Unpacking argumentation in oncological settings: a study of doctor-patient communication practices

Several studies have underscored the significance of physicians substantiating treatment recommendations with evidence through argumentation, particularly in the context of communication practices aligned with concepts like shared decision-making (SDM) and patient-centered communication (PCC). Drawing on a corpus of 42 video recorded oncological visits, this chapter analyzes the argumentative practices used by oncologists during the process of treatment recommendation. We examine qualitative differences in argumentative practices between two types of encounters: first-time and follow-up visits. Our analysis shows that oncologists adapt their argumentative approaches based on the nature of the visit, showing more complexity in first-time encounters. In these initial visits, argumentation is crucial in balancing the provision of information and managing potential patient resistance to demanding treatments. Follow-up visits, on the other hand, involve simpler decision-making processes, characterized by shorter and less informative argumentative sequences but increased patient involvement. Overall, these observed practices indicate a departure from the ideals of PCC and SDM, corroborating previous findings that patients' consent is often minimally sought. Further research could delve into the alignment between traditional patient-centered communication and institutional practices in oncological contexts.