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Objective Providing a second opinion (SO) in oncology is complex, and communication during SOs remains poorly understood. This study aimed to systematically observe how patients and oncologists communicate about SO-specific topics (i.e., patient motivation, the referring oncologist, treatment transfer/back-referral), and how such communication affects patient satisfaction. Methods A prospective mixed-methods study of cancer patients seeking a SO (N = 69) and consulting oncologists was conducted. Before the SO, patients reported their expected place of future treatment. Following the SO, patients’ and oncologists’ satisfaction was assessed. All SOs were audio-recorded. Absolute and relative duration of SO-specific talk were calculated and specific events (e.g., questions/utterances) were coded (incl. valence, explicitness). Results SOs lasted 19–73 min, of which 3.7% was spent discussing motivations. Oncologists rarely explored patients’ motivations. Talk about referring oncologists (12.5% of consultation) was mostly critical by patients (M = 43.0%), but positive/confirming by consulting oncologists (M = 73.5%). Although 22.2% of patients expected a treatment transfer, this topic (3.3% of consultation time) was rarely explicitly discussed. Patients who were referred back were significantly less satisfied (d = 0.85). Conclusion Patient-provider communication in oncological SOs appears insufficiently aligned. Practice Implications Patients and oncologists need support to explicitly and productively communicate about SO-specific topics and to better manage expectations. Recommendations are provided.

ObjectivesPhysician gaze towards patients is fundamental for medical consultations. Physicians’ use of Electronic Health Records (EHR) affects their gaze towards patients, and may negatively influence this interaction. We aimed to study conversation patterns during gaze shifts of physicians from the patient towards the EHR.MethodsOutpatient consultations (N=8) were eye-tracked. Interactions around physician gaze shifts towards the computer were transcribed.ResultsWe found that physician gaze shifts have different interactional functions, e.g., introducing a topic switch or entering data into the EHR. Furthermore, physicians differ in how they account for their gaze shifts, i.e., both implicitly and explicitly. Third, patients vary in treating the gaze shift as an indication to continue their turn or not.ConclusionsOur results suggest that physician gaze shifts vary in function, in how physicians account for them, and in how they influence the conversation. Future research should take into account distinctions when relating gaze to patient outcomes.Practice implicationsPhysicians may be aware of the interactional context of their gaze behaviour. Patients respond differently to various types of gaze shifts. How physicians handle gaze shifts can therefore have different consequences for the interaction.

Objective Genetic counselors need advanced communication skills, particularly when discussing tests involving massively parallel sequencing. Increasingly, non-genetic healthcare professionals (HCPs) also need to provide genetic counseling. Communication skills training (CST) may equip HCPs with the required communication skills. This scoping review provides an overview of the content, approach, effectiveness and effective features of CSTs aimed at improving genetic and non-genetic HCPs’ communication skills in providing genetic counseling. Methods Following the PRISMA-ScR statement, four databases were searched for articles. Two researchers independently screened titles and abstracts, and extracted data. When applicable, information on effectiveness and effective features of CST was collated. Results Twenty-three articles were included. Sixteen CSTs targeted non-genetic HCPs, five targeted genetic HCPs and two targeted both. Most CSTs addressed multiple communication behaviors and consisted of role play. CSTs were found to be effective for improving HCPs (mainly self-reported) attitudes and skills. Limited evidence on specific effective features of CST was found. Conclusions There is a clear need for evidence on the effectiveness of CST on improving both HCPs’ communication skills in the context of genetic counseling, and patient outcomes, and its specific effective features. Practice implications Clinical practice could benefit from evidence-based CST for genetic and non-genetic HCPs.

Objective Cancer genetic counseling increasingly involves discussing uncertain test results, for example because multiple genes are sequenced simultaneously. This review was performed to provide insight into how counselors’ communication of uncertain test results during genetic counseling for cancer affects counselors and counselees. Methods A systematic mixed studies review was undertaken to review research on the effects of communicating uncertain test results. Four databases were searched using a PICO search strategy. Study findings of articles meeting the inclusion criteria were synthesized narratively. Results Twenty-four articles were included. Uncertain test results encompassed either an inconclusive test result or a variant of unknown significance (VUS). Counselees involved almost exclusively women at risk of hereditary breast and/or ovarian cancer. None of the articles reported effects on counselor outcomes. Counselee outcomes were categorized as cognitive, affective or behavioral. Interpretation of a VUS was overall reported as difficult, and counselees’ distress and worry were repeatedly found to decrease over time after the discussion of any uncertain test result. For most other outcomes, findings were sparse and/or inconsistent. Conclusion Evidence on effects on counselee outcomes is scant and inconsistent. Future studies are warranted to provide insight into how counselees and counselors are affected. Practice implications Clinical practice could benefit from guidelines on how to address uncertain test results during pre- and posttest genetic consultations.

