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Eligible participants for the SO-COM study were adult cancer patients with any type of solid tumor, and who were proficient in the Dutch language (Lehmann et al., 2020). A total of N = 69 SOs were audio-recorded and for the current qualitative analysis, a purposive selection of audio-recorded consultations was used.

To create maximum variation in communication about uncertainty, we deliberately selected SO consultations based on two characteristics expected to be strongly associated with such communication: (1) the degree of patient-centered communication (PCC) by the oncologists and (2) oncologists' gender. First, PCC can be defined as physician behaviors which enable patients to express their perspectives on illness, treatment and health-related behavior, including symptoms, concerns and expectations (page 662; Zandbelt et al., 2005). Because “uncertainty management” is a key component of PCC (Epstein and Street, 2007), we hypothesized that oncologists' use of PCC would be associated with their communication about uncertainty. Therefore, we purposively selected the n = 6 highest and n = 6 lowest PCC-scoring consultations for qualitative analysis (N = 12). As part of the larger SO-COM study, PCC scores had been rated by trained coders, based on three items of the Euro-communication scale (Mead and Bower, 2000), focusing on whether the oncologists encouraged patients to express themselves, listened, and involved them in any decisions. Second, previous findings suggest that physician's sex may determine how they communicate uncertainty. For example, females may convey uncertainty more apologetically than males (Schumann and Ross, 2010) and female physicians used more non-verbal indicators of uncertainty than male physicians (Blanch et al., 2009). Therefore, we expected that purposive selection for physician sex would enhance variability in our data. We ensured equal representation of both sexes (n = 6 each), and selected the n = 3 lowest scoring (on PCC) SOs by male and n = 3 lowest scoring by female oncologists, and did the same for the highest scoring consultations (i.e., n = 3 male, n = 3 female). We further increased variability by selecting only one consultation per oncologist (i.e., 12 out of 24 different oncologists were included; see Results section). We closely monitored whether data saturation was achieved after analysis of our initial selection of 12 consultations. We concluded this was the case, as indicated by the two final consultations not yielding any significant new information (Francis et al., 2010).

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