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Oncologist Communication About Emotion During Visits With Patients With Advanced Cancer

Kathryn I. Pollak, Robert M. Arnold, Amy S. Jeffreys, Stewart C. Alexander, Maren K. Olsen, Amy P. Abernethy, Celette Sugg Skinner, Keri L. Rodriguez, James A. Tulsky

From the Duke Comprehensive Cancer Center, Cancer Prevention, Detection, and Control Research Program; the Department of Community and Family Medicine; the Department of Biostatistics and Bioinformatics; the Department of Medicine; the Center for Palliative Care, Duke University Medical Center; the Center for Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC; the Division of General Internal Medicine, Department of Medicine; the Institute for Doctor-Patient Communication; the Institute to Enhance Palliative Care, University of Pittsburgh School of Medicine; and the Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

Address reprint requests to Kathryn I. Pollak, PhD, Duke University Medical Center, Community and Family Medicine, 2424 Erwin Rd, Suite 602, Durham, NC 27705; e-mail: polla007{at}mc.duke.edu

Introduction Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses.

Patients and Methods We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care.

Results In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements.

Conclusion Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.

Supported by National Cancer Institute Grant No. R01CA100387.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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