Background Ductal carcinoma in situ (DCIS) is characterized by abnormal cells confined to the milk ducts of the breast. Despite being confined to milk ducts, untreated DCIS can progress to invasive disease. Women diagnosed with low-grade DCIS are often advised to undergo surgery, radiation, and/or chemotherapy, despite the possibility that the condition may never progress. This frequently leads to confusion, distress, and long-term anxiety. Clear, consistent, and patient-centred communication is therefore critical to support informed decision-making for women with DCIS. The objective of this study was to identify preferred terminology, language, and strategies that would act as recommendations to improve communication about DCIS.Methods A mixed-methods design was employed, integrating a theoretical review with interviews to capture both conceptual insights and lived experience to inform recommendations. Findings from the theoretical review and interviews were analyzed using Communication Accommodation Theory (CAT) and then mapped to five domains—approximation, interpretability, interpersonal control, discourse management, and emotional regulation—to assess how clinicians adapt communication to meet women's needs. This approach highlighted areas of alignment and misalignment between women and clinician perspectives.Results Mapping results to CAT demonstrated that language and interaction styles strongly influenced women’s understanding and emotional responses. Women consistently preferred clear, non-threatening terms such as “abnormal cells,” while clinicians tended to rely on more technical terminology. Communication improved when clinicians adapted their language, acknowledged uncertainty, and engaged in collaborative dialogue. Recommendations to improve communication included using plain language, visual aids, extended consultations, reassurance, and active listening to reduce distress and enhance informed decision-making.Conclusion Terminology significantly shapes women’s understanding of DCIS and their emotional reactions. Misalignment between women’s preferences and clinicians language can hinder communication. Applying CAT-informed strategies, including preferred terminology and clarification of distinctions from invasive cancer, can improve understanding, reduce anxiety, and support patient-centred care.