Table 2.

The battling patient

This patient’s son reveals, 25 min into the 33‐min session, that his father prefers laser surgery. The recruiter appears not to hear this, proceeding with a misaligned turn about the mechanics of randomization.

Son: I think you were under the impression that you were going to get the endoscope but [

Pat: [aye, well, I was hoping, you know, but as you explained to me that‐ consider some pure advice before it can be decided.

Nur: What I’ll do today, if you agree to participate in the study, I would phone the centre and I would be able to tell you what that treatment was [to be

It becomes clear that the patient’s preference is based on his earlier – positive – experience with endoscopic biopsy. His son and the nurse point out that laser surgery may have more side‐effects. The patient appears not to accept this caveat. The nurse repeatedly reminds the patient that he can decide on the spot and the patient repeats his preference each time.

Following a break in the recording, the son suggests that radiotherapy may produce a better outcome. The patient says:

Pat: Oh, I think the endoscope is the best.

This is followed by more discussion between the son and the nurse about the potential superiority of radiotherapy. The patient says:

Pat: [Want to ( ) again

Nur: OK that’s fine, the laser gun?

Pat: The laser gun

Nur: That’s absolutely fine.

The son casts one last doubt over the decision:

Son: You would rather have that than the other?

Nur: Ok that’s fine. So I can take your name…