title: Talking about feelings and worries in cancer consultations: the effects of an interactive tailored symptom assessment on source, explicitness, and timing of emotional cues and concerns.
abstract: BACKGROUND
  Patients are experts of their own symptoms and worries, but tend not to express their concerns spontaneously in the consultation. Even when emotions are brought up, they are discussed briefly.
  
  
  OBJECTIVE
  The objective of this study was to examine the impact of an interactive tailored patient assessment (Choice) on communication of emotional cues and concerns expressed by cancer patients in terms of source of initiation of cues/concern, explicitness, timing during the consultation, and consultation type (inpatient/outpatient).
  
  
  METHODS
  We audiotaped and coded consultations between cancer patients and nurses or physicians in 1 control group (n = 99) with standard consultations and 1 intervention group (n = 97) where patients used Choice prior to the consultation. Direct and interaction effects were tested using multilevel analyses.
  
  
  RESULTS
  In the Choice intervention group, there were significantly more frequent and more explicit expressions of cues and concerns; more clinician-initiated concerns occurred during the first 10 minutes; and it was more likely for any cue or concern to be succeeded by a subsequent one. In consultations with many cues/concerns, these were on average more emotionally descriptive or explicit and occurred somewhat earlier in the consultation in the Choice group. Furthermore, more cues/concerns were expressed in inpatient consultations with nurses than in outpatient consultations with physicians.
  
  
  CONCLUSIONS
  Cancer patients' expressions of cues and concerns do not occur at random. More cues/concerns are expressed early in the consultation, in consultations with nurses, and in the Choice intervention group.
  
  
  CONCLUSIONS
  Choice may be a useful clinical tool. Use of Choice might aid cancer patients in handling their emotions.
authors: Center for Shared Decision Making, Oslo University Hospital Rikshospitalet, University of Oslo, Norway. lena.heyn@rr-research.no
authors: Lena
authors: L
authors: Heyn
authors: Arnstein
authors: A
authors: Finset
authors: Cornelia M
authors: CM
authors: Ruland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D016022:Case-Control Studies; D003142:Communication; D004644:Emotions; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D009664:Norway; D009723:Nurse-Patient Relations; D010045:Outpatients / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012494:Sampling Studies; D063189:Symptom Assessment / Q000451:nursing*; D013637:Tape Recording / Q000706:statistics & numerical data; D013813:Therapy, Computer-Assisted / Q000706:statistics & numerical data; D014584:User-Computer Interface