Imperial College London

Ged M Murtagh M.Phil, PhD

Faculty of MedicineDepartment of Surgery & Cancer

Senior Lecturer in Clinical Communication
 
 
 
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Contact

 

+44 (0)20 3312 7761g.murtagh Website

 
 
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Location

 

Paterson WingSt Mary's Campus

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Summary

 

Publications

Publication Type
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65 results found

Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh Get al., 2023, Physiotherapists' perceptions on using a multidimensional clinical reasoning form during psychologically informed training for low back pain, Musculoskeletal Science and Practice, Vol: 66, Pages: 1-7, ISSN: 2468-7812

PURPOSE: Building clinical reasoning skills is important to effectively implement psychologically informed practice. We developed a multidimensional clinical reasoning form (CRF) to be used by physiotherapists in a psychologically informed practice training programme for low back pain. In this paper we describe the development of the CRF, how the CRF was used in the training, and present an evaluation of physiotherapists' perceptions of the CRF. METHODS: Qualitative semi-structured interviews were conducted with ten physiotherapists purposively sampled in primary care. Data were gathered through pre, and post training focus group interviews and a secondary analysis of individual physiotherapist interviews conducted after the training. Thematic analysis was used to analyse the data and capture the emergent themes. RESULTS: Two main themes emerged before the training: (1) the CRF 'needs formal training' and (2) 'lacked instruction'. Three main themes emerged after the training (1) it provided 'a helpful framework for multidimensional clinical reasoning' (2) the CRF, and accompanying operational definitions, helped physiotherapists 'elicit information, with 'question prompts' helpful in facilitating patient disclosure (3) 'Utility' - although the CRF was not formally used by the physiotherapists it provided a conceptual reasoning framework to work from with more challenging patients. CONCLUSION: The CRF was not designed to be used in isolation by clinicians without training. However, when used as a training adjunct it appears to be valued by physiotherapists to help develop their critical thinking and better characterise patients' presentations in order to personalise care from a bio-psychosocial perspective.

Journal article

Soukup T, Lamb BW, Green JSA, Sevdalis N, Murtagh Get al., 2023, Analysis of communication styles underpinning clinical decision-making in cancer multidisciplinary team meetings, Frontiers in Psychology, Vol: 14, Pages: 1-13, ISSN: 1664-1078

INTRODUCTION: In cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying to maximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: "Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70?". This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings. MATERIALS AND METHODS: This was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some principles of conversation analysis (qualitative). RESULTS: We found that, across teams, surgeons were the most frequent initiators and responders of interactional sequences, speaking on average 47% of the time during case discussions. Cancer nurse specialists and coordinators were the least frequent initiators, with the former speaking 4% of the time and the latter speaking 1% of the time. We also found that the meetings had high levels of interactivity, with an initiator-responder ratio of 1:1.63, meaning that for every sequence of interactions initiated, the initiator received more than a single response. Lastly, we found that verbal dysfluencies (laughter, interruptions, and incomplete sentences) were more common in the second half of meetings, where a 45% increase in their frequency was observed. DISCUSSION: Our findings highlight the importance of teamwork in planning MDT meetings, particularly with regard to Cancer Research UK in 2017 cognitive load/fatigue and decision-

Journal article

Murtagh GM, 2023, A critical look at ideas, concerns and expectations in clinical communication, Medical Education, Vol: 57, Pages: 331-336, ISSN: 0308-0110

CONTEXT: For medical students and doctors, capturing the patient's perspective is critical if the consultation is to be meaningful for both parties. Medical students are taught the import of this in their communication skills training aided by inquiring into the patient's ideas, concerns, and expectations (ICE) during the consultation. Ensuring the effectiveness of those inquiries can be a challenge for different reasons. Yet apart from a handful of papers on the subject, there is little guidance on the efficacy of ICE as a communication technique and specifically how to successfully blend questions about ICE within the interaction between doctor and patient. PROPOSAL: This paper takes a closer look at this communication technique and explores some of the interactional features of inquiries into ICE. First, the background to ICE and its emergence within the field of medical education is considered. Next the argument considers some of the contextual and pedagogical issues which ICE gives rise to. The discussion then goes on to explore some conceptual underpinnings drawing on findings from Conversation Analysis which provide some direction in approaching questions about what the patient thinks. Finally, the implications of the argument presented are considered in relation to the teaching and assessment of medical students with a short proposal for next steps. CONCLUSION: Capturing the patient's perspective through an exploration of their ideas, concerns and expectations remains a valuable approach in communication skills training in medical education. It is important, however, that inquiries into ICE are used carefully and responsively if it is to be used to improve communication with patients.

