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Race influences participation of companions in cancer consultations

Racial disparities in cancer care may be influenced by how the patient or their companion communicates with the doctor, according to a study of newly diagnosed lung cancer patients. The new study recorded and analyzed conversations between clinicians from a medical center's oncology or thoracic surgery clinics and newly diagnosed patients and (if accompanied) the patients' companions.

The researchers found that the companions of black patients were less active participants in the conversation than were the companions of white patients. Earlier work at the same medical center found that black patients were less active participants in talking with their clinicians than were white patients. Companions can play an important role in meetings between newly diagnosed patients and clinicians, the researchers noted.

Whether family or friends, companions can help patients provide important parts of their medical history, as well as reinforce, confirm, and strengthen patients' statements. In the study of 48 unaccompanied patients, 84 accompanied patients, and 84 companions, overall participation by accompanied patients and their companions was comparable to that for unaccompanied patients. However, almost half of the 84 pairs had an actively participating patient and a relatively passive companion, while a third had a passive patient and an actively participating companion. Nearly one-fifth of the pairs acted more like equal partners. Companions were more likely to be active participants when the physician's communication emphasized partnership building and supportive talk, and when there was a confirmed diagnosis of lung cancer before the visit.

Patients were less satisfied with the consultation when they and their companion participated equally than when either one was more active in talking with the physician. It may be that the roles have been decided in advance when the patient or companion does most of the talking in the interaction with the physician. When participation is comparable, there may be a struggle between the patient and companion over their respective roles and control of the communication.

Based on their findings, the researchers recommended developing interventions for the physician and the patient/companion pair to make it more likely that each participant in a cancer consultation can be as actively involved as they wish. The study was funded in part by the Agency for Healthcare Research and Quality (HS10876).

More details are in "Companion participation in cancer consultations," by Richard L. Street and Howard S. Gordon in Psycho-Oncology 17, pp. 244-251, 2008.

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