Oncologist Communication About Emotion During Visits With Patients With Advanced Cancer

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

doi:10.1200/jco.2007.12.4180

Cited by 347 publications

(262 citation statements)

References 27 publications

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“…Regarding source of emotion (i.e. cues elicited by patients versus clinicians), Pollack et al found that, when patients initiated negative emotions, oncologists responded with a terminator statement 73% of the time, to discourage further disclosure of emotions [15]. Similar findings were reported in more recent studies, where a multilevel approach was adopted to respect the clustered nature of the data contained within the consultation [16,17].…”

Section: Introductionsupporting

confidence: 62%

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How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations: a multilevel study

Zhou

Humphris

Ghazali

et al. 2014

Eur Arch Otorhinolaryngol

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Abstract:Objectives: Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional wellbeing) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress.Methods: Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence (VR-CoDES). Multilevel logistic regression modelled the probability of the occurrence of consultant reduce space response as a function of patient distress cue expression, controlling for consultation and patient-related variables.Results: An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional wellbeing. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduce space response was more pronounced as the consultation continued. However, about six minutes into the consultation, this effect (i.e. tendency to block patients) started to weaken.Conclusions: Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.

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Section: Introductionsupporting

confidence: 62%

“…utterance) level, source [15][16][17], type [18,19] and timing [17,19] of emotional expression were found to be important predictors for clinicians' responses. Regarding source of emotion (i.e.…”

Section: Introductionmentioning

confidence: 99%

How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations: a multilevel study

Zhou

Humphris

Ghazali

et al. 2014

Eur Arch Otorhinolaryngol

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“…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]. Research shows that when clinicians repeatedly miss patients' expressions of emotion, patients eventually cease to express emotion [56].…”

Section: Discussionmentioning

confidence: 99%

“…Given the methodology of our study, we cannot know how many patients were concerned about death and dying. However, past studies indicate that patients who described their concerns about symptoms and medical issues narrowly might have given a fuller account if their oncologists had responded empathically to their expressions of emotion [36,42].…”

Section: Discussionmentioning

confidence: 99%

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

Anderson

Alexander

Rodriguez

et al. 2007

Support Care Cancer

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Objective-Cancer patients have high levels of distress, yet oncologists often do not recognize patients' concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists. Materials and methods-As part of the Studying Communication in Oncologist-PatientEncounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content.

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“…Overall, survey data indicate that oncologists from Western countries are more disclosive than those practicing in nonWestern countries [61], and that other factors such as sex [61], age [61], training in the communication of bad news [4,[69][70][71][72], and frequent requests from family members for non-disclosure [40,55,73] may affect attitudes and actual clinical behaviors.…”

mentioning

confidence: 99%

Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer

Cherny

2010

Psycho-Oncology

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Objective: To evaluate the attitudes of the European Oncologists to information disclosure to patients with advanced cancer, their self-reported behaviors, and the factors that influence both attitudes and behaviors.Methods: ESMO members were invited to complete an online questionnaire to evaluate both attitudes and clinical behaviors relating to the disclosure of information to patients with advanced cancer. Data were analyzed to evaluate demographic, educational and social factors influencing attitudes and behaviors.Results: Two hundred and ninety-eight completed surveys were returned. The survey demonstrated strong internal consistency construct validity. The responses indicate that individual clinicians generally display a range of behaviors including non-disclosive as well as disclosive behaviors depending on the dynamics of individual interactions between oncologist and specific patient. Although regional cultural norms influence oncologists' attitudes toward disclosure and, indirectly, their self-reported behaviors, the impact is influenced by other factors: in particular, perceived institutional professional norms, the degree of training in breaking bad news and the frequency of exposure to requests by family members to withhold information from the patient.Conclusions: Positive attitudes regarding disclosure of information to patients and disclosive behaviors can be encouraged, even in non-Western countries, by the development of strong professional norms and education in breaking bad news and coping with the emotional responses of patients.

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Oncologist Communication About Emotion During Visits With Patients With Advanced Cancer

Cited by 347 publications

References 27 publications

How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations: a multilevel study

How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations: a multilevel study

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

Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer

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