title: Emotional concerns in follow-up consultations between paediatric oncologists and adolescent survivors: a video-based observational study.
abstract: OBJECTIVE
  The present study aimed to explore (a) to what extent adolescent cancer survivors express emotional concerns during follow-up consultations, (b) the content of these expressions, and (c) the responses to their concerns by the paediatric haemato-oncologists (oncologists).
  
  
  METHODS
  Sixty-six follow-up consultations between adolescent patients (aged 12-20 years old; mean = 16) and oncologists (n = 10) were video recorded. Emotional concerns were coded using the Verona coding definitions of emotional sequences (VR-CoDES). The content of the concerns was analysed using thematic analysis.
  
  
  RESULTS
  Emotional concerns (n = 115) were identified in 50% of the consultations. Of the concerns, 87% were expressed implicitly as hints to the underlying emotion (cues) rather than explicitly (concerns). The oncologists elicited 66.9% of these expressions. Four main categories of emotional concerns were identified in the thematic analysis: physical (31%), psychological (29%), social (17%), and cancer related (23%). The majority (76.5%) of the oncologists' responses to the cues and/or concerns provided space for further disclosure. The oncologists responded less explicitly to the emotional aspects of physical and cancer-related issues in comparison with the cues or concerns of psychological origin. More cues and concerns were expressed when parents were not present in the consultation.
  
  
  CONCLUSIONS
  In this study, almost half of the adolescent patients presented emotional concerns, and a subgroup presented many concerns; these were mainly expressed when initiated by the oncologists. Oncologists should therefore be attentive to hints to underlying emotions to help the adolescent bring forward his or her concerns.
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: A V
authors.initials: AV
authors.lastname: Mellblom
authors.forename: A
authors.initials: A
authors.lastname: Finset
authors.forename: L
authors.initials: L
authors.lastname: Korsvold
authors.forename: J H
authors.initials: JH
authors.lastname: Loge
authors.forename: E
authors.initials: E
authors.lastname: Ruud
authors.forename: H C
authors.initials: HC
authors.lastname: Lie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003463:Cues; D004644:Emotions; D005260:Female; D006801:Humans; D007938:Leukemia / Q000523:psychology*; D008223:Lymphoma / Q000523:psychology*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D017741:Survivors / Q000523:psychology*; D014741:Video Recording; D055815:Young Adult
keywords: cancer; clinician-patient relationship; communication; emotion; oncology