Accommodating Communication and Cancer Patients
Abby Combs
Arizona State University
COM 207: Introduction to Communication Inquiry
Dr. Ferderer
December 1, 2023
Accommodating Communication and Cancer Patients
Often, physicians are the first people to tell patients their life- altering diagnosis: cancer. From this moment on, a unique relationship is built between physicians and patients that is rooted in a patient’s need for guidance, medical expertise, comfort and support (Ahmed & Bates, 2016; Baxter et al., 2021). The purpose of this literature review is to examine research on physician and patient communication to support the argument that studies on cancer patients and accommodating communication still need to be studied. It begins with an overview of communication accommodation theory (CAT) and how it applies to physician/patient communication. The essay then explains the general overview of research on physician accommodation in clinical settings, then slowly narrows the research to specifically accommodating cancer patients. The literature review concludes by determining the need for a study to be done that is framed by CAT, on the usefulness of communication accommodation from physicians to cancer patients.
Communication Accommodation Theory
Communication between physicians and patients is commonly studied under the framework of Communication Accommodation Theory (CAT). The theory seeks to explain whether or not people choose to adjust their communication to accommodate someone (Griffin et al., 2023). Convergence is the coined term within CAT to describe accommodating behaviors in which someone adapts their communication to be closer to someone. In the context of physician/ patient relationships, convergence could be a doctor attempting to relate to a patient or reassure them when they are anxious. Theorists believe that convergence is a behavior implemented to gain social approval (Griffin et al., 2023). On the opposite side, divergence is used within the theory to explain when a person accentuates the differences between them and another person. Divergence in a clinical context could be a physician purposefully emphasizing their education and knowledge to highlight the differences between them and their patient. Divergence is described by CAT theorists as the need for someone to create distinctiveness for their own social identity purposes (Griffin et al., 2023). This theory is important to understand to explain the interactions between doctors and patients. If CAT can identify the use of convergent and divergent behavior from physicians, then surely communication improvements can be made through CAT guided studies. In the following synthesis of literature, studies guided by CAT will be examined to determine the usefulness of the theory when examining physician and patient communication.
Patient Accommodation
The purpose of this literature review is to examine the usefulness of CAT in physician and patient relationships. The following synthesis of literature will link together how convergence and divergence are both useful behaviors used by providers to improve patient satisfaction (Ahmed & Bates, 2016; Baker et al., 2021). Then, the literature review will delve deeper into specific accommodating language and behaviors that help patients better understand their treatment plan as well as improve their willingness to follow through with the plan (Liao et al., 2023). The synthesis will conclude with studies on cancer patients and how accommodating behaviors like empathy, reassurance and adjustment of language need to be applied in future cancer patient studies to improve patient satisfaction and care.
Accommodating Emotional Needs
Given the high amount of uncertainty that follows a cancer diagnosis, it’s no surprise that patients go to their providers looking for answers. While it’s evident that a patient’s priority is to receive medical care from their physician, there is also an expectation for emotional needs to be met (Baker et al., 2021). When a doctor intentionally meets a patients’ emotional needs, they are practicing convergence, an accommodating behavior. Ahmed and Bates (2016) found that “patients strongly prefer doctors who converge by reassuring the patient and reducing the patient’s anxiety” (p. 28). It’s evident that patients not only want to feel reassured by their provider, but it’s also proven by multiple studies that patients are more satisfied when their provider attempts to relate to them (Ahmed & Bates, 2016; Baker et al., 2021; Liao et al., 2023).
The research of patients preferring relatability doesn’t imply that patients want or expect doctors to be their close friend. It is collectively found that although patients enjoy it when doctors relate to them, they also want a certain level of social separation (Ahmed & Bates, 2016; Baker et al., 2021). This is because patients reported better satisfaction when they felt their doctor was a “medical expert” and led the clinical conversation with dominance (Ahmed & Bates, 2016; Baxter et al., 2021). This tension of wanting both divergence and convergence from a provider does not go unnoticed by researchers and is recognized as a complex relationship to understand. Ahmed and Bates (2016) emphasize the need for providers to look at their patients on an individual basis, and to accommodate each patient as needed. At the core of patient and provider communication is the ability for both parties to understand each other, which will be supported in the following section.
Accommodation and Patient Understanding
While it is important for patients to feel satisfied with their provider’s ability to meet their emotional needs, a patient’s ability to comprehend health information given to them is arguably more important. Unfortunately, it’s common for patients to not understand their doctors use of medical jargon as well as the speed in which the provider delivers medical information (Liao et al., 2023). This is a problem because a patient’s ability to understand their treatment plan and medical diagnosis leads to more informed medical decision making which leads to better medical care (Liao et al., 2023). Not accommodating a patient is not always intentional on the provider’s behalf; instead, many doctors believe they are speaking in simple language, but the patient does not perceive it the same way (Ahmed & Bates, 2016; Baker et al., 2021). This is a reason why providers knowledge of behavioral adjustments like convergence are important to learn to implement into their practice for better patient care.
