Supportive Care in Cancer

, Volume 26, Issue 3, pp 957–965 | Cite as

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

  • Chetna MalhotraEmail author
  • Ravindran Kanesvaran
  • Lalit Krishna
  • Ling Xiang
  • Nesaretnam Barr Kumarakulasinghe
  • Sing-Huang Tan
  • James A. Tulsky
  • Kathryn I. Pollak
Original Article



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.


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.


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.


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.


Negative emotion Empathy Communication Caregiver Cancer Oncology 


Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Chetna Malhotra
    • 1
    Email author
  • Ravindran Kanesvaran
    • 2
  • Lalit Krishna
    • 2
    • 3
  • Ling Xiang
    • 1
  • Nesaretnam Barr Kumarakulasinghe
    • 4
  • Sing-Huang Tan
    • 5
  • James A. Tulsky
    • 6
    • 7
  • Kathryn I. Pollak
    • 8
    • 9
  1. 1.Lien Centre for Palliative CareDuke-NUS Medical SchoolSingaporeSingapore
  2. 2.National Cancer Centre SingaporeSingaporeSingapore
  3. 3.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  4. 4.National University Cancer Institute Singapore (NCIS)National University HospitalSingaporeSingapore
  5. 5.OncoCare Cancer CentreGleneagles Medical CentreSingaporeSingapore
  6. 6.Dana-Farber Cancer InstituteBostonUSA
  7. 7.Brigham and Women’s HospitalBostonUSA
  8. 8.Cancer Control and Population SciencesDuke Cancer InstituteDurhamUSA
  9. 9.Community and Family MedicineDuke UniversityDurhamUSA

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