Communication: Observational StudyNegative emotions in cancer care: Do oncologists’ responses depend on severity and type of emotion?
Introduction
Patients with advanced cancer often experience strong emotions such as sadness, anxiety, and fear which, if unaddressed, can impair function and emotional well being and may negatively affect survival [1], [2], [3]. Many patients find relief in discussing emotional concerns with their oncologists and prefer seeing physicians who are willing to address such concerns [4]. Additionally, when oncologists attend to distress, patients receive tangible benefits; they report improved quality of life, adherence to treatment plans, overall satisfaction, and willingness to disclose future concerns [1], [5], [6].
When patients discuss feelings with their oncologists, doctors can respond in a number of ways, including acknowledging the emotion by offering an empathic response or ignoring the emotion through blocking or distancing behaviors [7]. Empathic responses let patients know they have been heard and may allow, or even encourage, them to continue sharing their concerns. Unfortunately, research shows that oncologists often ignore rather than address the emotion [8], [9], [10]. There are several possible explanations. Oncologists may not recognize patients’ emotions, worry that addressing emotions takes too much time, or fear becoming emotionally involved in patients’ distress [10].
In recent years, the medical community has focused on understanding and improving physicians’ abilities to recognize and respond to patients’ emotions [11], [12], [13]. However, there is a lack of data to document how oncologists respond to different types and severity levels of emotion, or whether various types of emotions trigger different responses from doctors. The current research on “empathic opportunities” treats all emotions equally, despite a wide range in both the type and intensity of emotions patients express. A patient's fear about her life ending before seeing her daughter graduate from high school likely warrants a different response than her frustration that low blood counts will postpone her chemotherapy treatment.
Further, existing literature has shown that empathic responses by physicians facilitate patient discussion of emotions [14], [15]; however, there is little empirical evidence identifying which types of emotional disclosures prompt oncologists’ empathic responses. We conducted this study to identify which negative emotions are most likely to elicit empathic language from oncologists, and to determine how the conversation proceeds after an oncologist responds empathically to a patient.
Section snippets
Participants
Data for this report were collected as part of the Study of Communication in Oncologist–Patient Encounters (SCOPE), a three-site project analyzing audio-recorded conversations between advanced cancer patients and their oncologists from Duke University Medical Center (DUMC), the Durham Veterans Affairs Medical Center (DVAMC), and the University of Pittsburgh Medical Center (UPMC). Results reported in this manuscript represent data collected in the clinical trial portion of the SCOPE study.
Demographics
Forty-eight oncologists completed the study. We recorded a range of 1–7 conversations from each oncologist (mean = 5.5) with a total of 264 patients (one recording per patient). One hundred thirty five of these patients disclosed at least one negative emotion to their oncologist. Patient and oncologist background characteristics are presented in Table 2.
Empathic opportunities
We identified 275 empathic opportunities in a total of 264 conversations. About half of the conversations (N = 135) had at least one empathic
Discussion
We analyzed conversations between advanced cancer patients and their oncologists for discussions of negative emotion and made several observations. First, these patients most often expressed fear, and emotional disclosures were most often of moderate severity. Second, oncologists seemed to have trouble both in recognizing patients’ expressions of negative emotion and in acknowledging and responding to the emotion; when they did respond empathically, they were most responsive when patients
Acknowledgement
This work has been funded by a grant from the National Cancer Institute (R01-CA100387).
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