Wednesday, December 19, 2007

Cancer docs often ignore patients fears

Cancer Docs Often Miss Patient Fears
Doctors Respond With Empathy Only One-Fourth of Time, Study Shows
By Salynn Boyles WebMD Medical News
Reviewed by Louise Chang, MD
Dec. 18, 2007 -- Cancer patients who expect their oncologist to lend an empathetic ear are often disappointed, new research suggests.
Researchers found that the emotional concerns of patients with advanced cancer often went unrecognized or unaddressed by the doctors treating them.
The researchers recorded close to 400 conversations between oncologists and patients and then counted how often the patients sought empathy from the doctors and how often the doctors responded empathetically to patient concerns.
Showing support or asking patients to elaborate on their concerns, legitimizing the expressed emotion and praising patients for their strength were all considered empathetic responses.
When the patients expressed concerns and negative emotions, the oncologists responded empathetically 22% of the time.
Researcher Kathryn Pollak, PhD, of Duke Comprehensive Cancer Center, says the findings illustrate the need for teaching oncologists better communication skills.
"We know that oncologists care deeply for their patients," she tells WebMD. "They wouldn't be in the field if they weren't caring people. But they often don't verbalize their feelings to their patients."
Difficult Questions, Difficult Answers
Pollak recounted one exchange from the recorded conversations that went like this: When the patient told her oncologist that she had been really depressed lately, the oncologist responded, "So are you still smoking?"
Pollak says patients often ask difficult questions in indirect ways, and their doctors may or may not pick up on this.
"Patients may ask if their tumors are getting bigger, but what they are really saying is they are scared their cancer is getting worse," she says.
The researchers found that younger oncologists were more likely to respond empathetically than older ones, possibly because training in communication is being stressed more in medical schools today.
Carma Bylund, PhD, who runs a communications skills training course for oncologists at New York's Memorial Sloan-Kettering Cancer Center, tells WebMD the younger doctors in her program have often had courses in patient communication.
"There has been a definite shift," she says. "Younger residents and interns tell me they did a lot of this in medical school, while older fellows or attending physicians say no one ever talked about it."
Downsides to Good Bedside Manner
Atlanta oncologist Otis Brawley, MD, believes most of his patients would rate him high on the empathy scale.
But he adds that there are definite downsides to being too emotionally involved with very ill patients.
"We really have to develop emotional calluses, for lack of a better word, to keep our focus on our work," he says. "Being very empathetic can affect decision making. Physicians who spend a lot of time dealing with the emotional aspects of their patient's disease may be shortchanging them in other areas."
Physician burnout is also a huge issue in oncology, in part because the emotional toll can be so great.
A professor of oncology at Atlanta's Emory University, Brawley says he became an academic doctor and administrator, in part, to protect himself from burnout.
He does agree that communication is critical when it comes to the medical aspects of cancer care.
"In my opinion, a patient who can't talk to their doctor about their disease needs to find another doctor," he says. "But a doctor who is somewhat cold or emotionally detached may be providing very high-quality care."

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