Cancer Docs' Bedside Manner Often Lacks Empathy

WEDNESDAY, Dec. 19 (HealthDay News) -- Most cancer specialists do notrespond to the emotional concerns of their patients with verbalexpressions of empathy and support, a new study reveals.
The finding suggests that cancer patients' quality of life might besignificantly improved if doctors were better trained to recognize andaddress 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 KathrynL. Pollak, an associate professor at Duke University Medical Center'sCommunity and Family Medicine Department, in Durham, N.C.
Pollak's team published its findings in the Dec. 20 issue of theJournal of Clinical Oncology.
To assess the frequency of empathetic interactions in an oncologysetting, the authors first surveyed 51 oncologists who were caring for atotal of 270 cancer patients at Duke, the Durham Veterans Affairs MedicalCenter, or the University of Pittsburgh.
The physicians, mostly white and male, were questioned about theirlevel of confidence in addressing patient concerns; their sense of howvarious communication approaches might affect a patient; and their generalcomfort level with psycho-social types of conversation.
As well, the doctors were asked if they felt they were more inclinedtoward the technological and scientific aspects of patient care or moredisposed to focus on the social and emotional side of treatment.
The researchers also recorded almost 400 audiotapes of conversationsthat had taken place between physicians and patients.
All the patients had advanced-stage cancer, and their physiciansindicated that they would not be surprised if they ended up dying fromtheir illness within a year. Almost three-quarters of the patients werewhite, and they averaged a little over 60 years of age.
Most of the patients had established a relationship with theironcologist -- 90 percent said they had known their doctor for at least sixmonths prior to the study.
According to the researchers, more than two-thirds of the physicianssaid they were oriented toward the technical aspects of patient care, butmost were also highly confident in their ability to deal with patientconcerns. Most of the doctors also believed they were comfortable withemotionally charged conversations.
Yet, after reviewing all the tapes, Pollak and her colleaguesdetermined that cases in which doctors responded to patients' concernswith empathy were rare.
Fewer than 300 so-called "empathic opportunities" occurred during thealmost 400 conversations. Such opportunities were defined as points atwhich a patient had verbally expressed negative emotions -- such as fearor worry -- to which the doctor could respond as he or she saw fit.
Female patients were more likely to express such feelings, particularlyif their doctor was also female, the researchers observed.
When such emotions were expressed, almost three-quarters of thetime doctors chose to "terminate" the conversation by offering, forexample, 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 formof understanding or support were far less frequent, occurring little morethan a quarter of the time.
Oncologists who offered more empathic statements were younger thanthose who didn't, and those who stayed longer to converse with thedistressed patient were more likely to have described themselves as highlyfocused on the emotional dimension of patient care.
The research team concluded that oncologists need better education torecognize and respond appropriately to patients' emotions.
"Oncologists clearly care about their patients," said Pollak. "Theywouldn't go into oncology if they didn't. But oncology is a reallychallenging field, and, in general, oncologists have not been trained inhow to communicate with patients. So, it's a pretty difficult situationfor them."
"The good news is that the ability to communicate is something that canbe taught," she added. "I wouldn't say it's an innate skill. Many doctorswho say they are less comfortable conveying emotions with patients sufferfrom a lack of training. What they need is to be taught how to verbalizehow they feel, and there have been several programs around the world thathave shown that this kind of communication training can produce goodcommunicators."
Pollak noted that she and her team are now conducting a follow-up studyto see how communication skills might improve if oncologists were givenpersonalized CD-Roms to screen video of their own interactions withpatient. 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 emotionalside of things," noted Kevin Ochsner, an assistant professor of psychologyat Columbia University, New York City. "It's about being able to get thediagnosis right. But, in fact, it's as important to communicate that apatient's feelings matter and are an important part of the equation as itis to convey the probability that a certain procedure will or will nothave a positive outcome."
"Empathy," added Ochsner, "is the social glue that knits peopletogether because the ability to connect with one another emotionally andto understand the feelings of one another promotes rapport and bonding.So, making patients feel that they're heard will help them feel secure andless anxious. It helps regulate their emotions, and this has all kinds ofimportant mental and physical health effects."