Communication and cancer : the impact of locus of control on communication between the medical specialist and his patient

The aim of this thesis is to study (1) the impact of physicians' locus of control (LOC) on their communication styles in interviews with cancer patients as well as (1) the impact of physicians' LOC on their acquisition of effective communication skills in a communication skills training program. LOC is a generalised belief regarding the extent to which life outcomes are controlled by an individual's actions ("internal" LOC) or by external forces such as luck, fate or other individuals ("external" LOC). (1) Although is it widely recognised that physicians' characteristics could influence their communication styles and may thus interfere with a patient-centred communication, no empirical evidence is currently available. No studies are available on the impact of physicians' LOC on their communication skills. It was hypothesised that physicians with an "external" LOC have a different communication style than physicians with an "internal" LOC. Eighty-one voluntary physicians with a practice in oncology were recorded performing an actual and a simulated interview with a cancer patient as wall as an actual and a simulated interview with a cancer patient and a relative. Physicians' communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t-test. Results show that physicians with "external" LOC give more appropriate information than physicians with "internal" LOC in simulated interviews with a cancer patient (P=0.011) and less premature information than physicians with "internal" LOC in clinical interviews with a cancer patient (P=0.015).

Moreover, in actual interviews with a cancer patient and a relative, physicians with an "external" LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an "internal" LOC. In simulated interviews with a cancer patient and a relative, physicians with an "external" LOC used less utterances giving premature information (P=0.031) and used more utterances with a supportive function such as empathy and reassurance (P=0.029) than physicians with an "internal" LOC. (2) Although it is widely recognised that educational interventions may be more effective for people with an "internal" LOC compared to people with an "external" LOC, no study has yet assessed the influence of physicians' LOC on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an "internal" LOC would demonstrate communication skills acquisition to a greater degree than those with an "external" LOC. A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated to a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance. In the two-person and three-person interviews, the increase in open directive questions was more important among physicians with an "internal" LOC compared to physicians with an "external" LOC (P=0.066 and P=0.004 respectively). In the three-person interview, the increase in directive questions (P=0.001), in assessing functions (P=0.002) and in the use of moderate feelings stated explicitly (P=0.011) was more important among physicians with an "internal" LOC compared to physicians with an "external" LOC. Conclusion. These results provide evidence that physicians' LOC can influence their communication styles as well as the efficacy of a communication skills training program. Physicians' awareness of first results constitutes a step towards a tailoring of their communication skills to every patient's and relative's concerns and needs and thus towards a patient-centred communication. The second results support the idea that a psychological characteristic such as "internal" LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.