Journal article

Soukup T, Lamb BW, Bali A, Gandamihardja T, Darzi A, Green JSA, Sevdalis N, Murtagh GMet al., 2022, Sometimes we discuss up to seventy patients…Would you want to be number seventy?” Communication and decision-making in cancer multidisciplinary team meetings, Forthcoming in Frontiers in Psychology

Journal article

Cowell I, McGregeor AH, O Sullivan P, O Sullivan K, Poyton R, Schoeb V, Murtagh Get al., 2022, A detailed analysis of how physiotherapists ‘give’ reassurance for patients’ concerns in back pain consultations, Submitted and under review in PLOS One

Journal article

Murtagh GM, Kong W, Kaneria A, Rahman Set al., 2022, Forum Theatre:An effective method of combined communication and ethics teaching in UG clinical medical students, Transform MedEd 2022

Conference paper

Murtagh G, 2022, Capturing the patient’s perspective, Submitted and under review in Medical Education

Journal article

Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Schoeb V, Murtagh Get al., 2021, Physiotherapists' approaches to patients' concerns in back pain consultations following a psychologically informed training program, Qualitative Health Research, Vol: 13, Pages: 1-16, ISSN: 1049-7323

Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient-focused style of communication where trained physiotherapists demonstrated a collaborative and responsive style of verbal and nonverbal communication to solicit, explore, and validate patients’ concerns.

Journal article

Belsi A, Eves S, Frame K, Murtagh Get al., 2021, Lessons Learnt and Implemented from the first online Simulated Patient Sessions in Clinical Communication at Imperial College London, International Conference for Communication in Healthcare 2021

Conference paper

Belsi A, Susannah E, Murtagh G, Frame Ket al., 2021, First Year students' experiences from online teaching of clinical communication skills at Imperial College London School of Medicine, International Conference on Communication in Healthcare 2021

Conference paper

Soukup T, Murtagh GM, Lamb BW, Bali A, Gandamihardja T, Darzi A, Green JSA, Sevdalis Net al., 2021, Gaps and overlaps in cancer multidisciplinary team communication: analysis of speech, Small Group Research, Vol: 52, Pages: 189-219, ISSN: 1046-4964

Guided by the principles of conversation analysis, we examined the communication practices used to negotiate levels of participation in cancer multidisciplinary team meetings and their implications for patient safety. Three cancer teams participated. Thirty-six weekly meetings were video recorded, encompassing 822 case reviews. A cross-section was transcribed using Jefferson notation. We found a low frequency of gaps between speakers (3%), high frequency of overlaps (24%), and no-gaps-no-overlaps (73%), suggesting fast turn transitions. Securing a turn to speak is challenging due to a systematic reduction in turn-taking opportunities. We contribute to group research with the development of a microlevel methodology for studying multidisciplinary teams.

Journal article

Murtagh GM, Bezemer J, 2021, ‘Hm no-one says anything, did you notice?’Communication in the operating theatre amidst a hierarchy of expertise, Communication and Medicine, ISSN: 1612-1783

Journal article

Soukup T, Murtagh G, Lamb BW, Green JSA, Sevdalis Net al., 2021, Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: conversation analysis, Journal of Multidisciplinary Healthcare, Vol: 14, Pages: 411-424, ISSN: 1178-2390

Purpose: Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK’s Department of Health, UK’s National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales.Patients and Methods: This is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the ‘Orientation-Discussion-Decision-Implementation’ framework, and the cancer guidelines.Results: Eight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team.Conclusion: We found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guideli

Journal article

Morley I, Gabuniya N, Kum F, Murtagh G, Oakley Ret al., 2019, Smoking Cessation Intervention for Head and Neck Patients: a Comparison in Practice between ENT Consultants and Trainees, European Journal of Surgical Oncology, Vol: 45, Pages: 2205-2205, ISSN: 0748-7983

Journal article

Mohiaddin H, Malik A, Murtagh G, 2019, Maximising the acquisition of core communication skills at the start of medical training, Advances in Medical Education and Practice, Vol: 10, Pages: 727-735, ISSN: 1179-7258

BackgroundClinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. AimTo explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students.MethodsAs part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. ResultsQuantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. ConclusionReal patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundat

Journal article

Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh GMet al., 2019, How do physiotherapists solicit and explore patients' concerns in back pain consultations: a conversation analytic approach, Physiotherapy Theory and Practice, Vol: 37, Pages: 693-709, ISSN: 1532-5040

Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient’s perspective as part of the treatment process. ‘Agenda setting’ has been introduced as the key to understanding patients’ concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients’ with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analysed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients’ concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.

