In an era where digital healthcare is rapidly transforming patient-doctor interactions, a recent groundbreaking study has introduced and rigorously validated a novel instrument designed to measure the quality of physician-patient dialogue about cancer treatment risks within Chinese online medical consultations (OMCs). This pioneering research addresses an essential gap in understanding how effectively physicians communicate risk information in digital environments, a critical factor in patient outcomes and decision-making when navigating complex cancer therapies.
The study recruited a total of 263 participants fitting strict inclusion criteria via the online platform WJX, achieving an impressive response rate of 95.1% with 250 complete questionnaire responses. High response rates underscore the clinical relevance and participant engagement in the subject matter. Incomplete responses were primarily attributed to factors such as inadequate financial incentives, the time commitment required, question complexity, and occasional internet connectivity issues. Despite these challenges, the robustness of the dataset allows for high-confidence conclusions to be drawn regarding physician dialogic risk communication (PDRC) within this context.
Demographically, the study sample consisted of 40% male and 60% female participants, representing a broad adult age range from 18 to over 45 years. Notably, the dominant age cohort was 31–40 years, comprising nearly half of the respondents. The majority of participants were married, which may influence consultation dynamics given the family-centered nature of healthcare decisions in Chinese culture. Socioeconomically, over 42% of respondents earned a monthly income between RMB 5001 to RMB 10,000, indicating a middle-income bracket, while nearly all participants were employed within business sectors or public institutions. Educational attainment was high, with approximately 80% holding at least a bachelor’s degree, a factor potentially influencing digital literacy and attitudes towards online health interactions.
Crucially, over half of the participants reported engaging in online medical consultations for cancer treatment risks sometimes, while a quarter consulted online physicians quite frequently. An overwhelming majority—97.6%—considered the PDRC crucial in the context of risk communication, with 90.4% believing such dialogic communication to be prevalent in their online engagements. These findings highlight widespread recognition among patients of the importance and current use of effective risk dialogues within digital settings.
The temporal characteristics of participants’ last OMCs revealed that approximately one in seven had their last consultation within one week, while a quarter had consulted within two weeks, demonstrating that the sample involved recent, active users of online health services. Importantly, all participants confirmed that their last OMC involved discussions surrounding cancer treatment-associated risks, affirming the relevance of dialogic communication in these encounters. Participants often engaged in OMCs on behalf of family members (58.8%) and friends (30%), emphasizing the socially embedded nature of health decision-making in China.
Methodologically, the consultations predominantly occurred through text-based messaging, used by over 92% of participants, followed by the use of picture sharing, voice, and video, showcasing a multifaceted communication landscape within online platforms. Leading platforms included Baidu Doctor, Haodaifu Online, and Dingxiang Doctor — each playing integral roles in facilitating these critical risk discussions.
The crux of the research centered on assessing the perceived importance of individual items developed to measure Chinese physician dialogic risk communication (PDRC). Participants rated the relevance of eight measurement items associated with PDRC with remarkable consensus; more than 92% found each item important to varying degrees. Items 1 through 3 were particularly well-regarded, with over 93.5% indicating high importance. Despite item 8 receiving comparatively lower importance scores, nearly 88% still considered it valuable, underscoring broad acknowledgment of multiple facets of risk communication.
Importantly, statistical analysis indicated significant variation in “very important” ratings among items, with items 2, 3, and 7 receiving the highest marks. This stratification suggests particular elements within the PDRC scale resonate more profoundly with patients, potentially guiding future refinement to emphasize these critical aspects in physician-patient dialogues about cancer treatment risks.
The overall PDRC composite scores demonstrated a normal distribution, with a mean score of 31.2 out of a possible 40, reflecting generally positive perceptions of dialogic risk communication quality. Half of the consultations received scores suggesting high satisfaction, while a negligible proportion of participants assigned max scores, affirming the scale’s sensitivity without ceiling effects. Of clinical importance, participants who felt the PDRC met their expectations rated it significantly higher than those advocating for improvement, demonstrating the instrument’s discriminative validity.
Further associations were observed between PDRC scores and consultation frequency; participants engaging seldomly had lower scores compared to those consulting sometimes or often. This finding elucidates the potential impact of repeated online interactions on perceived dialogic quality, hinting at the value of ongoing patient-physician engagement in fostering effective communication and trust.
At the heart of the study’s technical rigor was the extensive validation of the Chinese PDRC instrument scale. Internal consistency was affirmed with a Cronbach’s alpha of 0.801, indicating reliable item coherence. Item-level analyses demonstrated corrected item-total correlations well above the 0.2 benchmark, confirming the scale’s homogeneity. Factor analyses, including Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA), robustly supported a unidimensional construct underlying the eight measurement items. This one-factor model exhibited excellent fit indices such as RMR, SRMR, TLI, NFI, CFI, and IFI, all within acceptable thresholds, establishing a stable and valid measurement structure.
The Kaiser-Meyer-Olkin (KMO) measure of 0.849 and statistically significant Bartlett’s test reinforced the adequacy of the sampling and appropriateness for factor analysis. Factor loadings ranging between 0.563 and 0.706 further support the construct validity of the instrument, ensuring its capacity to reliably capture the essence of physician dialogic risk communication in the Chinese OMC context.
Beyond psychometric solidification, the research offers profound insights into the evolving landscape of digital health communication in oncology. The development of a culturally and technologically tailored PDRC instrument addresses a critical unmet need for standardized assessment tools that accommodate the unique challenges of remote, digitally mediated consultations. Given the rising prevalence of online medical platforms in China, particularly for sensitive and complex diseases like cancer, such measurements enable clinicians, researchers, and policymakers to monitor, refine, and enhance dialogic practices critical to patient safety and informed decision-making.
This study’s findings underscore the imperative for digital health systems to embed dialogic approaches explicitly within their frameworks, ensuring that risk communication is not merely transactional but dialogic, fostering shared understanding, empathy, and patient empowerment. The robust validation of this tool paves the way for future research exploring intervention efficacy, longitudinal monitoring of communication quality, and tailoring strategies to diverse patient populations.
In summary, the unveiling of the Chinese Physician Dialogic Risk Communication instrument scale represents a significant leap forward in the quantitative assessment of online medical consultations concerning cancer treatment risks. The scale’s demonstrated reliability, validity, and nuanced psychometric properties position it as a critical asset for advancing patient-centered digital oncology care. As healthcare continues to digitize on an unprecedented scale, such innovative tools will play indispensable roles in safeguarding the quality and humanity of patient-provider interactions, ultimately improving cancer care outcomes in China and potentially beyond.
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Article References:
Lu, W., Yorke, J., Li, Y. et al. Development and validation of a physician dialogic risk communication instrument scale in Chinese online medical consultations on cancer treatment risks.
Humanit Soc Sci Commun 12, 658 (2025). https://doi.org/10.1057/s41599-025-04758-3
Image Credits: AI Generated
