Abstract
ObjectiveTo explore socioeconomic status (SES) differences in patterns of doctor‐patient communication within head and neck cancer clinics and why such differences exist.MethodsThirty‐six head and neck cancer review appointments with five Physicians were observed and audio‐taped, along with follow‐up interviews involving 32 patients. Data were analysed using Thematic Analysis, and compared by patient SES (education, occupation and Indices of Multiple Deprivation).ResultsThree main themes were identified: (a) Physicians used more humour and small talk in their consultations with high SES patients; (b) Low SES patients were more passive in their participation, engaged in less agenda setting and information‐seeking, and framed their clinical experience differently; (c) Low SES patients had different preferences for involvement, defining involvement differently to high SES patients and were seen to take a more stoical approach.ConclusionLow SES patients take a more passive role in medical consultations, engage in less relational talk and are less likely to raise concerns, but were satisfied with this. Physicians may adapt their communication behaviour in response to low SES patients’ expectations and preferences.Practice ImplicationsA question prompt list may help low SES patients to raise concerns during their consultations. This may reduce inequalities in communication and health.
Highlights
Stoicism (Low socioeconomic status (SES) patients had a more stoic attitude) distributed by SES, but we found more highly educated patients appeared confident about raising concerns they had about their quality of life
When asking whether they received sufficient information, we found that higher SES patients actively sought information from the Physician, even outside of the consultation if they had forgotten to ask something during their appointment—seeing this as their responsibility: if someone has not received sufficient information this was seen as their fault
Our finding that patients from less deprived areas had longer appointments is consistent with the findings from our previous study which showed a significant positive correlation between appointment length and SES as measured by indices of multiple deprivation (IMD) decile.[31]. This may reflect the lack of much relational talk which occurred between Physicians and low SES patients
Summary
Effective doctor-patient communication contributes to better treatment outcomes.[1,2,3,4,5] Its importance makes it the ‘heart and art’ of medicine.[6]. This is in contrast with a patient with lower SES (Table 3, Theme 2, sub-theme 2.1, Patient 8) who was an auto-electrician working on motorway signage; who made reference to his occupation, but in a different way. (3-second silence while Physician continues to write) I don’t know if it’s the air or you know sensitive or...’ This was in contrast to low SES patients, who took a more passive approach as illustrated in sub-theme 2.2 in Table 3 (Patient 7): waiting for the Physician to set the agenda which was focused on medical, or task aspect of the appointment.
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