Computer tutorial helps oncologists handle patient emotions

A computer-based training program improved oncologists' responses to patients' expressions of negative emotions.

Patients with advanced cancer have considerable distress, and oncologists can manage this distress by recognizing and empathizing with patient concerns, according to James A. Tulsky, MD, director of the Duke Center for Palliative Care at Duke University School of Medicine, Durham, North Carolina, and colleagues (Ann Intern Med. 2011;155:593-601; www.annals.org/content/155/9/593.full.pdf+html). This, in turn, can lead to greater satisfaction, better adherence to treatment, and improved quality of life for the patient. However, oncologists frequently miss opportunities to respond to patient emotion, and may instead exhibit behaviors that create emotional distance, often because they do not have time to address nonmedical concerns or because they fear that such discussions will increase rather than relieve the patient's stress.

Although courses are available to teach oncologists skills for handling patient emotions, such workshops are long and costly.

Tulsky's group tested a brief, computerized intervention to determine its ability to help oncologists empathize more with patient concerns. A total of 48 medical, gynecologic, and radiation oncologists attended a 1-hour lecture on communication skills. Half the participants were then randomly assigned to receive an interactive CD-ROM that offered instructions on basic communication skills, including how to recognize and respond to opportunities in conversations when patients share a negative emotion and how to share prognosis information. The CD-ROM also contained tailored feedback on the oncologists' own conversations, recorded during 4 to 8 visits between the doctors and patients with advanced cancer.

The investigators used postintervention audio recordings to identify the number of empathic statements and responses to patients' expressions of negative emotions, and surveyed 264 patients with advanced cancer regarding the patients' trust in their oncologists and perceptions of their oncologists' communication skills.

Oncologists who had been part of the intervention group used nearly twice as many empathic statements and were more likely to respond to negative emotions empathically than the control oncologists. Patients of the intervention oncologists reported greater trust in these providers than did patients of the control oncologists. The two groups of patients reported no significant differences in perceptions of communication skills.

In a statement announcing the study results, Tulsky pointed out that the computer-based program is an easy, relatively inexpensive way to train physicians to respond to patients' most basic needs.

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