Patients' reflections on communication in the second-opinion hematology-oncology consultation

Objective: The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients' perceptions of their second-opinion hematology-oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients' care and decision-making. Methods: In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations. Results: Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians' consideration of the unique elements of patients' cases, and demonstrations of empathy and respect made patients' feel positively about the encounter, regardless of the prognosis. Conclusions: Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation. Practice implications: Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits. (c) 2008 Elsevier Ireland Ltd. All rights reserved.