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Missed Opportunities for Interval Empathy in Lung Cancer Communication
Diane S. Morse, MD;
Elizabeth A. Edwardsen, MD;
Howard S. Gordon, MD
Arch Intern Med. 2008;168(17):1853-1858.
Background Empathy is important in patient-physician communication and is associated with improved patient satisfaction and adherence to physicians' recommendations.
Methods To evaluate empathic opportunities and physician responses, we conducted a qualitative thematic analysis of 20 audiorecorded, transcribed consultations between patients with lung cancer and their thoracic surgeons or oncologists, from a larger observational study of 137 patients in a Veterans Affairs hospital in the southern United States. Using qualitative analysis, we collaboratively developed themes and subthemes until saturation. Then, each transcript was coded, using grounded theory methods, until consensus was achieved, counting and sequentially analyzing patient empathic opportunities and physician responses.
Results Subthemes regarding patients’ statements about lung cancer included (1) morbidity or mortality concerns, (2) cancer-related symptoms, (3) relationship to smoking, (4) decisions about treatment, (5) beliefs about or mistrust of medical care, (6) factors limiting ability to treat cancer, and (7) confusion regarding cancer status and treatment. We identified 384 empathic opportunities and found that physicians had responded empathically to 39 (10%) of them. Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements. We defined this phenomenon as missed opportunities for "interval empathy." When empathy was provided, 50% of these statements occurred in the last one-third of the encounter, whereas patients' concerns were evenly raised throughout the encounter.
Conclusions Physicians rarely responded empathically to the concerns raised by patients with lung cancer, and empathic responses that did occur were more frequently in the last third of the encounter. Our results may provide a typologic approach to help physicians recognize empathic opportunities and with further development may aid in improving physicians' communication skills.
Author Affiliations: University of Rochester School of Medicine and Dentistry (Drs Morse and Edwardsen), Department of Medicine, Rochester General Hospital (Dr Morse), and Department of Emergency Medicine, University of Rochester Medical Center (Dr Edwardsen), Rochester, New York; Fulbright Program, Hebrew University of Jerusalem, Jerusalem, Israel (Dr Morse); and Jesse Brown Veterans Affairs Medical Center, Center for Management of Complex Chronic Care, and Sections of Health Promotion Research and General Internal Medicine, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago (Dr Gordon). Dr Morse is now with the Departments of Psychiatry and Medicine, University of Rochester Medical Center.
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