nach oben

Erschienen in:

01.07.2008 | Original Article

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

verfasst von: Wendy G. Anderson, Stewart C. Alexander, Keri L. Rodriguez, Amy S. Jeffreys, Maren K. Olsen, Kathryn I. Pollak, James A. Tulsky, Robert M. Arnold

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2008

Einloggen, um Zugang zu erhalten

Abstract

Objective

Cancer patients have high levels of distress, yet oncologists often do not recognize patients’ concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists.

Materials and methods

As part of the Studying Communication in Oncologist–Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content.

Results

Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: “concern,” “scared,” “worried,” “depressed,” and “nervous.” Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time.

Conclusions

Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.

Dictionary.com Unabridged (v 1.1) from Dictionary.com website: http://dictionary.reference.com

Roget’s New Millennium™ Thesaurus, First Edition (v 1.3.1) from Thesaurus.com website: http://thesaurus.reference.com

Badger TA, Braden CJ, Mishel MH (2001) Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum 28:567–574PubMed

Badger TA, Braden CJ, Mishel MH, Longman A (2004) Depression burden, psychological adjustment, and quality of life in women with breast cancer: patterns over time. Res Nurs Health 27:19–28PubMedCrossRef

Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284:2907–2911PubMedCrossRef

Butow PN, Brown RF, Cogar S, Tattersall MH, Dunn SM (2002) Oncologists’ reactions to cancer patients’ verbal cues. Psychooncology 11:47–58PubMedCrossRef

Chaturvedi SK, Shenoy A, Prasad KM, Senthilnathan SM, Premlatha BS (1996) Concerns, coping and quality of life in head and neck cancer patients. Support Care Cancer 4:186–190PubMedCrossRef

Clayton JM, Butow PN, Arnold RM, Tattersall MH (2005) Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer 103:1965–1975PubMedCrossRef

Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRef

10.

Corbin J, Strauss A (1990) Basics of qualitative research: grounded theory, procedures and techniques. Sage, Thousand Oaks, CA

11.

Crabtree BF, Miller W (1992) Doing qualitative research. Sage, Newbury Park, CA

12.

Davenport S, Goldberg D, Millar T (1987) How psychiatric disorders are missed during medical consultations. Lancet 2:439–441PubMedCrossRef

13.

Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL Jr (1983) The prevalence of psychiatric disorders among cancer patients. JAMA 249:751–757PubMedCrossRef

14.

Detmar SB, Muller MJ, Wever LD, Schornagel JH, Aaronson NK (2001) The patient–physician relationship. Patient–physician communication during outpatient palliative treatment visits: an observational study. JAMA 285:1351–1357PubMedCrossRef

15.

DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107PubMedCrossRef

16.

Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015PubMedCrossRef

17.

Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet 359:650–656PubMedCrossRef

18.

Farrell C, Heaven C, Beaver K, Maguire P (2005) Identifying the concerns of women undergoing chemotherapy. Patient Educ Couns 56:72–77PubMedCrossRef

19.

Fawzy FI, Fawzy NW, Hyun CS, Elashoff R, Guthrie D, Fahey JL, Morton DL (1993) Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 50:681–689PubMed

20.

Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR (1999) Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol 17:371–379PubMed

21.

Ford S, Fallowfield L, Lewis S (1994) Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations? Br J Cancer 70:767–770PubMed

22.

Fulop G, Strain JJ, Vita J, Lyons JS, Hammer JS (1987) Impact of psychiatric comorbidity on length of hospital stay for medical/surgical patients: a preliminary report. Am J Psychiatry 144:878–882PubMed

23.

George LK (2002) Research design in end-of-life research: state of science. Gerontologist 42(3):86–98PubMed

24.

Grabsch B, Clarke DM, Love A, McKenzie DP, Snyder RD, Bloch S, Smith G, Kissane DW (2006) Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey. Palliat Support Care 4:47–56PubMedCrossRef

25.

Hagerty RG, Butow PN, Ellis PA, Lobb EA, Pendlebury S, Leighl N, Goldstein D, Lo SK, Tattersall MH (2004) Cancer patient preferences for communication of prognosis in the metastatic setting. J Clin Oncol 22:1721–1730PubMedCrossRef

26.

Heaven CM, Maguire P (1998) The relationship between patients’ concerns and psychological distress in a hospice setting. Psychooncology 7:502–507PubMedCrossRef

27.

Kissane DW, Clarke DM, Ikin J, Bloch S, Smith GC, Vitetta L, McKenzie DP (1998) Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Med J Aust 169:192–196PubMed

28.

Koropchak CM, Pollak KI, Arnold RM, Alexander SC, Skinner CS, Olsen MK, Jeffreys AS, Rodriguez KL, Abernethy AP, Tulsky JA (2006) Studying communication in oncologist patient encounters: The SCOPE Trial. Palliat Med 20:813–819PubMedCrossRef

29.

Kristjanson LJ (1993) Validity and reliability testing of the FAMCARE Scale: measuring family satisfaction with advanced cancer care. Soc Sci Med 36:693–701PubMedCrossRef

30.

Kurtz ME, Kurtz JC, Given CW, Given B (1995) Relationship of caregiver reactions and depression to cancer patients’ symptoms, functional states and depression—a longitudinal view. Soc Sci Med 40:837–846PubMedCrossRef

31.

