Turn analysis and patient-centredness in paediatric otolaryngology surgical consultations

Objectives: Physician and patient/parent communication is of utmost importance in consultations to improve the shared decision-making (SDM) processes. This study investigated SDM-related outcomes through turn analysis and an assessment of patient-centred dialogue. Design: Multi-centre prospective cohort study analysing audio- and video-recorded patient/parent-physician interactions. Setting: Two tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah. Participants: Paediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy. Main outcome measures: Medical dialogue measures (turn analysis, patient-centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM-Q-9). Results: Turn density was significantly higher for physicians than patients/parents (P <.001), as were total statements (P <.001), and total time talking (P <.001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P =.003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient-centredness score was 0.2 (range 0-0.56). Significant negative correlations between patient-centredness score and physician turn density (r = −.390, P =.002), physician mean turn time (r = −.406, P =.001), total physician statements (r = −.426, P =.001) and total physician speaking time (r = −.313, P =.016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient-centredness scores. Conclusions: Surgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient-centredness nor turn analysis correlated with perceptions of SDM from the parents' perspective.