Open Access Open Badges Study protocol

Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

Brittany C Kimball1, Katherine M James1, Kathleen J Yost2, Cara A Fernandez3, Ashok Kumbamu1, Aaron L Leppin1, Marguerite E Robinson1, Gail Geller456, Debra L Roter56, Susan M Larson6, Heinz-Josef Lenz7, Agustin A Garcia7, Clarence H Braddock8, Aminah Jatoi9, María Luisa Zúñiga de Nuncio10, Victor M Montori3, Barbara A Koenig11 and Jon C Tilburt1123*

Author Affiliations

1 Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA

2 Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

3 Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

4 Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA

5 Johns Hopkins School of Medicine, Baltimore, MD, USA

6 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

7 Department of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA

8 Division of General Internal Medicine, Stanford University, Stanford, CA, USA

9 Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA

10 Division of Global Public Health, University of California San Diego, La Jolla, CA, USA

11 Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA

12 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

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BMC Cancer 2013, 13:455  doi:10.1186/1471-2407-13-455

Published: 4 October 2013



The quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient’s position on the cancer care continuum. Yet, many of the routine needs of cancer patients after initial cancer treatment are often not addressed adequately. Our goal is to identify areas of strength and areas for improvement in cancer communication by investigating real-time cancer consultations in a cross section of patient-clinician interactions at diverse study sites.


In this paper we describe the rationale and approach for an ongoing observational study involving three institutions that will utilize quantitative and qualitative methods and employ a short-term longitudinal, prospective follow-up component to investigate decision-making, key topics, and clinician-patient-companion communication dynamics in clinical oncology.


Through a comprehensive, real-time approach, we hope to provide the fundamental groundwork from which to promote improved patient-centered communication in cancer care.

Cancer; Oncology; Physician-patient communication