Treatment Recommendations in Oncology Visits: Implications for Patient Agency and Physician Authority

ABSTRACT

Although oncology is a major site for clinician‒patient treatment negotiation requiring a careful balance of potentially competing viewpoints, little is known about how clinicians promote their treatment recommendations to patients and what the manner of promotion tells us about the oncologist‒patient relationship. Utilizing an already-established schema of coding treatment recommendations, I draw on 61 treatment recommendations to examine treatment decision-making in oncology. This paper investigates how physicians balance asserting their authority while at the same time attending to patient agency and involvement in decision-making. Taking this one step further, this paper explores how physicians negotiate decision-making with patients given that they occupy a liminal state between obligations to policy imperatives and commitments to their professional knowledge and technical expertise. How do they do this, and what accounts for this? To answer these questions, this paper analyzes the ways in which physicians present treatment recommendations and the treatment contexts in which they are made.

Acknowledgments

I thank Tanya Stivers, John Heritage, Stefan Timmermans, Patricia Ganz, and the UCLA Conversation Analysis Working Group for feedback on earlier versions of this paper.

Additional information

Funding

This article was supported by the National Research Service Award under grant award 5TL1TR002388 (PI: David Meltzer, MD, PhD). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCATS/NIH.