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Cited by 44Patient-Provider Communication in HealthcarePalliative Care and End-of-Life IssuesEmpathy and Medical Education

What Patients Value When Oncologists Give News of Cancer Recurrence: Commentary on Specific Moments in Audio-Recorded Conversations

Open access
Back, Anthony L., Trinidad, Susan B., Hopley, Elizabeth K., Arnold, Robert M., Baile, Walter F., Edwards, Kelly A.·2011·The Oncologist
DOI 10.1634/theoncologist.2010-0274PMC PMC3228111
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Abstract

Learning Objectives: After completing this course, the reader will be able to: Incorporate the three themes identified in this study to refine discussion with patients of their cancer recurrence.Manage discussion with patients of cancer recurrence with recognition of the impact of the news on the patient and guidance as to next steps. This article is available for continuing medical education credit at CME.TheOncologist.com Purpose.: Recommendations for communicating bad or serious news are based on limited evidence. This study was designed to understand patient perspectives on what patients value when oncologists communicate news of cancer recurrence. Study Design and Methods.: Participants were 23 patients treated for a gastrointestinal cancer at a tertiary U.S. cancer center within the past 2 years, who had semistructured qualitative interviews in which they listened to audio recordings of an oncology fellow discussing news of cancer recurrence with a standardized patient. Participants paused the audio recording to comment on what they liked or disliked about the oncologist's communication. Results.: Three themes were identified that refine existing approaches to discussing serious news. The first theme, recognition, described how the oncologist responded to the gravity of the news of cancer recurrence for the patient. Participants saw the need for recognition throughout the encounter and not just after the news was given. The second theme, guiding, describes what participants wanted after hearing the news, which was for the oncologist to draw on her biomedical expertise to frame the news and plan next steps. The third theme, responsiveness, referred to the oncologist's ability to sense the need for recognition or guidance and to move fluidly between them. Conclusion.: This study suggests that oncologists giving news of cancer recurrence could think of the communication as going back and forth between recognition and guidance and could ask themselves: “Have I demonstrated that I recognize the patient's experience hearing the news?” and “Have I provided guidance to the next steps?”

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  • Clinician empathy, direct eye contact, and sympathetic engagement are valuable.

    “These parents also reinforced what we already know about the value of clinician empathy, direct eye contact, and sympathetic engagement [39].”

    From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [39]

    The Recognition and Responsiveness sections report that participants valued oncologists’ acknowledgment of patients’ emotions and engaged, back-and-forth communication. They do not establish the value of direct eye contact; the study used audio recordings, and its reference to a “baby gaze” describes conversational connection rather than observed eye contact. No page numbers were supplied for these passages. (LLM, conf=0.88)

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  • One communication model from oncology demonstrates that patients at the end of life value the physician's ability to move fluidly between providing recognition of suffering, emotional support, and guidance based on clinical expertise.

    “One communication model from oncology demonstrates that patients at the end of life value the physician’s ability to move fluidly between providing recognition of suffering, emotional support, and guidance based on clinical expertise [39,40].”

    From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [39]

    The Themes and Responsiveness sections support the communication model: participants valued recognition of emotional impact, guidance grounded in biomedical expertise, and the oncologist’s ability to move fluidly between them. But the Participants and Setting and Participant Demographics sections say participants were cancer-free and none had experienced recurrence, so the study does not establish what patients at the end of life value. Page numbers were not available in our copy. (LLM, conf=0.90)

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Research works printed but not linked: 2

  1. [2]2. Butow PN, Kazemi JN, Beeney LJ et al. When the diagnosis is cancer: pa- tient communication experiences and preferences. Cancer 1996;77:2630 - 2637.
  2. [6]6. Dowsett SM, Saul JL, Butow PN et al. Communication styles in the cancer consultation: preferences for a patient-centred approach. Psychooncology 2000;9:147-156.

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Authors
Back, A. L., Trinidad, S. B., Hopley, E. K., Arnold, R. M., Baile, W. F., & Edwards, K. A.
Affiliations
  • University of Washington (US)
  • University of Pittsburgh (US)
  • The University of Texas MD Anderson Cancer Center (US)
ORCID
Venue
The Oncologist
Publisher
Oxford University Press (OUP)
Published
2011-02-24
Volume
16
Issue
3
Pages
342-350
ISSN
  • 1083-7159 (ISSN-L)
  • 1549-490X
DOI
10.1634/theoncologist.2010-0274
PMC
PMC3228111
OpenAlex
W2122954317
Cited by
44
References
39
Citations by year
2025: 1 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 2 · 2012: 5
FWCI
5.94
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • The Oncologist (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
Lance Armstrong Foundation
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
Keywords
tumor recurrence, breaking bad news, physician-patient communication, patient perspectives, gastrointestinal cancer, recognition, guidance, responsiveness, standardized patients
MeSH terms
Adult, Aged, Communication, Female, Gastrointestinal Neoplasms, Humans, Interviews as Topic, Male, Medical Oncology, Middle Aged, Neoplasm Recurrence, Local, Physician-Patient Relations, Truth Disclosure, Patient Satisfaction

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