The link between the use of accommodating communication by physicians to improve patient satisfaction is shown in multiple studies (Ahmed & Bates, 2016; Baker et al., 2021). Unlike the others, Liao et al. (2023) makes the additional connection that when a patient understands their providers, they are more likely to follow through with their treatment plan and listen to medical advice. This is an important discovery because it links the importance of accommodating communication from providers to actual patient behavior and medical decisions.
Cancer Patients
So far, this literature review has been focused on general physician and patient communication with the application of accommodating communication. The next section of this literature review will focus on applying the studies above into the more specific topic of physicians accommodating cancer patients. Specific studies on cancer patients and accommodating communication have yet to be made, which is why this review will end with an argument for future research to be done.
Cancer is a diverse, life- altering diagnosis that affects millions of people every year (Johnson Shen et al., 2019). A critical part of navigating a cancer diagnosis is the relationship between the patient and doctor. Many cancer patients go through cycles of anxiety and depression that need to be addressed by their physician (Bauer et al., 2013; Johnson Shen et al., 2019). Generally, patients expect emotional support from their physicians and are more satisfied when they feel their doctor cares about them as an individual (Ahmed & Bates, 2016). The same could be applied to cancer patients during treatment, and it’s possible that more emotional support is required for those with cancer.
Johnson Shen et al. (2019) studied cancer patients and provider conversations, which found that providers missed most of the opportunities to show understanding towards their patients. They found in most cases providers were more likely to engage in empathic behaviors when a patient was hopeful about their diagnosis, while on the other hand they avoided difficult topics like palliative care and end-of-life decisions (Johnson Shen et al., 2019). This is supported further by the evidence found in Bauer et al. (2013) study that found that even though providers are known to be a guide in the grueling cancer treatment process, cancer patients reported the absence of conversations about end-of-life decisions with their doctors. The lack of conversation surrounding negative topics could be related to a lack of accommodating communication or divergence. The ability of a physician to adjust their communication for their patient to better understand them is imperative. Not only could this be correlated with better willingness to follow a treatment plan, but also a way to decrease uncertainty and upset (Liao et al.,2023; Johnson Shen et al., 2019).
Conclusion
This literature review has laid out the evidence explaining the importance of accommodating communication in a clinical setting between a physician and patient. The research shows that when providers use accommodating behavior to adjust their communication like reassurance, plain language, warmth and empathy, patients are better satisfied (Ahmed & Bates, 2016; Baker et al., 2021; Liao et al., 2023). Not only does the research show improved satisfaction, but studies show the promising effects of accommodating communication to create a higher willingness to follow through with treatment plans (Liao et al., 2023).
So far, accommodative communication has only been studied in a general patient population with no specific diagnosis. This means the data is lacking on how cancer patients specifically could benefit from accommodating communication framed through CAT. The possibility that there is data yet to be discovered on how to improve cancer patients’ health care is exciting. CAT can help frame future studies to better understand the communication between physicians and cancer patients. Accommodating cancer patients with better communication from physicians could potentially lead to better outcomes of care and improve an individual’s life greatly.
References
Ahmed, R., & Bates, B. R. (2016). To accommodate, or not to accommodate: Exploring patient satisfaction with doctors’ accommodative behavior during the clinical encounter. Journal of Communication in Healthcare, 9(1), 22-32. https://doi.org/10.1080/17538068.2015.1126936
Baker, S. C., Watson, B. M., Jamieson, B., Jamieson, R. (2021). How do patients define satisfaction? The role of patient perceptions of their participation and health provider emotional expression. Health Communication, 36(14), 1970-1979. https://doi.org/10.1080/10410236.2020.1808409
Bauer-Wu, S., Yeager, K., Norris, R. L, Quin Liu, Habin, K. R., Hayes, C., & Jurchak, M. (2013). Communication and planning at the end-of-life: A survey of women with advanced stage breast cancer. Journal of Communication in Healthcare, 2(4), 371-386. https://doi.org/10.1179/cih.2009.2.4.371
Griffin, E., Ledbetter, A., & Sparks, G. (2023). Communication accommodation theory. In A First Look at Communication Theory (11th ed., pp. 328–338). McGraw Hill.
Johnson Shen, M., Ostroff, J. S., Hamann, H. A., Haque, N., Banerjee, S. C., McFarland, D. C., Molena, D., & Bylund, C. L. (2019). Structured analysis of empathic opportunities and physician responses during lung cancer patient-physician consultations. Journal of Health Communication, 24(9), 711-718. https://doi.org/10.1080/10810730.2019.1665757
Liao, D., Yan, J., Wilson, S. R. (2023). How does physician (non)accommodation affect patient behavioral intention? Using a web-based experiment to examine indirect effects of language type on behavioral intention through goal inferences and source appraisals. Journal of Health Communication, 28(9), 585-594. https://doi.org/10.1080/10810730.2023.2237435