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Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting

Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Patients with advanced cancer and their caregivers experience many negative emotions. Empathic responses from oncologists can help alleviate their distress. We aimed to assess expressions of negative emotions among patients with advanced cancer and their caregivers and oncologists’ empathic responses during consultations in an Asian setting. We also assessed the association between oncologists’ expression of empathy and patients’ and caregivers’ perception of communication quality.

Methods

We surveyed 100 patients with advanced cancer and their caregivers and audio recorded consultations with their oncologists. We coded expressions of negative emotions by patients and caregivers and oncologists’ empathic responses. We also surveyed participating oncologists (n = 30) about their confidence in expressing empathy and perceived communication behavior outcomes.

Results

About 52% of patients and 49% of caregivers expressed at least one negative emotion during the consultation, though 59% of patients and 48% of caregivers reported not wanting to discuss negative emotions. Oncologists responded empathically to 12% of patients’ negative emotions and 9% of caregivers’ negative emotions, despite 92% of them reporting confidence in expressing empathy. Oncologists’ expression of empathy did not vary significantly by patient, caregiver, or their own demographic characteristics. It also did not differ based on their confidence in expressing empathy and positive outcome expectations. When oncologists responded empathically just one time, patients perceived communication more favorably.

Conclusions

In this Asian setting, patients and caregivers commonly expressed negative emotions. Oncologists’ expressed empathy infrequently, although when they were empathic, it was related to improved patient perception of communication quality.

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References

  1. Aass N, Fossa SD, Dahl AA, Moe TJ (1997) Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer 33:1597–1604

    Article  CAS  PubMed  Google Scholar 

  2. Ciaramella A, Poli P (2001) Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 10:156–165

    Article  CAS  PubMed  Google Scholar 

  3. Segrin C, Badger T, Dorros SM, Meek P, Lopez AM (2007) Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psychooncology 16:634–643

    Article  PubMed  Google Scholar 

  4. Bruce M (2006) A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev 26:233–256

    Article  PubMed  Google Scholar 

  5. Hodges LJ, Humphris GM, Macfarlane G (2005) A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 60:1–12

    Article  CAS  PubMed  Google Scholar 

  6. Adams K, Cimino JE, Arnold RM, Anderson WG (2012) Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters. Patient Educ Couns 89:44–50

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, Pollak KI (2011) Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med 155:593–601

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kennifer SL, Alexander SC, Pollak KI, Jeffreys AS, Olsen MK, Rodriguez KL, Arnold RM, Tulsky JA (2009) Negative emotions in cancer care: do oncologists’ responses depend on severity and type of emotion? Patient Educ Couns 76:51–56

    Article  PubMed  Google Scholar 

  9. Morse DS, Edwardsen EA, Gordon HS (2008) Missed opportunities for interval empathy in lung cancer communication. Arch Intern Med 168:1853–1858

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Sugg Skinner C, Rodriguez KL, Tulsky JA (2007) Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol 25:5748–5752

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Ishikawa H, Takayama T, Yamazaki Y, Seki Y, Katsumata N (2002) Physician-patient communication and patient satisfaction in Japanese cancer consultations. Soc Sci Med 55:301–311

    Article  PubMed  Google Scholar 

  14. Suh DH, Hong JS, Lee DH, Gonnella JS, Hojat M (2012) The Jefferson Scale of Physician Empathy: a preliminary psychometric study and group comparisons in Korean physicians. Med Teach 34:e464–e468

    Article  PubMed  Google Scholar 

  15. Guy GP Jr, Richardson LC (2012) Visit duration for outpatient physician office visits among patients with cancer. Am J Manag Care 18:Sp49–Sp56

    PubMed  Google Scholar 

  16. Schouten BC, Meeuwesen L (2006) Cultural differences in medical communication: a review of the literature. Patient Educ Couns 64:21–34

    Article  PubMed  Google Scholar 

  17. Tsai JL, Chentsova-Dutton Y, Freire-Bebeau L, Przymus DE (2002) Emotional expression and physiology in European Americans and Hmong Americans. Emotion 2:380–397

