title: A content analysis of emotional concerns expressed at the time of receiving a cancer diagnosis: An observational study of consultations with adolescent and young adult patients and their family members.
abstract: OBJECTIVE
  Little is known about the emotional concerns expressed by adolescent and young adult (AYA) patients in consultations when a diagnosis of cancer is delivered. Here, we investigated the content of such concerns and how health care providers respond to them.
  
  
  METHODS
  We audio-recorded nine consultations with AYA cancer patients (ages: 12-25 years) at the time of diagnosis. We have previously identified and coded 135 emotional concerns and the responses to these in the nine consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) framework. Here, we used qualitative content analysis to study these emotional concerns and categorize them according to overarching themes. We then quantitatively explored associations between the themes of the concerns and whether the responses to them varied according to their themes.
  
  
  RESULTS
  We identified four themes for the content of concerns: "Side-effects/late-effects" (39%), "What happens in the near future/practical aspects" (16%), "Fear" (27%) and "Sadness" (17%) (e. g. crying, sighing or other sounds that expressed sadness). Health care providers' responses did not appear to vary according to the different themes of concerns, but typically consisted of providing medical information.
  
  
  CONCLUSIONS
  The content analysis revealed that patients and family members expressed a wide range of emotional concerns. Health care providers tended to respond to the content-aspect of the concerns, but did rarely explicitly acknowledge the affective-aspect of the concerns. The effect of responses to patients' emotional concerns in the important first consultations about the cancer diagnosis and planned treatment should be investigated in future studies.
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Paediatric Medicine, Children's and Adolescents Division, Oslo University Hospital, Norway. Electronic address: live.korsvold@medisin.uio.no.
authors.forename: Live
authors.initials: L
authors.lastname: Korsvold
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway. Electronic address: anneli.mellblom@medisin.uio.no.
authors.forename: Anneli Viktoria
authors.initials: AV
authors.lastname: Mellblom
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway. Electronic address: arnstein.finset@medisin.uio.no.
authors.forename: Arnstein
authors.initials: A
authors.lastname: Finset
authors.affiliation: Department of Paediatric Medicine, Children's and Adolescents Division, Oslo University Hospital, Norway. Electronic address: elruud@ous-hf.no.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ruud
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Paediatric Medicine, Children's and Adolescents Division, Oslo University Hospital, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Radiumhospitalet, Norway. Electronic address: h.c.lie@medisin.uio.no.
authors.forename: Hanne Cathrine
authors.initials: HC
authors.lastname: Lie
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003142:Communication; D004644:Emotions; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009664:Norway; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D014743:Videotape Recording; D055815:Young Adult
keywords: Adolescents and young adults; Cancer; Clinician-patient relationship; Emotional communication; Empathy