Questionable quality of health communication is a worldwide issue that can negatively affect patient outcomes, satisfaction, decision-making quality, patient–provider relationship, and health care resource utilization and expenditures.1, 2, 3 Poor health communication quality also contributes to an increase in medical errors, adverse events, and patient aggression or violent behavior.4, 5, 6 Although health communication has continuously gained attention over the decades, it remains a complicated and abstract concept that is difficult to conceptualize, compare, and evaluate. The following background information presents the importance and knowledge gap of health communication, especially symptom communication. Then, the theories related to health communication and the needs of conducting a mixed-methods research (MMR) to study relevant issues are highlighted.

Symptom management is among the multiple aspects of health care that can be affected by communication and one of the critical outcomes of health communication.7, 8, 9 Indeed, symptoms are often major topics communicated between patients with cancer and their health care providers (HCPs).10 Although symptom management is a primary care goal for patients with advanced cancer, symptom communication quality is beyond satisfactory.11,12 For example, a qualitative content analysis that explored how patients with cancer discuss their pain with their HCPs revealed that HCPs asked predominately close-ended questions and frequently interrupted patients’ answers.13 Some studies have shown that patients with cancer do not always receive symptom management recommendations from HCPs.11,14 Patient-related barriers to symptom communication in cancer populations, such as low motivation for discussing significant symptoms with HCPs, have been identified.11,12,15 Such ineffective communication threatens a wide range of outcomes for patients with cancer, including the accurate evaluation of disease severity or symptoms, quality of life, treatment-related emotions, self-management, self-efficacy, and goal-concordant care.16,17

Although previous studies have shown relationships between health communication and patient outcomes, the information is fragmented and does not always reflect real situations. Most relevant studies focused on separated communication behaviors, such as expressing empathy18 rather than examining real clinical encounters as a whole. In addition to disintegrated observations, most studies examined designed scenarios, such as after communication training or simulations,19 which may deviate from naturally occurring medical encounters. Moreover, clinical studies considering the theoretical underpinnings of interpersonal communication are lacking. Using a theoretical model or conceptual framework in either the study design or the interpretation of the results will help highlight the comprehensive picture of health communication. For example, the dual process theory of supportive messages20 delineates how the quality of a message can affect communication outcomes through the ability to handle the message. The concept of the “ability to handle the message” is close to the broadly discussed concept of “self-efficacy” in the medical field and means “a person's belief in their capability to execute behaviors to achieve the expected outcomes.”21 This communication self-efficacy is particularly important in health communication because most patients are unfamiliar with medical terms. Communication self-efficacy also associated with “power”—a complex concept that is closely linked to status, authority, and knowledge.22 Clearly, the power of HCP and patients or caregivers during communication is uneven and requires special treatment. Other theories, such as multiple goals theory, propose that communication partners have various goals for the interactions that can be obvious or implicit.23 This goal alignment concept is similar to “patient-centered care” or “shared decision-making,” which have long been promoted by medical experts. Although these concepts proposed by interpersonal communication experts echo the focus in medical care, they were not systematically explored in health communication.

To fully map out health communication with the essence of a qualitative nature and to further link it to measurable patient outcomes, MMR is the most reasonable selection that allows researchers to integrate qualitative and quantitative data. MMR, which considers different aspects together, is also closer to a clinical situation in which the patient's medical needs are evaluated based on both subjective and objective data. This MMR study defines its overarching goal of providing a systematic description of health communication, including its relationship with patient outcomes. Informed by the dual process theory of supportive message, the specific aims are to (1) validate and expand a previously established typology of interaction patterns (TIPS) regarding symptom communication in patients with advanced cancer and (2) examine relationships among interaction patterns (quality of message), patients’ health communication self-efficacy (ability to handle the message), and patients’ outcomes, including congruence in symptom assessment between patients and HCP and patient satisfaction.