Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients.
Josef Bartels, Rachel Rodenbach, Katherine Ciesinski and 3 others
PMID 27156659WHAT IT FOUND
During oncologist-patient visits for advanced cancer, silences marked as emotionally connected happened later amid rapid turn-taking, short utterances, and overlapping speech, not as topic breaks.
Key findings
01Of 1211 silences longer than 2 seconds, 10 were coded as connectional, occurring in 5 conversations.
02Connectional silences averaged 3.6 seconds, while other silences averaged 5.79 seconds, and connectional silences occurred in the latter two-thirds of conversations.
03Around connectional silences, speakers averaged 17.2 alternations per minute, with short utterances and frequent overlapping vocalizations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an exploratory secondary analysis of recordings made for another trial, not a study designed to test silence or communication outcomes. Only 10 connectional silences were found in 5 conversations, so the patterns are descriptive and may not generalize. The coding framework was developed by the study team, including 10 lexical and musical dimensions, and some judgments relied on trained analysts. Analysis used audio only, so facial expression, body position, and gaze were not observed. Participants were English-speaking patients and oncologists in two US regions, limiting transfer to other settings. Pitch and volume were coded by human raters because background noise prevented digital quantification.
Declared interests
No conflicts of interest were declared. The publication types list NIH extramural research support.
The easy way to misread this
Do not read connectional silence as an empathetic technique proven to improve care. This exploratory audio analysis found only 10 connectional silences and reported descriptive patterns, not patient outcomes.