Journal article

Mohiaddin H, Malik A, Murtagh GM, 2019, <p>Maximizing the acquisition of core communication skills at the start of medical training</p>, Advances in Medical Education and Practice, Vol: Volume 10, Pages: 727-735

Journal article

Cowell I, O'Sullivan P, O'Sullivan K, Poyton R, McGregor A, Murtagh Get al., 2019, The Perspectives of physiotherapists on managing non-specific low back pain following a training programme in Cognitive Functional Therapy: a qualitative study, Musculoskeletal Care, Vol: 17, Pages: 79-90, ISSN: 1478-2189

Background: It has long been acknowledged that nonspecific chronic low back pain (NSCLBP) is associated with a complex combination of biopsychosocial (BPS) factors, and recent guidelines advocate that the management of back pain should reflect this multidimensional complexity. Cognitive functional therapy (CFT) is a behaviourally oriented intervention that targets patients' individual BPS profiles. Although the efficacy of CFT has been demonstrated in primary care, little evidence exists about the training requirements of this approach.Methods: Qualitative semistructured interviews were conducted with 10 physiotherapists working in primary care, who had undergone a formal training programme in CFT. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.Results: Five main themes emerged: (i) the learning challenge; (ii) self‐reported changes in confidence; (iii) self‐reported changes in communication practice; (iv) self‐reported changes in attitudes and understanding; (v) the physiotherapists felt that CFT was more effective than their usual approach for NSCLBP but identified barriers to successful implementation, which included a lack of time and difficulties in engaging patients with strong biomedical beliefs.Conclusions: The study suggested that training in CFT has the capacity to produce self‐reported changes in physiotherapists' attitudes, confidence and practice. The provision of such training has implications in terms of time and costs; however, this this may be warranted, given the physiotherapists' strong allegiance to the approach compared with their usual practice.

Journal article

Cowell I, O'Sullivan P, O'Sullivan K, Poyton R, McGregor A, Murtagh Get al., 2018, Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study, Musculoskeletal Science and Practice, Vol: 38, Pages: 113-119, ISSN: 2468-8630

BackgroundPhysiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.ObjectiveTo explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.MethodQualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.ResultsThree main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.ConclusionAlthough employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.

Journal article

Murtagh GM, Furber L, Thomas A, 2018, Does the delivery of diagnostic news affect the likelihood of whether or not patients ask questions about the results? A conversation analytical study, Health Expectations, Vol: 21, Pages: 1002-1012, ISSN: 1369-6513

Background:Asymmetries in knowledge and competence in the medical encounter often mean that doctor-patient communication can be compromised. This paper explores this issue and examines whether the likelihood of patient question asking is increased following the delivery of diagnostic test results. It also examines if that likelihood is related to the way in which the test results are delivered. Objective:To examine when and how patients initiate questions following diagnostic news announcements. Methods:We audio recorded oncology consultations (n=47) consisting of both first consultations and follow up consultations with patients with different types of cancer, at a leading UK teaching hospital. From the primary sample, we identified 30 consultations based on a basic count of the frequency of patient questions and their positioning in relation to diagnostic announcements. This subset of 30 consultations consisted of a mix of first and follow up consultations. Results:Our data demonstrates how the design and delivery of diagnostic news announcements can either discourage or provide the opportunity for a patient initiated question in the next turn of talk. We identified two types of announcement. Q+ generally provided for a patient initiated question as a relevant next turn following the news announcement, whereas Q- did not. Q+ was sometimes followed up with the explanation of test results which appeared to encourage further patient questions. Conclusion:The design and delivery of diagnostic news announcements can make a patient-initiated question more or less appropriate, in the next turn of talk. In addition, showing and explaining test results can encourage further opportunities for patients’ questions.

