title: "What concerns me is..." Expression of emotion by advanced cancer patients during outpatient visits.
abstract: OBJECTIVE
  Cancer patients have high levels of distress, yet oncologists often do not recognize patients' concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists.
  
  
  METHODS
  As part of the Studying Communication in Oncologist-Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content.
  
  
  RESULTS
  Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: "concern," "scared," "worried," "depressed," and "nervous." Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time.
  
  
  CONCLUSIONS
  Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.
authors.affiliation: Department of Medicine, Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, 521 Parnassus Avenue, Suite C-126, Box 0903, San Francisco, CA, 94143-0903, USA. anderson.wg@gmail.com
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D003863:Depression / Q000209:etiology* / Q000523:psychology; D018450:Disease Progression; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D010045:Outpatients; D013637:Tape Recording