The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations
Background: Information provision about prognosis, treatments, and side-effects is important in advanced cancer, yet also associated with impaired patient well-being. To counter potential detrimental effects, communication strategies based on placebo and nocebo effect mechanisms might be promising t...
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Frontiers Media S.A.
2019-07-01
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Anneke L. Francke Anneke L. Francke Maartje C. Meijers Maartje C. Meijers Janine Westendorp Hinke Hoffstädt Andrea W.M. Evers Andrea W.M. Evers Andrea W.M. Evers Elsken van der Wall Paul de Jong Kaya J. Peerdeman Kaya J. Peerdeman Jacqueline Stouthard Sandra van Dulmen Sandra van Dulmen Sandra van Dulmen |
spellingShingle |
Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Anneke L. Francke Anneke L. Francke Maartje C. Meijers Maartje C. Meijers Janine Westendorp Hinke Hoffstädt Andrea W.M. Evers Andrea W.M. Evers Andrea W.M. Evers Elsken van der Wall Paul de Jong Kaya J. Peerdeman Kaya J. Peerdeman Jacqueline Stouthard Sandra van Dulmen Sandra van Dulmen Sandra van Dulmen The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations Frontiers in Psychiatry communication placebo effects nocebo effects empathy expectancy cancer |
author_facet |
Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Liesbeth Mirjam van Vliet Anneke L. Francke Anneke L. Francke Maartje C. Meijers Maartje C. Meijers Janine Westendorp Hinke Hoffstädt Andrea W.M. Evers Andrea W.M. Evers Andrea W.M. Evers Elsken van der Wall Paul de Jong Kaya J. Peerdeman Kaya J. Peerdeman Jacqueline Stouthard Sandra van Dulmen Sandra van Dulmen Sandra van Dulmen |
author_sort |
Liesbeth Mirjam van Vliet |
title |
The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations |
title_short |
The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations |
title_full |
The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations |
title_fullStr |
The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations |
title_full_unstemmed |
The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient Consultations |
title_sort |
use of expectancy and empathy when communicating with patients with advanced breast cancer; an observational study of clinician–patient consultations |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Psychiatry |
issn |
1664-0640 |
publishDate |
2019-07-01 |
description |
Background: Information provision about prognosis, treatments, and side-effects is important in advanced cancer, yet also associated with impaired patient well-being. To counter potential detrimental effects, communication strategies based on placebo and nocebo effect mechanisms might be promising to apply in daily practice. This study aimed to provide more insight into how often and how oncologists use expectancy and empathy expressions in consultations with patients with advanced breast cancer.Methods: Forty-five consultations between oncologists and patients were audiotaped. To determine how often expectancy and empathy expressions were used, a coding scheme was created. Most consultations (n = 33) were coded and discussed by two coders, and the remaining 13 were coded by one coder. To determine how expectancy and empathy expressions were used, principles of inductive content analysis were followed.Results: Discussed evaluation (i.e., scan) results were good (n = 26,58%) or uncertain (n = 12,27%) and less often bad (n = 7,15%). Uncertain expectations about prognosis, treatment outcomes, and side effects occurred in 13, 38, and 27 consultations (29%, 85%, and 56%), followed by negative expectations in 8, 26, and 28 consultations (18%, 58%, and 62%) and positive expectations in 6, 34, and 17 consultations (13%, 76%, and 38%). When oncologists provided expectancy expressions, they tapped into three different dimensions: relational, personal, and explicit. Positive expectations emphasized the doctor–patient relationship, while negative expectations focused on the severity of the illness, and uncertainty was characterized by a balance between (potential) negative outcomes and hope. Observed generic or specific empathy expressions were regularly provided, most frequently understanding (n = 29,64% of consultations), respecting (n = 17,38%), supporting (n = 16,36%), and exploring (n = 16,36%). A lack of empathy occurred less often and contained, among others, not responding to patients’ emotional concerns (n = 13,27% of consultations), interrupting (n = 7,16%), and an absence of understanding (n = 4,9%).Conclusion: In consultations with mainly positive or uncertain medical outcomes, oncologists predominantly made use of uncertain expectations (hope for the best, prepare for the worst) and used several empathic behaviors. Replication studies, e.g., in these and other medical situations, are needed. Follow-up studies should test the effect of specific communication strategies on patient outcomes, to counter potential negative effects of information provision. Studies should focus on uncertain situations. Ultimately, specific placebo and nocebo effect-inspired communication strategies can be harnessed in clinical care to improve patient outcomes. |
