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Cancer Docs' Bedside Manner Often Lacks Empathy

Study of physician-patient conversations shows oncologists could do better

WEDNESDAY, Dec. 19 (HealthDay News) -- Most cancer specialists do not respond to the emotional concerns of their patients with verbal expressions of empathy and support, a new study reveals.

The finding suggests that cancer patients' quality of life might be significantly improved if doctors were better trained to recognize and address patients' emotional concerns as they battle the disease.

"We audio-recorded doctor-patient interactions, and we analyzed them, and what we found is that when patients expressed negative emotions, doctors did not always respond empathetically," said study author Kathryn L. Pollak, an associate professor at Duke University Medical Center's Community and Family Medicine Department, in Durham, N.C.

Pollak's team published its findings in the Dec. 20 issue of the Journal of Clinical Oncology.

To assess the frequency of empathetic interactions in an oncology setting, the authors first surveyed 51 oncologists who were caring for a total of 270 cancer patients at Duke, the Durham Veterans Affairs Medical Center, or the University of Pittsburgh.

The physicians, mostly white and male, were questioned about their level of confidence in addressing patient concerns; their sense of how various communication approaches might affect a patient; and their general comfort level with psycho-social types of conversation.

As well, the doctors were asked if they felt they were more inclined toward the technological and scientific aspects of patient care or more disposed to focus on the social and emotional side of treatment.

The researchers also recorded almost 400 audiotapes of conversations that had taken place between physicians and patients.

All the patients had advanced-stage cancer, and their physicians indicated that they would not be surprised if they ended up dying from their illness within a year. Almost three-quarters of the patients were white, and they averaged a little over 60 years of age.

Most of the patients had established a relationship with their oncologist -- 90 percent said they had known their doctor for at least six months prior to the study.

According to the researchers, more than two-thirds of the physicians said they were oriented toward the technical aspects of patient care, but most were also highly confident in their ability to deal with patient concerns. Most of the doctors also believed they were comfortable with emotionally charged conversations.

Yet, after reviewing all the tapes, Pollak and her colleagues determined that cases in which doctors responded to patients' concerns with empathy were rare.

Fewer than 300 so-called "empathic opportunities" occurred during the almost 400 conversations. Such opportunities were defined as points at which a patient had verbally expressed negative emotions -- such as fear or worry -- to which the doctor could respond as he or she saw fit.

Female patients were more likely to express such feelings, particularly if their doctor was also female, the researchers observed.

When such emotions were expressed, almost three-quarters of the time, doctors chose to "terminate" the conversation by offering, for example, blanket reassurance that time would solve the problem.

Occasions in which doctors would empathetically promote "continuation" of the conversation by encouraging elaboration and/or expressing some form of understanding or support were far less frequent, occurring little more than a quarter of the time.

Oncologists who offered more empathic statements were younger than those who didn't, and those who stayed longer to converse with the distressed patient were more likely to have described themselves as highly focused on the emotional dimension of patient care.

The research team concluded that oncologists need better education to recognize and respond appropriately to patients' emotions.

"Oncologists clearly care about their patients," said Pollak. "They wouldn't go into oncology if they didn't. But oncology is a really challenging field, and, in general, oncologists have not been trained in how to communicate with patients. So, it's a pretty difficult situation for them."

"The good news is that the ability to communicate is something that can be taught," she added. "I wouldn't say it's an innate skill. Many doctors who say they are less comfortable conveying emotions with patients suffer from a lack of training. What they need is to be taught how to verbalize how they feel, and there have been several programs around the world that have shown that this kind of communication training can produce good communicators."

Pollak noted that she and her team are now conducting a follow-up study to see how communication skills might improve if oncologists were given personalized CD-Roms to screen video of their own interactions with patient. Data from the study has yet to be analyzed.

Another expert agreed that training could only help.

"The emphasis in medical school is not usually focused on the emotional side of things," noted Kevin Ochsner, an assistant professor of psychology at Columbia University, New York City. "It's about being able to get the diagnosis right. But, in fact, it's as important to communicate that a patient's feelings matter and are an important part of the equation as it is to convey the probability that a certain procedure will or will not have a positive outcome."

"Empathy," added Ochsner, "is the social glue that knits people together because the ability to connect with one another emotionally and to understand the feelings of one another promotes rapport and bonding. So, making patients feel that they're heard will help them feel secure and less anxious. It helps regulate their emotions, and this has all kinds of important mental and physical health effects."

More information

For more on physician empathy, visit the American Medical Association.

SOURCES: Kathryn L. Pollak, Ph.D., associate professor, Duke University Medical Center's Community and Family Medicine Department, Durham, N.C.; Kevin Ochsner, Ph.D., assistant professor, psychology, Columbia University, New York; Dec. 20, 2007, Journal of Clinical Oncology

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