Abstract
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.
Highlights
When faced with a serious disease such as advanced breast cancer, patients need information to understand what is going on and to plan for their future [1]
The aim of this study is to provide more insight into how often and how oncologists use expectancy and empathy expressions in consultations with patients with advanced breast cancer
While there has been a recent interest in the placebo and nocebo effects of communication, and clinicians’ empathic responses to patients’ expressed cues and concerns have extensively been studied [42], to the best of our knowledge, this is the first study to objectively determine how clinicians use expectancy and empathy expressions in advanced clinical breast cancer care
Summary
When faced with a serious disease such as advanced breast cancer, patients need information to understand what is going on and to plan for their future [1]. Information provision about prognosis, treatments, and side-effects is important in advanced cancer, yet associated with impaired patient well-being. Characteristics of the consultation were assessed by the coding team This included consultation time and whether the provided evaluation results (i.e., scan results) in the consultations were “good” (e.g., regression or stable disease), “uncertain” (e.g., clinical data from scan results and blood results are contradictory), or “bad” (e.g., disease progression). These criteria were determined in collaboration with the practicing oncologists who were part of the research and authorship team (EW, PJ, and JS).
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