title: How do non-physician clinicians respond to advanced cancer patients' negative expressions of emotions?
abstract: OBJECTIVE
  Patients with advanced cancer often experience negative emotion; clinicians' empathic responses can alleviate patient distress. Much is known about how physicians respond to patient emotion; less is known about non-physician clinicians. Given that oncology care is increasingly provided by an interdisciplinary team, it is important to know more about how patients with advanced cancer express emotions to non-physician clinicians (NPCs) and how NPCs respond to those empathic opportunities.
  
  
  METHODS
  We audio recorded conversations between non-physician clinicians and patients with advanced cancer. We analyzed 45 conversations between patients and oncology physician assistants, nurse practitioners, and nurse clinicians in which patients or their loved ones expressed at least one negative emotion to the NPC (i.e., an empathic opportunity). Empathic opportunities were coded three ways: type of emotion (anger, sadness, or fear), severity of emotion (least, moderate, or most severe), and NPC response to emotion (not empathic, on-topic medical response, and empathic response).
  
  
  RESULTS
  We identified 103 empathic opportunities presented to 25 different NPCs during 45 visits. Approximately half of the empathic opportunities contained anger (53%), followed by sadness (25%) and fear (21%). The majority of emotions expressed were moderately severe (73%), followed by most severe (16%), and least severe (12%). The severity of emotions presented was not found to be statistically different between types of NPCs. NPCs responded to empathic opportunities with empathic statements 30% of the time. Additionally, 40% of the time, NPCs responded to empathic opportunities with on-topic, medical explanations and 30% of the responses were not empathic.
  
  
  CONCLUSIONS
  Patients expressed emotional concerns to NPCs typically in the form of anger; most emotions were moderately severe, with no statistical differences among types of NPC. On average, NPCs responded to patient emotion with empathic language only 30% of the time. A better understanding of NPC-patient interactions can contribute to improved communication training for NPCs and, ultimately, to higher quality patient care in cancer.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA. alexa045@mc.duke.edu
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.forename: Perri A
authors.initials: PA
authors.lastname: Morgan
authors.forename: Justine
authors.initials: J
authors.lastname: Strand
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Maren
authors.initials: M
authors.lastname: Olsen
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Garrigues
authors.forename: Justin R E
authors.initials: JR
authors.lastname: Manusov
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000786:Anger; D001291:Attitude of Health Personnel; D004644:Emotions; D004645:Empathy; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D011369:Professional-Patient Relations; D013637:Tape Recording
references.citation: Br J Cancer. 1995 Jun;71(6):1263-9
references.pmid: 7540037
references.citation: BMJ. 1994 Aug 13;309(6952):448
references.pmid: 7920129
references.citation: JAMA. 2000 Aug 23-30;284(8):1021-7
references.pmid: 10944650
references.citation: Eur J Cancer. 1993;29A(13):1858-63
references.pmid: 8260242
references.citation: Palliat Med. 2006 Dec;20(8):813-9
references.pmid: 17148536
references.citation: Psychooncology. 2002 Jan-Feb;11(1):35-46
references.pmid: 11835591
references.citation: J Clin Oncol. 1999 Jan;17(1):371-9
references.pmid: 10458256
references.citation: J Oncol Pract. 2007 Mar;3(2):79-86
references.pmid: 20859376
references.citation: Clin J Oncol Nurs. 2006 Oct;10(5):604-8
references.pmid: 17063614
references.citation: Psychooncology. 2002 Jan-Feb;11(1):47-58
references.pmid: 11835592
references.citation: JAMA. 1997 Feb 26;277(8):678-82
references.pmid: 9039890
references.citation: Br J Cancer. 2003 Mar 10;88(5):658-65
references.pmid: 12618870
references.citation: Cancer Nurs. 2009 May-Jun;32(3):E1-7
references.pmid: 19295421
references.citation: Br J Cancer. 2000 Nov;83(10):1261-7
references.pmid: 11044347
references.citation: Br J Cancer. 2001 Apr 20;84(8):1011-5
references.pmid: 11308246
references.citation: Oncology (Williston Park). 2006 Jan;20(1):67-74; discussion 77-8, 83
references.pmid: 16572594
references.citation: Br J Cancer. 2002 Jul 1;87(1):1-7
references.pmid: 12085247
references.citation: Br J Psychiatry Suppl. 1996 Jun;(30):109-16
references.pmid: 8864156
references.citation: Patient Educ Couns. 2009 Jul;76(1):51-6
references.pmid: 19041211
references.citation: J Clin Oncol. 2007 Dec 20;25(36):5748-52
references.pmid: 18089870
references.citation: Cancer. 1996 Jun 15;77(12):2630-7
references.pmid: 8640715
references.citation: J Oncol Pract. 2010 Jan;6(1):7-11
references.pmid: 20539724
references.citation: Lancet. 2002 Feb 23;359(9307):650-6
references.pmid: 11879860
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571