title: How can we explain physician accuracy in assessing patient distress? A multilevel analysis in patients with advanced cancer.
abstract: OBJECTIVE
  To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression.
  
  
  METHODS
  Twenty-eight physicians assessed their patients' distress level on the distress thermometer, while patients (N=201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out.
  
  
  RESULTS
  Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA.
  
  
  CONCLUSIONS
  This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA.
  
  
  CONCLUSIONS
  Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns.
authors: University of Lille Nord de France, Department of Psychology, Lille, France; UDL3, URECA, Villeneuve d'Ascq, France. Electronic address: sophie.lelorain@univ-lille3.fr.
authors: Sophie
authors: S
authors: Lelorain
authors: Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057 - IUPDP, Boulogne-Billancourt, France.
authors: Anne
authors: A
authors: Brédart
authors: Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Universtity of Paris-Sud and University of Paris Descartes, UMR-S0669, Paris, France.
authors: Sylvie
authors: S
authors: Dolbeault
authors: Institut Curie, Psycho-oncology Unit, Paris, France.
authors: Alejandra
authors: A
authors: Cano
authors: University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France.
authors: Angélique
authors: A
authors: Bonnaud-Antignac
authors: University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France.
authors: Florence
authors: F
authors: Cousson-Gélie
authors: University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada.
authors: Serge
authors: S
authors: Sultan
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D004644:Emotions; D004645:Empathy; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D020377:Self Efficacy; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Expressive suppression; Oncology; Patient distress; Physician empathic accuracy; Rapport