    Article  PubMed  Google Scholar 

  18. Markus HR, Kitayama S (1991) Culture and the self: implications for cognition, emotion, and motivation. Psychol Rev 98:224

    Article  Google Scholar 

  19. Keller H, Otto H (2009) The cultural socialization of emotion regulation during infancy. J Cross-Cult Psychol 40:996–1011

    Article  Google Scholar 

  20. 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 20:813–819

    Article  PubMed  Google Scholar 

  21. Siminoff LA, Graham GC, Gordon NH (2006) Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns 62:355–360

    Article  PubMed  Google Scholar 

  22. Pollak KI, Arnold R, Alexander SC, Jeffreys AS, Olsen MK, Abernethy AP, Rodriguez KL, Tulsky JA (2010) Do patient attributes predict oncologist empathic responses and patient perceptions of empathy? Support Care Cancer 18:1405–1411

    Article  PubMed  Google Scholar 

  23. Ammentorp J, Sabroe S, Kofoed PE, Mainz J (2007) The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy. A randomized controlled trial. Patient Educ Couns 66:270–277

    Article  PubMed  Google Scholar 

  24. Fujimori M, Shirai Y, Asai M, Akizuki N, Katsumata N, Kubota K, Uchitomi Y (2014) Development and preliminary evaluation of communication skills training program for oncologists based on patient preferences for communicating bad news. Palliat Support Care 12:379–386

    Article  PubMed  Google Scholar 

  25. Uitterhoeve RJ, Bensing JM, Grol RP, Demulder PH, V.A.N.A. T (2010) The effect of communication skills training on patient outcomes in cancer care: a systematic review of the literature. Eur J Cancer Care (Engl) 19:442–457

    Article  CAS  Google Scholar 

  26. Bensing J (1991) Doctor-patient communication and the quality of care. Soc Sci Med 32:1301–1310

    Article  CAS  PubMed  Google Scholar 

  27. Maguire P, Pitceathly C (2002) Key communication skills and how to acquire them. BMJ 325:697–700

    Article  PubMed  PubMed Central  Google Scholar 

  28. Maguire P (1985) Barriers to psychological care of the dying. Br Med J (Clin Res Ed) 291:1711–1713

    Article  CAS  Google Scholar 

  29. Parle M, Maguire P, Heaven C (1997) The development of a training model to improve health professionals’ skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 44:231–240

    Article  CAS  PubMed  Google Scholar 

  30. Makoul G, Krupat E, Chang CH (2007) Measuring patient views of physician communication skills: development and testing of the communication assessment tool. Patient Educ Couns 67:333–342

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  32. Smith RC, Hoppe RB (1991) The patient’s story: integrating the patient- and physician-centered approaches to interviewing. Ann Intern Med 115:470–477

    Article  CAS  PubMed  Google Scholar 

  33. Takayama T, Yamazaki Y, Katsumata N (2001) Relationship between outpatients’ perceptions of physicians’ communication styles and patients’ anxiety levels in a Japanese oncology setting. Soc Sci Med 53:1335–1350

    Article  CAS  PubMed  Google Scholar 

  34. Stewart MA (1984) What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sci Med 19:167–175

    Article  CAS  PubMed  Google Scholar 

  35. Themessl-Huber M, Humphris G, Dowell J, Macgillivray S, Rushmer R, Williams B (2008) Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies. Patient Educ Couns 71:157–168

    Article  PubMed  Google Scholar 

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Correspondence to Chetna Malhotra.

Ethics declarations

All oncologists, patients, and caregivers provided written informed consent. The study was approved by the SingHealth Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest. The corresponding author has full control of all primary data and agrees to allow the journal to review data if requested.

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Malhotra, C., Kanesvaran, R., Krishna, L. et al. Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting. Support Care Cancer 26, 957–965 (2018). https://doi.org/10.1007/s00520-017-3916-0

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  • DOI: https://doi.org/10.1007/s00520-017-3916-0

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