Negative emotions in cancer care: Do oncologists’ responses depend on severity and type of emotion?

Abstract

Objective

To examine how type and severity of patients’ negative emotions influence oncologists’ responses and subsequent conversations.

Methods

We analyzed 264 audio-recorded conversations between advanced cancer patients and their oncologists. Conversations were coded for patients’ expressions of negative emotion, which were categorized by type of emotion and severity. Oncologists’ responses were coded as using either empathic language or blocking and distancing approaches.

Results

Patients presented fear more often than anger or sadness; severity of disclosures was most often moderate. Oncologists responded to 35% of these negative emotional disclosures with empathic language. They were most empathic when patients presented intense emotions. Responding empathically to patients’ emotional disclosures lengthened discussions by an average of only 21 s.

Conclusion

Greater response rates to severe emotions suggest oncologists may recognize negative emotions better when patients express them more intensely. Oncologists were least responsive to patient fear and responded with greatest empathy to sadness.

Practice implications

Oncologists may benefit from additional training to recognize negative emotions, even when displayed without intensity. Teaching cancer patients to better articulate their emotional concerns may also enhance patient–oncologist communication.

Introduction

Patients with advanced cancer often experience strong emotions such as sadness, anxiety, and fear which, if unaddressed, can impair function and emotional well being and may negatively affect survival [1], [2], [3]. Many patients find relief in discussing emotional concerns with their oncologists and prefer seeing physicians who are willing to address such concerns [4]. Additionally, when oncologists attend to distress, patients receive tangible benefits; they report improved quality of life, adherence to treatment plans, overall satisfaction, and willingness to disclose future concerns [1], [5], [6].

When patients discuss feelings with their oncologists, doctors can respond in a number of ways, including acknowledging the emotion by offering an empathic response or ignoring the emotion through blocking or distancing behaviors [7]. Empathic responses let patients know they have been heard and may allow, or even encourage, them to continue sharing their concerns. Unfortunately, research shows that oncologists often ignore rather than address the emotion [8], [9], [10]. There are several possible explanations. Oncologists may not recognize patients’ emotions, worry that addressing emotions takes too much time, or fear becoming emotionally involved in patients’ distress [10].

In recent years, the medical community has focused on understanding and improving physicians’ abilities to recognize and respond to patients’ emotions [11], [12], [13]. However, there is a lack of data to document how oncologists respond to different types and severity levels of emotion, or whether various types of emotions trigger different responses from doctors. The current research on “empathic opportunities” treats all emotions equally, despite a wide range in both the type and intensity of emotions patients express. A patient's fear about her life ending before seeing her daughter graduate from high school likely warrants a different response than her frustration that low blood counts will postpone her chemotherapy treatment.

Further, existing literature has shown that empathic responses by physicians facilitate patient discussion of emotions [14], [15]; however, there is little empirical evidence identifying which types of emotional disclosures prompt oncologists’ empathic responses. We conducted this study to identify which negative emotions are most likely to elicit empathic language from oncologists, and to determine how the conversation proceeds after an oncologist responds empathically to a patient.