Socio-economic Differences in Banter Between Cancer Patients and the Surgeon

Objectives: Head and neck cancer (HNC) patients with low socio-economic status (SES) backgrounds have been found to have shorter consultation appointments than higher SES groups and are quicker to express their concerns to the surgeon. Wider literature also shows that low SES patients ask fewer questions and are slow to express opinions or emotions during appointments.

Objectives: to explore SES differences in relational aspects of communication between head and neck cancer patients and the surgeon during follow-up consultations.
Methods: Interpersonal communication includes both verbal and non-verbal communication, so understanding SES differences in interaction involves studying both the language used during consultations and observation of non-verbal aspects. 36 head and neck cancer 12-24 month post-operation review appointments with 5 Consultants were observed and audio-taped, with 32 of these patients giving follow-up interviews. Data were analysed using Thematic Analysis and compared by patient SES (education, occupation, and Indices of Multiple Deprivation).
Results: 67% (24) of participants were men and 36% lived in the 10% most deprived area of the country. We found that the relational portion (non-task-based) portion of appointments was lower among low SES patients. The tone of appointments was also different – there were significantly more conversational jokes in appointments with higher status occupations: (median jokes per consultation =3, interquartile range 5), than for lower status occupations (median jokes = 2, IQR, 3.25). Higher SES patients were observed to make sarcastic remarks directed at the doctor during their banter and had a more personal and intimate tone than for low SES patients where appointments were more medically focused.
Conclusions: SES differences in superficial layers of communication exchanges between HNC patients and the doctor generate differences in the trajectory of self-disclosure and this may underpin differences in the extent patients’ intentionally reveal personal feelings thoughts and experiences.