. 2020 Nov 23;24(1):140–151. doi: 10.1111/hex.13163

Table 4.

Contrast between high and low SES patients in communication content

Themes and sub‐themes	Patients with high socioeconomic backgrounds	Patients with low socioeconomic backgrounds
1. Relational talk
1.1 Relational talk in the opening sequence	Physician: ‘No problems’? Patient: ‘No I feel great now. I feel back to normal’. Physician: ‘Yes? Still doing charity races and things like that’? (eye contact, sat closer) Patient: ‘I did erm… I did a hike for Macmillan Cancer in June… so I am minus about 6 toe‐nails at the moment because it's a marathon hike in the Lake District. So it took 14 hours’. Physician: ‘Oh right. Not the right shoes and all that’? Patient: ‘No… I had, it was just, you know, the terrain’. Patient 23, Physician 1, Consultation	Physician: ‘How are you’? Patient: ‘Fine’. Physician: ‘Good. No problems’? Patient: ‘No none at all’. Physician: ‘That's what we like to hear. Shall we have a little look down’? Patient: ‘Yeah yeah’. Patient 18, Physician 3, Consultation
1.2 Relational talk in the farewell sequence	Patient: ‘Thank you very much’ (shake hands, both sitting). Physician: ‘So see you in 3 months’. Patient: ‘Alright, thank you’. Physician: ‘Yeah, so for the person recording – he is very grateful he said!!!’ Patient: ‘I am extremely grateful’. Physician: ‘I know you are’. Patient: ‘Superb expertise’. Physician: ‘Cheers mate. I know you mean that by the way. Thank you very much’. Patient: ‘Thank you’. Patient 25, Physician 1, Consultation	Physician: ‘Alright Mr (patient)….. I can't see anything (Facing patient, making eye contact). We'll just get the scans to look at the tissues inside. I think, I think it's just the result of the surgery of the radiotherapy causing scarring in there, but we will get the scan and it will also act as a baseline for us. Now, I’ll see you back on the 7th June.’ Patient: ‘Alright, thanks very much’. Physician: ‘Alright, take care now. (shake hands both sat down, Physician lifts up a bit off his chair). Bye’. Patient: ‘Bye’. Patient 6, Physician 2, Consultation
2. Active or passive participation
2.1 Education and occupation as a cultural frame of reference	Patient: ‘I know a lot of patients going in they are probably quite nervous when they go to see a Physician like, you know what I mean, or any doctor, not just because of the illness but because of they see them as somebody quite powerful and very professional and very different. But having worked in that environment over the years I can converse with them much easier. I know the system I know how the system works and make it easier for myself and them as well’. Patient 12, Physician 3, Interview	Patient: ‘See I am in the motor trade as an auto‐electrician and erm, mechanics, and so I am mechanically minded. So, so, I know if someone is saying something is right, then it's got longevity at least’. Patient 8, Physician 1, Interview
2.2 Patients with an agenda	Patient: ‘Any concerns and you can bring anything up, I don't feel it's going to be a stupid question.” Interviewer: “Yeah. So, there wasn't anything else which you wanted to ask but didn't get out’? Patient: ‘No, I generally have a question every time I go…(chuckles)…I generally bring something up’. Interviewer: ‘You seem very comfortable to ask the questions you want’. Patient: ‘Yeah, Yeah I do, as I say in the past usually at every consultation that I have had I have asked something about some part of my mouth, throat, tongue…’ Patient 3, Physician 2, Interview	Interviewer: ‘You mentioned your problems with swallowing to Mr (Physician) in the appointment’? Patient: ‘I didn't I thought I would wait for the outcome, get the camera down and I will wait for the outcome and then if it was that the cancer had progressed then I would tell him how I felt about it beforehand’. Interviewer: ‘Yeah’. Patient: ‘But I didn't mention it’. Interviewer: ‘Okay, I think erm…you mentioned it a bit after he had given you the kind of…’ Patient: ‘He said ‘All clear’ and I said ‘Thank goodness for that’.’ Interviewer: Laughs… Patient: ‘That's all I said. I didn't say I had been worried or anything’. Patient 7, Physician 1, Interview
2.3 Responsibility for obtaining information	Patient: ‘Yeah…occasions erm…I have phoned up and said look I forgot to ask this or forgot to ask that, erm and I have done that with my doctor as well and someone phones me back or I phone back when they tell me to phone back or I get a letter or whatever. I think if you ask you will get the information’. Patient 3, Physician 2, Interview	Interviewer: ‘Do you feel like you get enough information from them’? Patient: ‘Yes yeah’. Interviewer: ‘Erm and do you find that you get reassurance as well’? Patient: ‘Yeah yeah. I mean especially with Mr (Physician), I mean he is straight with you’? Interviewer: ‘Yeah’. Patient: ‘I mean he won't try and kid you or nothing’ Interviewer: ‘Mmm’ Patient: ‘If he thinks there is something wrong he tells you he thinks there is something wrong’. Interviewer: ‘Yeah’ Patient 6, Physician 2, Interview
3. Preferences for involvement
3.1 Defining involvement in decision‐making	Patient: ‘Yeah I like to be involved ‘cause I like to know what is going on. Erm…I have always been explained to me why they are doing things and initially when the treatment was. When I was diagnosed and they said to me, “Well there is two courses of treatment,” he said “There is the tried and tested one or there is a new erm…one that they are trialling”… But obviously its not as, they do not know the results, so he said: “What do you want to do?”, he said “It's got to be your decision”.’ Patient 3, Physician 2, Interview	Patient: ‘Erm…well I expect to be 100% involved…You know if, say he was going to operate on me or things like that…I would like to be involved. You know I would want to know everything about it before it actually happened…And like I say I have only had the one operation you know when he took the tumours out and he explained everything about that you know before it got done and then after it had been done, the first time I seen him afterwards…He went through everything with me, he explained it all. He was very good, he really is.’ Patient 6, Physician 2, Interview
3.2 Stoicism	Patient: ‘I am comfortable like about expressing things, like you know what I mean like. I like to talk things through, I like to get to the very bottom of things. I like to get to understand it myself, like you know, because of my science, medical background I like to know and understand anything, you know what I mean? If there's something I don't know about, tell me more about it, I want to know’. Patient 12, Physician 3, Interview	Patient: ‘But I keep it to myself, I don't say it to my daughter as I don't like to upset her, you know, worry her. I wouldn't like to worry her and she says to me’ ‘Have you got any pains? Don't forget to tell the doctors, tell them everything, write everything down.’ I say, ‘I’m Okay, Okay’. I just keep on saying to myself that it's the chemo or the radio because a lot happens to the inside of your body so this is why this is happening and things like that and thinking about everything that he says to you and I just… you just have to get on with it’. Patient 13, Physician 4, Interview

