Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?

Objective: It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. Design: Cross-sectional observational study of audio-recorded conversations between patients and physicians. Setting: Three outpatient oncology practices. Patients: Ninety-four patients with advanced cancer and 52 physicians. Intervention: None. Main outcome measures: Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. Results: In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p<0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p<0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p<0.001). Conclusions: The use of metaphors and analogies may enhance physicians' ability to communicate.