Practices for initiating a conversation about fear of cancer recurrence after cancer treatment: A conversation analytic study of gynae-oncology outpatient consultations

Background Fear of cancer recurrence (FCR) is a top-rated concern and unmet need for support among gynaecological cancer patients yet seldom discussed during healthcare consultations. Clinicians report several challenges in initiating conversations about FCR with patients and limited practical guidance is available.Objective This study aimed to identify communication practices for initiating conversations about FCR during outpatient consultations after treatment for gynaecological cancer.Methods A collection of 30 audio-recorded outpatient consultations, involving 4 gynae-oncology clinicians, 30 people who had completed treatment for endometrial or ovarian cancer, and 11 accompanying family members and friends, were reviewed to identify instances where FCR was discussed. These instances were analysed using conversation analysis.Results Six of the 30 consultations, all involving the same gynae-oncology clinician, included talk about FCR. Two recurrent communication practices were used to initiate these conversations: (1) Universal claims (e.g., "I always ask…") framed talk about FCR as a routine part of post-treatment follow-up for all gynaecological cancer patients, and (2) General claims (e.g., "Some people find that…") normalised FCR post-treatment and provided opportunity for the patient to indicate if FCR was relevant to them and to describe their experience. Both practices provided avenues for the gynae-oncology clinician to discuss available support for FCR.Conclusions FCR was not regularly discussed in this collection of recordings, reflecting previous reports of clinical practice. Nonetheless, direct observation and detailed analysis of real-word consultations where FCR was discussed identified two simple strategies that clinicians can use to initiate these conversations. First, universal claims can shift the conversation to FCR specifically and frame this talk as routine. Second, general claims normalise FCR and invite patients to share their experiences. Future research could investigate use of these practices across multiple clinicians and patient groups and examine the impact of FCR conversations for patients and families.