Journal article

Belsi A, Murtagh G, 2018, Peer tutoring in clinical communication teaching: the experience of 1st year students and their peer tutors, MedEdPublish, Vol: 7, ISSN: 2312-7996

This study explored the impact of peer tutoring in Clinical Communication teaching as it was expressed in the views of Year 1 students and their Peer Tutors at Imperial College London.Methods: a mixed methods approach was used combining questionnaires and focus groups. Quantitative findings were analysed using SPSS v23 and qualitative findings were analysed using Framework Methodology.Results: the findings suggest a very positive experience for both Year 1 students and their Peer Tutors with the former reporting feeling supported to practice and improve on their Clinical Communication Skills in a collaborative environment, being taught and learning from peers who would share their past educational experiences. No significant differences were found between students taught by Peer Tutors and those taught by Course Tutors. Peer Tutors on the other hand, reported an equally positive experience, which gave them an insight into teaching, improved their leadership and feedback skills, enhanced their confidence and helped them reflect on their own Clinical Communication skills.Conclusion: peer tutoring has many advantages as an educational method in medical education and Clinical Communication teaching and should be promoted in medical curricula.

Journal article

Bezemer J, Murtagh GM, Cope A, Murtagh GMet al., 2018, Inspecting Objects: Visibility Manoeuvres in Laparoscopic Surgery, Embodied Activities, Editors: Gerhardt, Reber

Book chapter

Bezemer J, Cope A, Korkiakangas T, Kress G, Murtagh G, Weldon SM, Kneebone Ret al., 2016, Microanalysis of video from the operating room: an underused approach to patient safety research, BMJ Quality & Safety, Vol: 26, Pages: 583-587, ISSN: 2044-5423

Journal article

Bezemer J, Murtagh G, Cope A, Kneebone Ret al., 2016, Surgical decision making in a teaching hospital: a linguistic analysis, ANZ JOURNAL OF SURGERY, Vol: 86, Pages: 751-755, ISSN: 1445-1433

Journal article

Kum F, Murtagh GM, Oakley R, 2016, Surgeons and Smoking: Discussing smoking cessation with patients in head and neck cancer clinics, European Society of Surgical Oncology, Publisher: WB Saunders, ISSN: 1532-2157

Conference paper

Papi E, Murtagh GM, McGregor AH, 2016, Wearable technologies in osteoarthritis: A qualitative study of clinicians’ preferences., BMJ Open, Vol: 6, ISSN: 2044-6055

Objective This study investigates clinicians’ views of health-related wearable technologies in the context of supporting osteoarthritis (OA) long-term management. Clinicians’ preferences are critical in identifying realistic implementation strategies for such technologies.Design Qualitative study incorporating an inductive thematic analysis applied to identify key themes from clinicians’ responses.Participants Clinicians, including 4 general practitioners, 4 physiotherapists and 5 orthopaedic surgeons were interviewed.Setting The study was conducted in a University setting.Results Participants all agreed wearable technologies could positively complement their role and enhance their relationship with patients. Perceived benefits of wearable technologies included monitoring patients’ progress, treatment evaluation, monitoring compliance and informing clinical decision-making. The device should be designed to provide objective data of patients’ locomotion capability in an easy and timely fashion via a simple interface. Data should be available to both clinicians and patients to provide them with the motivation to achieve clinical goals and allow them to take ownership of their treatment. The use of technology was also seen as a way to more effectively plan treatment and manage patients’ contact time saving time and cost.Conclusions Findings support the use of wearable technologies to enhance current OA management and suggest clinical uses. Adoption of technologies could have implications on the effectiveness of treatment provided overcoming current barriers, in particular compliance with treatment.

Journal article

Cauldwell M, Chappell LC, Murtagh G, Bewley Set al., 2015, Learning about maternal death and grief in the profession: a pilot qualitative study, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Vol: 94, Pages: 1346-1353, ISSN: 0001-6349

Journal article

Murtagh GM, 2014, Simulated interaction and authentic interaction: A role for conversation analysis, Simulated Patient Methodology: Theory, Evidence and Practice, Editors: Nestel, Bearman, Publisher: Wiley Blackwell, Pages: 46-52, ISBN: 978-1-118-76100-7

Book chapter

Murtagh GM, Bezemer J, 2014, Communication during intra-operative decision making: A qualitative study, Behavioural Sciences Applied to Surgery and Acute Care Settings

Conference paper

Furber L, Murtagh GM, Bonas S, Bankart J, Thomas Aet al., 2014, Improving consultations in oncology: The development of a novel consultation aid, British Journal of Cancer, Vol: 110, Pages: 1101-11099, ISSN: 1532-1827

background: The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered.methods: We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid.results: A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid.conclusions: Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations.

Journal article

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