Background The development of novel diagnostics enables increasingly earlier diagnosis of Alzheimer's disease (AD). Timely diagnosis may benefit patients by reducing their uncertainty regarding the cause of symptoms, yet does not always provide patients with the desired certainty. Objective To examine, using both quantitative and qualitative methods, uncertainty communicated by memory clinic clinicians in post‐diagnostic testing consultations with patients and their caregivers. Methods First, we identified all uncertainty expressions of 22 clinicians in audiotaped post‐diagnostic testing consultations with 78 patients. Second, we statistically explored relationships between patient/clinician characteristics and uncertainty expressions. Third, the transcribed uncertainty expressions were qualitatively analysed, determining the topic to which they pertained, their source and initiator/elicitor (clinicians/patients/caregivers). Results Within 57/78 (73%) consultations, clinicians expressed in total 115 uncertainties, of which 37% elicited by the patient or caregiver. No apparent relationships were found between patient/clinician characteristics and whether or not, and how often clinicians expressed uncertainty. Uncertainty expressions pertained to ten different topics, most frequently patient's diagnosis and symptom progression. Expressed uncertainty was mostly related to the unpredictability of the future and limits to available knowledge. Discussion and conclusions The majority of clinicians openly discussed the limits of scientific knowledge and diagnostic testing with patients and caregivers in the dementia context. Noticeably, clinicians did not discuss uncertainty in about one quarter of consultations. More evidence is needed on the beneficial and/or harmful effects on patients of discussing uncertainty with them. This knowledge can be used to support clinicians to optimally convey uncertainty and facilitate patients' uncertainty management.

Objective Experimental vignette designs are used to systematically test the effects of medical communication. We tested the impact of two methodological choices –gender congruence and vignette modality– on analogue patient reported outcomes. Methods In an online experiment using a vignette portraying an oncological bad news consultation, we manipulated (1) gender congruence between the analogue and the vignette patient, and (2) vignette modality, i.e., text, audio, or video. Cancer-naive students acting as analogue patients (N = 209, 22 ± 3 years old, 75% F) were assigned one randomly-selected vignette variant and completed questionnaires. Using 3 × 2 (repeated-measures) ANOVAs, we tested main and interaction effects of gender congruence and modality on self-reported engagement, recall, trust, satisfaction and anxiety. Results We found no main effects of gender congruence or modality on any of the outcomes, nor any interaction effects between modality and congruence. Conclusion Our results indicate that researchers may needlessly create gender-congruent vignettes at considerable cost and effort. Also, the currently assumed superiority of videos over other modalities for experimental vignette-based research may be inaccurate. Practice implications Although further testing in an offline format and among different populations is warranted, decisions regarding gender congruence and modality for future vignette-based studies should be based primarily on their specific aims.

Pre-test counseling about multigene panel testing involves many uncertainties. Ideally, counselees are informed about uncertainties in a way that enables them to make an informed decision about panel testing. It is presently unknown whether and how uncertainty is discussed during initial cancer genetic counseling. We therefore investigated whether and how counselors discuss and address uncertainty, and the extent of shared decision-making (SDM), and explored associations between counselors’ communication and their characteristics in consultations on panel testing for cancer. For this purpose, consultations of counselors discussing a multigene panel with a simulated patient were videotaped. Simulated patients represented a counselee who had had multiple cancer types, according to a script. Before and afterwards, counselors completed a survey. Counselors’ uncertainty expressions, initiating and the framing of expressions, and their verbal responses to scripted uncertainties of the simulated patient were coded by two researchers independently. Coding was done according to a pre-developed coding scheme using The Observer XT software for observational analysis. Additionally, the degree of SDM was assessed by two observers. Correlation and regression analyses were performed to assess associations of communicated uncertainties, responses and the extent of SDM, with counselors’ background characteristics. In total, twenty-nine counselors, including clinical geneticists, genetic counselors, physician assistants-in-training, residents and interns, participated of whom working experience varied between 0 and 25 years. Counselors expressed uncertainties mainly regarding scientific topics (94%) and on their own initiative (95%). Most expressions were framed directly (77%), e.g. We don’t know, and were emotionally neutral (59%; without a positive/negative value). Counselors mainly responded to uncertainties of the simulated patient by explicitly referring to the uncertainty (69%), without providing space for further disclosure (66%). More experienced counselors provided less space to further disclose uncertainty (p