Themes and sub‐themes

Patients with high socioeconomic backgrounds

Patients with low socioeconomic backgrounds

1. Relational talk

1.1 Relational talk in the opening sequence

Physician: ‘No problems’?

Patient: ‘No I feel great now. I feel back to normal’.

Physician: ‘Yes? Still doing charity races and things like that’? (eye contact, sat closer)

Patient: ‘I did erm… I did a hike for Macmillan Cancer in June… so I am minus about 6 toe‐nails at the moment because it's a marathon hike in the Lake District. So it took 14 hours’.

Physician: ‘Oh right. Not the right shoes and all that’?

Patient: ‘No… I had, it was just, you know, the terrain’.

Patient 23, Physician 1, Consultation

Physician: ‘How are you’?

Patient: ‘Fine’.

Physician: ‘Good. No problems’?

Patient: ‘No none at all’.

Physician: ‘That's what we like to hear. Shall we have a little look down’?

Patient: ‘Yeah yeah’.

Patient 18, Physician 3, Consultation

1.2 Relational talk in the farewell sequence

Patient: ‘Thank you very much’ (shake hands, both sitting).

Physician: ‘So see you in 3 months’.

Patient: ‘Alright, thank you’.

Physician: ‘Yeah, so for the person recording – he is very grateful he said!!!’

Patient: ‘I am extremely grateful’.

Physician: ‘I know you are’.

Patient: ‘Superb expertise’.

Physician: ‘Cheers mate. I know you mean that by the way. Thank you very much’.

Patient: ‘Thank you’.

Patient 25, Physician 1, Consultation

Physician: ‘Alright Mr (patient)….. I can't see anything (Facing patient, making eye contact). We'll just get the scans to look at the tissues inside. I think, I think it's just the result of the surgery of the radiotherapy causing scarring in there, but we will get the scan and it will also act as a baseline for us. Now, I’ll see you back on the 7th June.’

Patient: ‘Alright, thanks very much’.

Physician: ‘Alright, take care now. (shake hands both sat down, Physician lifts up a bit off his chair). Bye’.

Patient: ‘Bye’.

