A Qualitative Examination of Companion Communication during Cancer Consultations for African American Male Patients

Background: More than a third of all adult medical visits in the U.S. are accompanied by spouses, adult children, and other companions. Women, and patients who are less educated in addition to those with more seriously compromised health are generally more likely to bring a companion and those companions are overwhelmingly women. Companions often aid in information recall, facilitate information exchange, advocate for patient needs, and motivate patients to adhere to treatment recommendations during medical visits. However, most research on patient-provider-companion interactions has neglected to capture the experiences of African American patients and their supportive care needs and resources. African American patients with cancer are at a distinct informational disadvantage because they often ask fewer questions and are less likely to have a companion present to support them in the communication exchange with their health care team. The purpose of this study was to characterize a companion’s communicative behavior and the influence of that behavior on doctor-patient communication during oncology consultations for African American male patients.

Methods: This study constitutes a secondary qualitative analysis of the doctor, patient, and companion verbal communication that occurred during oncology-related medical visits for 14 African American men served by Karmanos Cancer Institute in Detroit, Michigan between 2002 and 2006. As a part of a larger completed study on doctor-patient communication, African American patients and their companions and physicians were recruited and consented to be video-recorded during initial oncology consultations following a cancer diagnosis. Both the primary and secondary study was IRB approved. Audio content from each visit was transcribed, de-identified, and analyzed using DeDoose, a web application for managing, analyzing, and presenting qualitative and mixed method research data. Three researchers collaborated on content analysis to identify the frequency, content and context of codes corresponding to distinct companion communicative behaviors most prevalent during interactions. Patterns and categories were compared within and across transcripts. Team members reached consensus on final codes, themes, and participant quotes representative of each theme.

Findings: African American male patients with companions were 60.14 years old on average. Types of companions included spouses, adult children and non-relative caregivers, all but one were women. A total of 782 companion behaviors were coded across 14 medical interactions; 35.7% were comprised of companions answering a doctor’s questions (whether directed at them or not). Overall, companions were integral to the communicative context between African American men and their physicians. Their participatory behaviors consisted mainly of supplementing patient’s recall abilities, assisting patients in communicating concerns, and asking pointed questions to clarify physician directives. Spousal companions were particularly active, whereby patients in those encounters seemed to defer to the spouse on questioning and negotiating treatment recommendations.

Implications:  African American men with cancer are half as likely as White men to bring companions to medical visits, missing out on emotional and informational support that could facilitate improved outcomes. Social workers on integrated health care teams are positioned to identify and assess their needs, connect them with health-system or community support networks, and engage available companions with the care process.