Objective: Physicians are increasingly expected to share uncertain information, yet there is concern about possible negative effects on patients. How uncertainty is conveyed and by whom may influence patients’ response. We tested the effects of verbally and non-verbally communicating uncertainty by a male vs. female oncologist on patients’ trust and intention to seek a second opinion. Methods: In an experimental video vignettes study conducted in The Netherlands, oncologist communication behavior (verbal vs. non-verbal and high vs. low uncertainty) and gender (male vs. female) were systematically manipulated. Former cancer patients viewed one video variant and reported trust, intention to seek a second opinion, and experience of uncertainty. Results: Non-verbal communication of high uncertainty by the oncologist led to reduced trust (β = -0.72 (SE = 0.15), p < .001) and increased intention to seek a second opinion (β = 0.67 (SE = 0.16), p < .001). These effects were partly explained by patients’ increased experience of uncertainty (β = -0.48 (SE = 0.12), p < .001; and β = 0.34 (SE = 0.09), p < .001 respectively). Neither verbal uncertainty nor oncologists’ gender influenced trust or intention to seek a second opinion. Conclusion: Non-verbal communication of uncertainty by oncologists may affect patient trust and intention to seek a second-opinion more than verbal communication. Practice Implications: Further research to understand and improve oncologists’ non-verbal uncertainty behavior is warranted.

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., “I” vs. “we”; level of explicitness).Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.

PurposeThe original 18-item, four-dimensional Trust in Oncologist Scale assesses cancer patients’ trust in their oncologist. The current aim was to develop and validate a short form version of the scale to enable more efficient assessment of cancer patients’ trust.MethodsExisting validation data of the full-length Trust in Oncologist Scale were used to create a short form of the Trust in Oncologist Scale. The resulting short form was validated in a new sample of cancer patients (n = 92). Socio-demographics, medical characteristics, trust in the oncologist, satisfaction with communication, trust in healthcare, willingness to recommend the oncologist to others and to contact the oncologist in case of questions were assessed. Internal consistency, reliability, convergent and structural validity were tested.ResultsThe five-item Trust in Oncologist Scale Short Form was created by selecting the statistically best performing item from each dimension of the original scale, to ensure content validity. Mean trust in the oncologist was high in the validation sample (response rate 86%, M = 4.30, SD = 0.98). Exploratory factor analyses supported one-dimensionality of the short form. Internal consistency was high, and temporal stability was moderate. Initial convergent validity was suggested by moderate correlations between trust scores with associated constructs.ConclusionsThe Trust in Oncologist Scale Short Form appears to efficiently, reliably and validly measures cancer patients’ trust in their oncologist. It may be used in research and as a quality indicator in clinical practice. More thorough validation of the scale is recommended to confirm this initial evidence of its validity.

Accepted manuscript version, licensed CC BY-NC-ND 4.0. Objective - To promote a more systematic approach to research on uncertainty in health care, and to explore promising starting points and future directions for this research. Methods - We examine three fundamental aspects of medical uncertainty that a systematic research program should ideally address: its nature, effects, and communication. We summarize key insights from past empirical research and explore existing conceptual models that can help guide future research. Results - A diverse body of past research on medical uncertainty has produced valuable empirical insights and conceptual models that provide useful starting points for future empirical and theoretical work. However, these insights need to be more fully developed and integrated to answer remaining questions about what uncertainty is, how it affects people, and how and why it should be communicated. Conclusion - Uncertainty in health care is an extremely important but incompletely understood phenomenon. Improving our understanding of the many important aspects of uncertainty in health care will require a more systematic program of research based upon shared, integrative conceptual models and active, collaborative engagement of the broader research community. Practice Implications - A more systematic approach to investigating uncertainty in health care can help elucidate how the clinical communication of uncertainty might be improved.

Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to consider previously conveyed information and patients’ relationship with the referring oncologist. We qualitatively investigated how advanced cancer patients and consulting oncologists discuss prognosis during audio-recorded SO consultations (N = 60), including prognostic information received from the referring oncologist. Our results show that patients regularly expressed implicit cues to discuss prognosis or posed explicit questions tentatively. Consulting oncologists were mostly unresponsive to patients’ cues and cautious to prognosticate. They also seemed cautious when patients brought up the referring oncologist. Consulting oncologists checked which prognostic information patients had received from the referring oncologist, before estimating prognosis. They agreed with the first opinion or rectified discrepancies carefully. Altogether, this study exposes missed opportunities for open prognostic discussions in SOs. Consulting oncologists could explicitly explore patients’ information preferences and perceptions of prognosis. If desired, they can provide tailored, independent information to optimise patients’ prognostic awareness and informed medical decision-making. They may additionally support patients in dealing with prognosis and the uncertainties associated with it.

ObjectivesIn health communication research using video vignettes, it is important to assess viewers’ engagement. Engagement scores can indicate ecological validity of the design, and help distinguish between different engagement types. Therefore, we aimed to develop and validate a scale assessing viewers’ engagement with video vignettes.MethodsBased on an existing question set, the 15-item, five-dimensional Video Engagement Scale (VES) was developed. The VES was validated in two video-vignettes studies to investigate patient-physician communication. In addition to engagement, we assessed its presumed correlates, e.g., perceived realism of the video and identification with the patient.ResultsInternal consistency and test–retest reliability were adequate in both studies (N = 181 and N = 228). Positive correlations between the VES and perceived realism of the video, credibility of and identification with the patient suggested good content validity. Confirmatory factor analysis suggested a four-dimensional model fit, largely resembling our hypothesized model.ConclusionsThe VES reliably and validly measures viewers’ engagement in health communication research using video vignettes. It can be employed to assess ecological validity of this design. Further testing of the scale is needed to more solidly establish its dimensionality.Practice ImplicationsWe recommend that researchers use the VES, to ensure ecological validity of future video-vignettes studies.

Objective Persons seeking cancer genetic counseling mainly aim to obtain information and certainty about their medical situation. However, the information that counselees receive often involves many uncertainties. To develop strategies to enable optimal communication about uncertainties, the spectrum of uncertainty expressed within cancer genetic counseling needs to be established. This study aimed to gain insight into the uncertainties verbally expressed by counselors and counselees. Methods Twenty-five consultations were audiotaped, transcribed and qualitatively analyzed. A coding scheme identifying all uncertainties was developed parallel to the coding of the transcripts. Results Several uncertainties were identified varying in their source (i.e. the cause of uncertainty) and the issues involved (i.e. the topic to which uncertainty pertained). The main sources of uncertainty were the unpredictability of the future and a lack of knowledge. Counselees also expressed uncertainty related to the amount and complexity of the information. Counselors expressed uncertainties mainly related to scientific issues, whereas counselees’ uncertainty mainly related to personal and practical issues. Conclusion A wide range of uncertainties was expressed by both groups. Counselors differ from counselees in the degree and types of uncertainty they express. Practice implications Counselors should address scientific uncertainties during genetic counseling to increase awareness and understanding in counselees.

Objective To examine the relationship between physicians’ death anxiety and medical communication and decision-making. It was hypothesized that physicians’ death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments. Methods PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians’ death anxiety and medical communication and decision-making. Results This review included five quantitative and two qualitative studies (N = 7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians’ death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians’ guilt or doubt after a patient’s death. Conclusions There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians. Practice implications Education focused on death and dying and physicians’ emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.

