Recommending Cessation of Treatment in an Oncology Clinic: Is it Bad News?

• In Event: 122 - Regular Session. Ethnomethodology

Abstract

This paper investigates the structure of oncological visits, while paying special attention to the manner in which treatment recommendations are made. We draw from 120 audio recorded conversations between oncologists, caregivers, and their patients. Of those 120 audio files, we transcribed 64 of them using conversation analysis conventions. Each patient has terminal lung cancer and is in the late stages of their illness. Our analysis shows that a “typical” oncological visit contains three different phases: symptom-talk, scan-talk, and treatment-talk. We argue that this phase structure is co-constructed and reinforced by both doctors and patients. When treatment stops working effectively oncologist have the difficult task of transmitting this information. Closer examination of these instances reveals that oncologists often turn to what we call an exhausted current treatment statement (ECTS). Clinicians use ECTSs not only to inform patients about their current treatment protocol and then to transition into a different phases of the conversation, but also to provide information about the patient’s prognosis. Our data show that ECTSs do not adequately inform patients about their illness, are inefficient transitional agents, and have the potential to obscure any prognosis given. Analysis suggests that ECTSs often fail to achieve their purpose because they follow incomplete scan-talk. However, we contend that ECTSs can be effectively used if they are instituted after a clear and extensive review of the patient’s scan results. These observations can help oncologist reevaluate the way they approach the different phases of the oncological visit and improve interactions with patients and caregivers.

Authors

• Dagoberto Cortez, University of Wisconsin-Madison

• Douglas W. Maynard, University of Wisconsin

• Toby Campbell, University of Wisconsin