Patient 6, Physician 2, Consultation

2. Active or passive participation

2.1 Education and occupation as a cultural frame of reference

Patient: ‘I know a lot of patients going in they are probably quite nervous when they go to see a Physician like, you know what I mean, or any doctor, not just because of the illness but because of they see them as somebody quite powerful and very professional and very different. But having worked in that environment over the years I can converse with them much easier. I know the system I know how the system works and make it easier for myself and them as well’.

Patient 12, Physician 3, Interview

Patient: ‘See I am in the motor trade as an auto‐electrician and erm, mechanics, and so I am mechanically minded. So, so, I know if someone is saying something is right, then it's got longevity at least’.

Patient 8, Physician 1, Interview

2.2 Patients with an agenda

Patient: ‘Any concerns and you can bring anything up, I don't feel it's going to be a stupid question.”

Interviewer: “Yeah. So, there wasn't anything else which you wanted to ask but didn't get out’?

Patient: ‘No, I generally have a question every time I go…(chuckles)…I generally bring something up’.

Interviewer: ‘You seem very comfortable to ask the questions you want’.

Patient: ‘Yeah, Yeah I do, as I say in the past usually at every consultation that I have had I have asked something about some part of my mouth, throat, tongue…’

Patient 3, Physician 2, Interview

Interviewer: ‘You mentioned your problems with swallowing to Mr (Physician) in the appointment’?

Patient: ‘I didn't I thought I would wait for the outcome, get the camera down and I will wait for the outcome and then if it was that the cancer had progressed then I would tell him how I felt about it beforehand’.

Interviewer: ‘Yeah’.

Patient: ‘But I didn't mention it’.

Interviewer: ‘Okay, I think erm…you mentioned it a bit after he had given you the kind of…’

Patient: ‘He said ‘All clear’ and I said ‘Thank goodness for that’.’

Interviewer: Laughs…

Patient: ‘That's all I said. I didn't say I had been worried or anything’.

Patient 7, Physician 1, Interview

2.3 Responsibility for obtaining information

Patient: ‘Yeah…occasions erm…I have phoned up and said look I forgot to ask this or forgot to ask that, erm and I have done that with my doctor as well and someone phones me back or I phone back when they tell me to phone back or I get a letter or whatever. I think if you ask you will get the information’.

Patient 3, Physician 2, Interview

Interviewer: ‘Do you feel like you get enough information from them’?

Patient: ‘Yes yeah’.

Interviewer: ‘Erm and do you find that you get reassurance as well’?

Patient: ‘Yeah yeah. I mean especially with Mr (Physician), I mean he is straight with you’?

Interviewer: ‘Yeah’.

Patient: ‘I mean he won't try and kid you or nothing’

Interviewer: ‘Mmm’

Patient: ‘If he thinks there is something wrong he tells you he thinks there is something wrong’.

Interviewer: ‘Yeah’

Patient 6, Physician 2, Interview

3. Preferences for involvement

3.1 Defining involvement in decision‐making

Patient: ‘Yeah I like to be involved ‘cause I like to know what is going on. Erm…I have always been explained to me why they are doing things and initially when the treatment was. When I was diagnosed and they said to me, “Well there is two courses of treatment,” he said “There is the tried and tested one or there is a new erm…one that they are trialling”… But obviously its not as, they do not know the results, so he said: “What do you want to do?”, he said “It's got to be your decision”.’

Patient 3, Physician 2, Interview

Patient: ‘Erm…well I expect to be 100% involved…You know if, say he was going to operate on me or things like that…I would like to be involved. You know I would want to know everything about it before it actually happened…And like I say I have only had the one operation you know when he took the tumours out and he explained everything about that you know before it got done and then after it had been done, the first time I seen him afterwards…He went through everything with me, he explained it all. He was very good, he really is.’

Patient 6, Physician 2, Interview

3.2 Stoicism

Patient: ‘I am comfortable like about expressing things, like you know what I mean like. I like to talk things through, I like to get to the very bottom of things. I like to get to understand it myself, like you know, because of my science, medical background I like to know and understand anything, you know what I mean? If there's something I don't know about, tell me more about it, I want to know’.

Patient 12, Physician 3, Interview

Patient: ‘But I keep it to myself, I don't say it to my daughter as I don't like to upset her, you know, worry her. I wouldn't like to worry her and she says to me’ ‘Have you got any pains? Don't forget to tell the doctors, tell them everything, write everything down.’ I say, ‘I’m Okay, Okay’. I just keep on saying to myself that it's the chemo or the radio because a lot happens to the inside of your body so this is why this is happening and things like that and thinking about everything that he says to you and I just… you just have to get on with it’.

Patient 13, Physician 4, Interview