second question pertained to experienced intentions, "Overall, in talking with my patient/doctor I intended the content of my comments to be ..." for rating on the same scale for the first question.

Patients seemed to hear more positive information than the physician intended or believed was communicated. Of interest, patients and physicians, on average, rated their own intents similarly, i.e., 4.1 vs 3.9 (p>0.05). Physicians were more negative in rating the patients' intent than patients by 0.55 units (p<0.05).

Benefits from Patient Positivity Cella speculates on the physician and patient benefits gained from the patient positivity bias seen in this pilot study. Perhaps physicians respond by giving patients more information and find it less difficult to present bad news. Patients may need a positive bias to (1) agree to treatments which often are costly, toxic, or ineffective, (2) place their physicians on higher pedestals because of vested interests, and (3) deny the negativity of messages received from caregivers in order to remain optimistic. Overall, the bias seems helpful to patient and physician.

For professional correspondence, please contact Dr. Cella at: dcella@rpslmc.edu

Eugene A. Conrad

Presented at Third World Congress of Psycho-Oncology, 4 Oct 1996
CONRAD NOTES, © October 1996 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 9-Dec-1996

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