Background Video vignettes are used to test the effects of physicians’ communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants’ engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants’ engagement with a video vignette showing a bad news consultation. Methods Introduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient’s situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants’ electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction. Results The audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_{partial}^2 $$\end{document}ηpartial2= 0.05) and the consultation part of the vignette (p = 0.051, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_{partial}^2 $$\end{document}ηpartial2= 0.05), when compared to the written introduction. With respect to camera focus, results revealed that the variant focusing on the patient at emotional moments evoked a higher level of electrodermal activity (p = 0.003, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_{partial}^2 $$\end{document}ηpartial2= 0.06), when compared to the other two variants. Furthermore, an interaction effect was shown on self-reported emotional engagement (p = 0.045, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_{partial}^2 $$\end{document}ηpartial2= 0.04): the physician-only variant resulted in lower emotional engagement if the vignette was preceded by the audiovisual introduction. No effects were shown on the other dimensions of self-reported engagement. Conclusions Our findings imply that using an audiovisual introduction combined with alternating camera focus depicting patient’s emotions results in the highest levels of emotional engagement in analogue patients. This evidence can inform methodological decisions during the development of video vignettes, and thereby enhance the ecological validity of future video-vignettes studies.

Objective: Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation. Methods: An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trustconveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations. Results: Free recall, assessed 24-28 h after viewing, was higher (p = 0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p = 0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p = 0.037). No mediation effect nor an effect on electrodermal activity was found. Conclusion: These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response. Practice implications: The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation. (C) 2017 Elsevier B.V. All rights reserved

Purpose The aim of this study was to develop and validate the Trust in Oncologist Scale (TiOS), which aims to measure cancer patients' trust in their oncologist. Structure, reliability and validity were examined. Methods Construction of the TiOS was based on a multidimensional theoretical framework. Cancer patients were surveyed within a week after their consultation. Trust, satisfaction, trust in health care, self-reported health and background variables were assessed. Dimensionality, internal consistency, test–retest reliability and construct validity were investigated. Results Data of 423 patients were included (response rate = 65%). After item reduction, the TiOS included 18 items. Trust scores were high. Exploratory factor analysis suggested one-dimensionality. Confirmatory factor analysis nevertheless indicated a reasonable fit of our four-dimensional theoretical model, distinguishing competence, fidelity, honesty and caring. Internal consistency and test–retest reliabilities were high. Good construct validity was indicated by moderate correlations of trust (TiOS) with satisfaction, trust in health care, willingness to recommend and number of consultations with the oncologist. Exploratory analyses suggested significant correlations of trust with ethnicity and age. Conclusions The TiOS reliably and validly assesses cancer patients' trust in their oncologist. The questionnaire can be employed in both clinical practice and future research of cancer patients' trust.

Objective: Patient's trust in their physician is crucial for desirable treatment outcomes such as satisfaction and adherence. In oncology, trust is possibly even more essential, due to the life-threatening nature of cancer. A review was undertaken of the current knowledge of the conceptualization, assessment, correlates, and consequences of cancer patients' trust in their physician. Methods: The empirical literature published in peer-reviewed journals between October 1988 and October 2008 was searched, employing all combinations and variations of the following keywords: trust, physician-patient relations, and cancer. Results: The search identified 45 relevant papers, only 11 of which drew attention to the conceptualization of trust, and 5 of which focused on trust as the primary subject of interest. Trust in physicians was strong overall. Patients' trust appeared to be enhanced by the physician's perceived technical competence, honesty, and patient-centred behaviour. A trusting relationship between patient and physician resulted in facilitated communication and medical decision making, a decrease of patient fear, and better treatment adherence. Conclusions: A lack of focus on trust and the conceptualization thereof, strong methodological variations between studies and a possible publication bias lead us to conclude that cancer patients' trust in their physician deserves more systematic, theoretically based, research attention. Consequently, studies are needed aimed at gaining a thorough understanding of the nature and impact of cancer patients' trust in their physician, and how the interaction between physician and patient may contribute to such trust. Copyright (C) 2010 John Wiley & Sons, Ltd

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients’ trust. We were the first to experimentally examine (1) how the oncologist’s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients’ trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist’s amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = −.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (rs = .31, p

