Das Aufklärungsgespräch vor Strahlentherapie - eine qualitative und quantitative Analyse der Arzt-Patienten-Interaktion mit Hilfe des Roter Interaction Analysis System (RIAS)

The goal of this study is the analysis of the physician-patient relationship in patient briefings before radiotherapy. All data of this cohort study was collected from tape-recorded patient briefings of cancer patients treated in the department for radiotherapy of the university hospital Marburg. Data ascertainment was performed by wiretapping and coding of tape recordings using the modified Roter Interaction Analysis System (RIAS). In this manner we performed a qualitative analysis with an estimation of the total sentiment on the one hand and a quantitative analysis with an evaluation of the coding frequency of individual variables on the other hand. Furthermore, the RIAS allowed the documentation of external circumstances. In compliance with inclusion criteria we selected 57 of a total of 63 tape recordings for this study. The patient briefings were conducted by three specialists for radiotherapy. The patient groups assigned to the physicians were homogeneous concerning demographic characteristics such as age, sex and marital status on the one hand and clinic aspects like diagnosis and therapy on the other hand. The examination of the physician-patient relationship using the RIAS showed a significant difference in the conversation patterns not only between the physicians but also between the respective patient groups. Thus the differences were evident both for the quantitative and the qualitative analysis. Even though the objectives of the patient briefings – the preparation for radiotherapy – were very similar and the patient groups were structured homogeneously we observed a statistically significant difference regarding the topics of the briefings. A possible conclusion is that a patient briefing cannot be standardized and is highly dependent on the physician’s individual characteristics. Topics of physician-patient conversation like agreement, rising of emotional issues and positive characterization of a third person resulted in an increased frequency of verbal comments by the patient. Avoiding of paternalisms by the physician concerning general attitudes and every day life also leads to an increased verbal participation by the patient. In contrast we observed uncertainty and a resulting decrease in verbal participation by the patient when briefings were dominated by scientific topics like diagnostic results, therapies, drugs, adverse effects and schedules. Similar effects were evident when decision processes and responsibilities were assigned to the patient. Furthermore, we observed a reciprocal interaction between physician and patient. Emotional topics like uncertainties and fears mentioned by the patient were answered by emphatic statements and as well by scientific particulars. Conversation topics raised by one conversational partner were disproportionally often answered within the corresponding codifications. The results of this study showed a gender-dependent conversation behavior. Women often asked questions concerning fears, uncertainties, adverse effects, medical details and workflows, while male patients tried to place the responsibility for therapeutic decisions and workflows on the physician. Not unexpectedly, patients were inadequately included in decisions concerning their individual therapy. Thus, we found out that about 88% of patients were not asked for their opinion about the therapy and in 46% of the interviews there was no deal with therapeutic alternatives. Furthermore, most patients showed explicit indications for mental overloading when requested for therapeutic decisions. Recapitulatory, an adequate and extensive education of physicians, medical students and medical staff is crucial for an appropriate communication and consequently for a responsible cooperation of patients as considerable contribution to the therapeutic outcome.