Clinicians communicating with patients experiencing cancer pain

Abstract

Purpose: Provider-patient communication deficits are often implicated as barriers to adequate cancer pain relief. The purpose of this study was to describe verbal communication behaviors and interactions between providers and patients reporting cancer pain.

Methods: As part of a multisite clinical trial, we enrolled 17 oncology physician specialists and 84 patient participants who had reported cancer pain or treatment-related pain in the previous week associated with prostate or head and neck cancer. The study baseline clinic visits (N = 84) were audiotaped, transcribed, and entered into non-numerical unstructured data indexing searching and theorizing (NUD.IST) for content analysis. Each text unit in each transcript was coded as to conversation context: pain, additional symptom/side effects, tumor treatment, and/or personal remarks. Clinician questions were coded as either open-ended or closed-ended, clinician interruptions and subject changes were counted, and a measure of verbal dominance was calculated.

Results: The clinicians spent over half the conversations doing the talking. We calculated a close-ended to open-ended question ratio of 5.8:1. In 55% of the visits, the patient with cancer was interrupted by the clinician when the patient attempted to provide information or ask a question. Symptoms/side effects were addressed in practically all visits, whereas sensory pain was addressed in 90% of the visits.

Conclusions: The clinicians were attentive to daily problems relevant to treatment side effects; however, the results also indicate a pattern of communication during the clinic visit that is typically clinician oriented. The nature of such communication may prevent the patient from sharing significant facts and experiences relevant to cancer pain and thus compromise the quality of pain management.