Cancer Patients' Emotional Concerns Frequently Go Unrecognized By Their Doctors

Oncologists do not always respond to patients' expressions of negative emotion and may need to learn to demonstrate greater empathy, according to a new study led by Duke University Medical Center researchers.

"Effective communication between oncologists and their patients -- especially those with advanced cancer -- is essential to good care, yet challenging for both doctors and patients," said James Tulsky, M.D., director of Duke's Center for Palliative Care and senior investigator on the study. "However, many oncologists have never been trained to respond to patient emotions and concerns in a manner that shows their empathy. By teaching physicians to use explicit empathic language when communicating with distressed patients, we have a chance to improve patient quality of life."

The researchers published their findings in the December 20, 2007 issue of the Journal of Clinical Oncology. The study was funded by the National Cancer Institute.

The researchers audio-recorded nearly 400 conversations between 51 oncologists and their patients with advanced cancer in clinics at Duke, the Durham Veterans Administration Medical Center and the University of Pittsburgh Medical Center. The researchers coded when patients expressed negative emotions -- termed "empathic opportunities" -- and how doctors responded.

Patients can create empathic opportunities by expressing negative emotions, such as fear or worry, either directly or indirectly, Tulsky said.

"If the patient explicitly stated an emotion, such as, 'I have been really depressed lately,' we considered that a direct empathic opportunity," said Kathryn Pollak, Ph.D., a social psychologist at Duke and lead investigator on the study. "The question, 'Does this mean I'm going to die?' would be an example of an indirect empathic opportunity."

Doctors were considered to have an empathic response if they responded to the opportunity by legitimizing the emotion, praising the patient for his or her strength, showing support or asking the patient to elaborate, Pollak said.

"When patients expressed negative emotions, oncologists responded empathically only 22 percent of the time," Pollak said. "Interestingly, we found that female patients, particularly those speaking with female oncologists, were more likely to express negative emotions than their male counterparts."

Doctors who were younger or had previously identified themselves as more emotional than technical were also more likely to use empathic language, she said.

"The goal of the study was to assess how oncologists address patient negative emotion, and the results demonstrate a need for interventions to train clinicians and patients to handle negative emotions when they arise in clinic interactions," Pollak said.

She said that clinicians may be able to attend educational retreats addressing communication skills, but the time commitment is more than many oncologists can spare.

"We have designed an intervention that we are now studying which provides clinicians with personalized CD-Roms that highlight examples in which they responded empathically and also areas for improvement," Pollak said. "We are optimistic that this intervention will be a possible step toward a solution for this difficult and important problem."