Landis R, Koch G (1977) An Application of Hierarchical Kappa-type Statistics in the Assessment of Majority Agreement among Multiple Observers. Biometrics 33:363–374PubMedCrossRef

32.

Leech G, Rayson P, Wilson A (2001) Word frequencies in written and spoken English: based on the British National Corpus. Longman, London

33.

Levenson JL, Hamer RM, Rossiter LF (1990) Relation of psychopathology in general medical inpatients to use and cost of services. Am J Psychiatry 147:1498–1503PubMed

34.

Levinson W, Gorawara-Bhat R, Lamb J (2000) A study of patient clues and physician responses in primary care and surgical settings. JAMA 284:1021–1027PubMedCrossRef

35.

Loberiza FR Jr, Rizzo JD, Bredeson CN, Antin JH, Horowitz MM, Weeks JC, Lee SJ (2002) Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 20:2118–2126PubMedCrossRef

36.

Maguire P, Faulkner A, Booth K, Elliott C, Hillier V (1996) Helping cancer patients disclose their concerns. Eur J Cancer 32A:78–81PubMedCrossRef

37.

Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J, Etienne AM, Klastersky J, Reynaert C, Scalliet P, Slachmuylder JL, Razavi D (2005) Factors that influence physicians’ detection of distress in patients with cancer: can a communication skills training program improve physicians’ detection? Cancer 104:411–421PubMedCrossRef

38.

Parle M, Jones B, Maguire P (1996) Maladaptive coping and affective disorders among cancer patients. Psychol Med 26:735–744PubMedCrossRef

39.

Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16:1594–1600PubMed

40.

Patton M (1999) Enhancing the quality and credibility of qualitative analysis. Health Serv Res 34:1189–1208PubMed

41.

Pfeifer MP, Mitchell CK, Chamberlain L (2003) The value of disease severity in predicting patient readiness to address end-of-life issues. Arch Intern Med 163:609–612PubMedCrossRef

42.

Pollak K, Arnold R, Jeffreys A, Alexander S, Olsen M, Abernethy A, Skinner C, Rodriguez K, Tulsky J (2007) Oncologist communication about emotion during visits with advanced cancer patients. J Clin Oncol (in press)

43.

Pringle M, Stewart-Evans C (1990) Does awareness of being video recorded affect doctors’ consultation behaviour? Br J Gen Pract 40:455–458PubMed

44.

Roethlisberger FH, Dickson WJ (1939) Management and the Worker. Harvard University Press, Cambridge, MA

45.

Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP (1995) Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med 155:1877–1884PubMedCrossRef

46.

Roter DL, Frankel RM, Hall JA, Sluyter D (2006) The expression of emotion through nonverbal behavior in medical visits. Mechanisms and outcomes. J Gen Intern Med 21(1):S28–S34PubMedCrossRef

47.

Russell JA (1989) Measures of emotion. In: Plutchik R, Kellerman H (eds) Emotion, Theory, Research, and Experience vol 4: The Measurement of Emotions. Academic, New York

48.

Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, Girgis A, Bandaranayake D, Bowman D (2005) How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care (Engl) 14:7–15CrossRef

49.

Schofield PE, Butow PN, Thompson JF, Tattersall MH, Beeney LJ, Dunn SM (2003) Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol 14:48–56PubMedCrossRef

50.

Simon GE, VonKorff M, Barlow W (1995) Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry 52:850–856PubMed

51.

Sollner W, DeVries A, Steixner E, Lukas P, Sprinzl G, Rumpold G, Maislinger S (2001) How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counseling? Br J Cancer 84:179–185PubMedCrossRef

52.

Spiegel D, Bloom JR, Kraemer HC, Gottheil E (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2:888–891PubMedCrossRef

53.

Spiegel D (1996) Cancer and depression. Br J Psychiatry 109–116

54.

Stark D, Kiely M, Smith A, Velikova G, House A, Selby P (2002) Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 20:3137–3148PubMedCrossRef

55.

Strongman KT (2003) The Psychology of Emotion: From Everyday Life to Theory. Wiley, Chichester, West Sussex, England

56.

Suchman AL, Markakis K, Beckman HB, Frankel R (1997) A model of empathic communication in the medical interview. JAMA 277:678–682PubMedCrossRef

57.

Valdimarsdottir U, Helgason AR, Furst CJ, Adolfsson J, Steineck G (2002) The unrecognised cost of cancer patients’ unrelieved symptoms:a nationwide follow-up of their surviving partners. Br J Cancer 86:1540–1545PubMedCrossRef

58.

Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J (1989) The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA 262:914–919PubMedCrossRef

59.

Wenrich MD, Curtis JR, Shannon SE, Carline JD, Ambrozy DM, Ramsey PG (2001) Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Arch Intern Med 161:868–874PubMedCrossRef

60.

Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28PubMedCrossRef

Titel: “What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits
verfasst von: Wendy G. Anderson
Stewart C. Alexander
Keri L. Rodriguez
Amy S. Jeffreys
Maren K. Olsen
Kathryn I. Pollak
James A. Tulsky
Robert M. Arnold
Publikationsdatum: 01.07.2008
Verlag: Springer-Verlag
Erschienen in: Supportive Care in Cancer / Ausgabe 7/2008
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-007-0350-8

Springer Medizin

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits