Physicians May Miss Opportunities to Respond With Empathy Toward Patients With Lung Cancer

Newswise — In a small study of 20 audiorecorded interactions, physicians seldom responded empathetically to concerns raised by patients with lung cancer, according to a report in the September 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Empathy is an important element of effective communication between patients and physicians and is associated with improved patient satisfaction and compliance with recommended treatment," the authors write as background information in the article. "Patients who are more satisfied with the communication in their medical encounters have improved understanding of their condition, with less anxiety and improved mental functioning." However, responding to patients' emotional needs can be challenging for physicians; they may begin medical school with empathy for their patients but gradually learn detachment, perhaps in order to cope with time constraints or sadness.

Diane S. Morse, M.D., of the University of Rochester Medical Center, Rochester, N.Y, and colleagues conducted an analysis of 20 recorded and transcribed consultations between lung cancer patients (average age 65, all male) and nine physicians (three oncologists and six thoracic surgeons). Each visit contained an average of 326 statements, and those made by patients were coded into three themes: statements about the impact of lung cancer, statements about diagnosis or treatment and statements about health system issues affecting care.

Throughout the 20 visits, the researchers identified 384 statements by patients that provided opportunities for physicians to offer empathy. These included statements such as "This is kind of overwhelming" and "I'm fighting it." Most often—in 61 percent of the cases—opportunities for empathy were classified as relating to the impact of lung cancer. "Patients' morbidity [illness] and mortality [death] expectations and concerns were the most commonly coded empathic opportunity, which hinted at fears, worries and existential concerns and comprised 32 percent of overall empathic opportunities," the authors write.

Physicians responded with empathy to 39 (10 percent) of all 384 opportunities. "Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements," the authors write. "With a mean [average] of less than two empathic physician responses per encounter, empathy was an infrequent occurrence." Half of the empathic responses that physicians offered occurred in the last one-third of the encounter, although patients' concerns were raised throughout the visit.

There are several reasons that physicians may not display empathy, the authors note. They may believe there is no time for empathic responses, they may be too busy with other tasks to recognize opportunities for empathy or they may consciously avoid responding empathetically, perhaps believing that biomedical information is reassuring.

"We suggest the use of interval empathy to respond to empathic opportunities offered by patients periodically throughout the encounter, particularly in encounters with patients with life-threatening conditions who may be most likely to raise multiple empathic opportunities," the authors write. "Use of this communication skill may allow increased understanding and progressive rapport and trust with patients. Fortunately, studies indicate that expressing empathy can be taught and that these statements can be brief and powerful, not prolonging the encounter or necessarily changing a physician's style."

(Arch Intern Med. 2008;168[17]:1853-1858. Available pre-embargo to the media at http://www.jamamedia.org.)

Editor's Note: This research was supported in part by a Career Development Award to co-author Dr. Gordon from the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs, and by a grant from the Agency for Healthcare Research and Quality. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.