How to recognize and manage psychological distress in cancer patients

Abstract

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

“…Physician behaviors also influence patients' disclosure of concerns and distress. When physicians focus on psychosocial aspects of care, use open-ended questions, listen actively, and make empathic statements, their patients are more likely to express distress and concerns [36,48]. An analysis of the oncologists' behaviors in the recordings used in this study is reported elsewhere; in that analysis, oncologists responded empathically to patients' expressions of emotion less than one third of the time [42].…”

“…Patients may not discuss emotional issues because they do not feel it is their oncologists' role to address them [48]. Physician behaviors also influence patients' disclosure of concerns and distress.…”

“…First, we only coded the verbal expression of emotion. Although verbal expressions of emotion are the easiest to detect, they are less sensitive than tone of voice and nonverbal expressions, such as facial expressions and body language [12,48]. Second, we only coded negative emotions.…”

“…Patients express emotion in a variety of ways-through words, tone of voice, facial expressions, and body language [46]. Of these methods, direct verbal expression, where patients name the emotion they are experiencing, is not only the most overt and thus easiest to recognize, but also the most highly correlated with self-reported distress [12,48].…”

Understanding and Addressing the Informational Needs of Radiation Therapists Concerning the Management of Anxiety and Depression in Patients Receiving Radiation Therapy Treatment

“…A diagnosis of cancer causes some level of emotional distress in all people with some individuals experience major depression and anxiety symptoms [1,2,3] as a result of the diagnosis, treatment(s) and co-morbidities. It has been found that as many as thirty-five percent (35%) of cancer patients experience clinically significant distress [4].…”