Cancer patients, doctors talk little of emotions

People with advanced cancer may suffer substantial emotional distress, but relatively few may be discussing it with their doctors, new research suggests.

In a study that recorded conversations between 270 cancer patients and their oncologists, researchers found that patients broached the topic of emotional concerns only about one-third of the time. And when they did open the door, their doctors often failed to encourage a discussion.

The findings suggest that cancer specialists need more training in how to respond to patients' emotional needs, according to the researchers, led by Dr. Kathryn I. Pollak of Duke University Medical Center in Durham, North Carolina.

They report the findings in the Journal of Clinical Oncology.

Of 398 doctor-patient conversations the researchers recorded, 37 percent featured a moment of what they call an "empathic opportunity," where a patient opens up about his emotions, either directly or in more subtle ways.

The doctor can encourage the patient to go on in any number of ways - by asking questions, or simply expressing empathy and understanding. But in this study, doctors did that only 22 percent of the time.

More often, they cut the discussion short with statements like, "Give us time. We are getting there."

The findings do not mean, however, that doctors don't care about their patients' emotional well-being, according to Pollak.

"Cancer patients should know their oncologists care deeply about them," she told Reuters Health. "However, oncologists don't always know how to verbalize that they care."

In this study, younger doctors tended to encourage discussion more often than older doctors did, and female patients were more likely to open up about their emotions when they saw a female oncologist. Male patients talked about their emotions less often than female patients did, regardless of the sex of their doctor.

Communication skills are now commonly taught in medical school and residency programs, but many practicing oncologists have never been trained to respond to patients' emotional concerns with empathy, according to the researchers.

The current findings, they write, suggest that oncologists "may need more training to recognize emotions and to learn how to respond to patient concerns."

Patients may also be able to aid communication by being more direct about their emotions, Pollak suggested.

As an example, she said that, instead of saying something vague like "I'm not sure what I should do," a patient could say something specific and hard to misinterpret, like "I am really depressed. What should I do about that?"

SOURCE: Journal of Clinical Oncology, December 20, 2007.