The clinical context and patient participation in post-diagnostic consultations.

OBJECTIVE: Although patient participation is an important feature of patient-centered health care, few studies have examined how the clinical context affects patient involvement in medical encounters. This investigation examined the way patients communicate with physicians in two diverse post-diagnostic settings, post-angiogram consultations and initial lung cancer visits.

METHODS: From transcripts and audiorecordings of post-angiogram consultations (n=88) and initial lung cancer visits (n=62) within a VA hospital in the United States, three measures of patient participation were coded--number of active participation behaviors (questions, acts of assertiveness, and expressions of concern), proportion of patients' utterances in the form of active participation, and conversational involvement (ratio of patient utterances to physician plus patient utterances). Mixed linear regression procedures assessed the independent effects of the clinical setting, physicians' facilitative communication (partnership-building and supportive talk), and patients' age, education, and ethnicity on patient participation.

RESULTS: Not only was their less talk in the post-angiogram consultations compared with the lung cancer visits, heart patients also were less conversationally involved (accounted for 25% of the talk) than were lung cancer patients (45% of the talk) and their doctors used proportionally less facilitative talk than did the lung cancer physicians. In both settings, patients were more conversationally engaged when proportionally more of the physicians' talk was facilitative.

CONCLUSIONS: The clinical context has a profound effect on patient participation. However, within individual settings, physicians can increase patient involvement by using partnering and supportive communication.

PRACTICE IMPLICATIONS: Clinicians and administrators should assess clinical practices that restrict patient involvement in ways that could affect quality of decision-making.