Oncologist communication about emotion during visits with patients with advanced cancer.
BACKGROUND
Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses.


METHODS
We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care.


RESULTS
In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements.


CONCLUSIONS
Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.
Pollak
Kathryn I
KI
Duke Comprehensive Cancer Center, Cancer Prevention, Detection, and Control Research Program, Durham, NC, USA. polla007@mc.duke.edu
Arnold
Robert M
RM
Jeffreys
Amy S
AS
Alexander
Stewart C
SC
Olsen
Maren K
MK
Abernethy
Amy P
AP
Sugg Skinner
Celette
C
Rodriguez
Keri L
KL
Tulsky
James A
JA
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D004644:Emotions; D004645:Empathy; D005260:Female; D006176:Gynecology; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010817:Physician-Patient Relations; D018787:Radiation Oncology; D013637:Tape Recording