Item does not contain fulltext BACKGROUND: Cancer patients need to trust their oncologist to embark in the process of oncologic treatment. Yet, it is unclear how oncologist communication contributes to such trust. The aim of this study was to investigate the effect of three elements of oncologists' communication on cancer patients' trust: conferring competence, honesty, and caring. METHODS: Eight videotaped consultations, 'vignettes', were created, reflecting an encounter between an oncologist and a patient with colorectal cancer. All vignettes were identical, except for small variations in the oncologist's verbal communication. Cancer patients (n = 345) were randomly assigned to viewing two vignettes, asked to identify with the patient and afterwards to rate their trust in the observed oncologist. The effects of competence, honesty, and caring on trust were established with multilevel analysis. RESULTS: Oncologist's enhanced expression of competence (beta = 0.17, 95% CI 0.08, 0.27; P < 0.001), honesty (beta = 0.30, 95% CI 0.20, 0.40; P < 0.001), as well as caring (beta = 0.36, 95% CI 0.26, 0.46; P < 0.001) resulted in significantly increased trust. Communication of honesty and caring also increased patients' expectation of operation success and reported willingness to recommend the oncologist. CONCLUSION(S): As hypothesized, oncologists can influence their patients' trust by enhanced conveyance of their level of competence, honesty, and caring. Caring behavior has the strongest impact on trust. These findings can be translated directly into daily clinical practice as well as in communication skills training.

Objectives: To investigate how comparable outcomes of medical communication research are when using different patient accrual methods by comparing cancer patients organization members with outpatient clinic patients.Methods: In an experimental video-vignettes study, the impact of oncologist communication on trust was tested. Background characteristics (socio-demographics, trait anxiety, health locus of control and attachment style), reported trust, and the impact of communication on trust were compared between the two groups.Results: Cancer patient organization members (n = 196) were younger and higher educated than clinical patients (n = 148). Members felt more personal control over their health (p < .01) but were also more anxious (p < .05). They reported lower trust in general health care (p < .05), in their own oncologist (p < .001) and in the oncologist in the videos (p < .05). The impact of oncologist communication on trust was similar for both groups.Conclusions: Despite considerable differences in trust levels, both groups appear equally affected by oncologist communication. Thus, although including cancer patient organization members may impact the generalizability of some findings, using these participants to investigate communication appears justified.Practice implications: Cancer patient organization members may regard their oncologist more critically. Research including both members and patients recruited through hospital clinics could take group membership into account as a possible confounder. Nonetheless, communicating competence, honesty and caring may benefit the relation with these patients similarly as with other patients.

To examine the nature of the trust that Turkish and Arabic ethnic minority patients suffering from cancer have in their oncologist, and to explore how this trust is established.We interviewed 9 cancer patients with Turkish and Arabic backgrounds about the trust they have in their oncologist. Semi-structured qualitative interviews.We interviewed 9 cancer patients with Turkish and Arabic backgrounds about the trust they have in their oncologist.The trust that these patients have in their oncologist seemed to evolve gradually over time. According to the patients, three specific elements seemed to promote trust. Firstly, patients attached importance to a strongly proactive physician approach, even in the palliative phase when treatment was no longer indicated. A wait-and-see attitude was perceived by patients as a lack of willingness to help, and was detrimental to their trust. Secondly, patients indicated that they needed their oncologist to reassure them and avoided discussing depressing topics, so that they would not give up hope. Finally, the oncologist's non-verbal communication, particularly his or her facial expression, contributed to patients' trust.Among these Turkish and Arabic ethnic minority cancer patients, trust in the physician appeared not to be self-evident, and might to some extent need to be 'earned' by oncologists. Because of these patients' great need for a proactive attitude, it is desirable that oncologists clearly explain their motivation when choosing for a possibly less active approach. In order to preserve hope, it is important that oncologists discover exactly what their patients' information needs are. The results of this explorative, small-scale study may help physicians to optimise the trust that Turkish and Arabic ethnic minority patients have in them.

Objective We investigated whether the content of information provided by radiation oncologists and their information giving performance increase patients' trust in them. Methods Questionnaires were used to assess radiotherapy patients ( n =111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance. Results Patients mean trust score was 4.5 (sd=0.77). The more anxious patients were, the less they tended to fully trust their radiation oncologist ( p =0.03). Patients' age, gender, educational attainment and anxious disposition together explained 7%; radiation oncologists' information giving (content and performance) explained 3%, and patients' perception of radiation oncologists' information-giving explained an additional 4% of the variance in trust scores. Conclusion It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients. Practice implications It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation oncologists' information giving performance, our data suggest that they can particularly improve their assessments of patients' understanding.