Cancer Docs' Bedside Manner Often Lacks Empathy

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.

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