“Cancer patients have high needs for information and emotional support, but physicians are not always able to detect and respond effectively to these needs,” explains the study’s lead researcher, Phyllis N. Butow, Ph.D., of the Medical Psychology Research Unit at the University of Sydney in Australia. “Doctors appear to have particular difficulty detecting and responding to indirect forms of communication.”
Researchers at the University of Sydney reviewed transcripts of nine oncologists’ consultations with 298 adult cancer patients to understand how the patients communicated their informational and emotional needs and how the doctors responded. Each patient also answered questions measuring their satisfaction with the consultation and their anxiety before and after the consultation.
The patients, who ranged in age from 18 to 83 years, had genitourinary, breast, gastrointestinal, skin or other cancers.
During the medical consultations, the patients asked an average of nine direct questions and gave an average of three indirect verbal cues signaling that they needed information or emotional support. Indirect informational cues included statement such as “I really don’t know much about the different treatments,” and indirect emotional cues included statements such as “I get so upset sometimes that I can’t stop crying.”
Patients gave informational cues almost twice as often as emotional cues. Younger and female patients gave more emotional cues and asked more questions than did older and male patients. Most cues related to treatment issues rather than psychosocial, prognostic or other issues.
The oncologists effectively identified and responded to the patients’ needs for information, but less consistently addressed patients’ cues for emotional support. In fact, 38 percent of the emotional cues were not detected or not addressed by the oncologists.
Nevertheless, the patients’ satisfaction with the consultations and their anxiety immediately after the consultations and two weeks later seemed unaffected by the doctors’ responses to informational or emotional cues.
“These findings support earlier studies which showed that patients are reluctant to disclose emotional concerns, perhaps because they do not want to burden their doctors. They demonstrate how important it is for doctors to actively encourage emotional disclosure,” says Dr. Butow. “Without direct, effective intervention by physicians, many patients may not disclose their needs, making it difficult to help them adjust to their disease.”
Dr. Butow adds that it is significant that patient anxiety does not increase and consultations are not prolonged when doctors respond to patient cues. This may help assure doctors that placing increased focus on emotional issues doesn’t harm patients or make clinic times unmanageable.
The research was funded by the Australian National Health and Medical Research Council.
Psycho-Oncology is a bimonthly international journal devoted to the psychological, social and behavioral dimensions of cancer. Published by John Wiley, it is the official journal of the American, British and International Psycho-Oncology Societies. Contact Jimmie Holland, M.D., Co-Editor, at (212) 739-7051 for information.
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Psycho-Oncology