Researchers at Duke University (Duke, Durham, NC, USA) conducted a randomized, controlled, parallel-group trial to test whether a brief, computerized intervention improves oncologist responses to patient expressions of negative emotion. In all, 48 medical, gynecologic, and radiation oncologists were randomly assigned to receive a communication lecture, or the lecture plus a CD-ROM about responding to patients' negative emotions. The CD taught the doctors basic communication skills, including how to recognize and respond to opportunities in conversations when patients share a negative emotion, and how to share information about prognosis.

The researchers used audio recordings of the oncologists' conversations with 264 patients with advanced cancer to identify the number of empathic statements and responses to patients' expressions of negative emotion. The results showed that oncologists in the intervention group used more empathic sayings and were more likely to respond to negative emotions empathically than the control oncologists. They were also better at eliciting patient concerns, using tactics to promote conversations rather than shut them down. Patients of intervention oncologists reported greater trust in their oncologists than did patients of control oncologists. The study was published in the November 1, 2011, issue of Annals of Internal Medicine.

“Earlier studies have shown that oncologists respond to patient distress with empathy only about a quarter of the time,” said lead author James Tulsky, MD, director of the Duke Center for Palliative Care. “Often, when patients bring up their worries, doctors change the subject or focus on the medical treatment, rather than the emotional concern. Unfortunately, this behavior sends the message, 'this is not what we're here to talk about'.”

“Oncologists are among the most devoted physicians -- passionately committed to their patients. Unfortunately, their patients don't always know this unless the doctors articulate their empathy explicitly,” added Dr. Tulsky. “It's a skill set. It's not that the doctors are uncaring, it's just that communication needs to be taught and learned.”

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