topic |
communication placebo effects nocebo effects empathy expectancy cancer |
url |
https://www.frontiersin.org/article/10.3389/fpsyt.2019.00464/full |
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doaj-51e8818983514a709952d43a05ddf1cb2020-11-25T02:09:25ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402019-07-011010.3389/fpsyt.2019.00464461008The Use of Expectancy and Empathy When Communicating With Patients With Advanced Breast Cancer; an Observational Study of Clinician–Patient ConsultationsLiesbeth Mirjam van Vliet0Liesbeth Mirjam van Vliet1Liesbeth Mirjam van Vliet2Anneke L. Francke3Anneke L. Francke4Maartje C. Meijers5Maartje C. Meijers6Janine Westendorp7Hinke Hoffstädt8Andrea W.M. Evers9Andrea W.M. Evers10Andrea W.M. Evers11Elsken van der Wall12Paul de Jong13Kaya J. Peerdeman14Kaya J. Peerdeman15Jacqueline Stouthard16Sandra van Dulmen17Sandra van Dulmen18Sandra van Dulmen19Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsLeiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsAmsterdam Public Health Institute, Vrije Universiteit, Amsterdam, NetherlandsHealth, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsHealth, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, NetherlandsLeiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, NetherlandsDepartment of Psychiatry, Leiden University Medical Center, Leiden, NetherlandsDepartment of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, NetherlandsDepartment of Medical Oncology, St Antonius Hospital, Utrecht, NetherlandsHealth, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, NetherlandsLeiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, NetherlandsDepartment of Medical Oncology, Netherlands Cancer Institute, Amsterdam, NetherlandsDepartment of Communication, NIVEL, Netherlands Institute of Health Services Research, Utrecht, NetherlandsDepartment of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands0Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, NorwayBackground: Information provision about prognosis, treatments, and side-effects is important in advanced cancer, yet also associated with impaired patient well-being. To counter potential detrimental effects, communication strategies based on placebo and nocebo effect mechanisms might be promising to apply in daily practice. This study aimed to provide more insight into how often and how oncologists use expectancy and empathy expressions in consultations with patients with advanced breast cancer.Methods: Forty-five consultations between oncologists and patients were audiotaped. To determine how often expectancy and empathy expressions were used, a coding scheme was created. Most consultations (n = 33) were coded and discussed by two coders, and the remaining 13 were coded by one coder. To determine how expectancy and empathy expressions were used, principles of inductive content analysis were followed.Results: Discussed evaluation (i.e., scan) results were good (n = 26,58%) or uncertain (n = 12,27%) and less often bad (n = 7,15%). Uncertain expectations about prognosis, treatment outcomes, and side effects occurred in 13, 38, and 27 consultations (29%, 85%, and 56%), followed by negative expectations in 8, 26, and 28 consultations (18%, 58%, and 62%) and positive expectations in 6, 34, and 17 consultations (13%, 76%, and 38%). When oncologists provided expectancy expressions, they tapped into three different dimensions: relational, personal, and explicit. Positive expectations emphasized the doctor–patient relationship, while negative expectations focused on the severity of the illness, and uncertainty was characterized by a balance between (potential) negative outcomes and hope. Observed generic or specific empathy expressions were regularly provided, most frequently understanding (n = 29,64% of consultations), respecting (n = 17,38%), supporting (n = 16,36%), and exploring (n = 16,36%). A lack of empathy occurred less often and contained, among others, not responding to patients’ emotional concerns (n = 13,27% of consultations), interrupting (n = 7,16%), and an absence of understanding (n = 4,9%).Conclusion: In consultations with mainly positive or uncertain medical outcomes, oncologists predominantly made use of uncertain expectations (hope for the best, prepare for the worst) and used several empathic behaviors. Replication studies, e.g., in these and other medical situations, are needed. Follow-up studies should test the effect of specific communication strategies on patient outcomes, to counter potential negative effects of information provision. Studies should focus on uncertain situations. Ultimately, specific placebo and nocebo effect-inspired communication strategies can be harnessed in clinical care to improve patient outcomes.https://www.frontiersin.org/article/10.3389/fpsyt.2019.00464/fullcommunicationplacebo effectsnocebo effectsempathyexpectancycancer |