Patterns in clinicians' responses to patient emotion in cancer care.

OBJECTIVE: To investigate how patient, clinician and relationship characteristics may predict how oncologists and nurses respond to patients' emotional expressions.
METHODS: Observational study of audiotapes of 196 consultations in cancer care. The consultations were coded according to Verona Coding Definitions of Emotional Sequences (VR-CoDES). Associations were tested in multi-level analyzes.
RESULTS: There were 471 cues and 109 concerns with a mean number of 3.0 (SD=3.2) cues and concerns per consultation. Nurses in admittance interviews were five times more likely to provide space for further disclosure of cues and concerns (according to VR-CoDES definitions) than oncologists in out-patient follow-up consultations. Oncologists gave more room for disclosure to the first cue or concern in the consultation, to more explicit and doctor initiated cues/concerns and when the doctor and/or patient was female. Nurses gave room for further disclosure to explicit and nurse initiated cues/concerns, but the effects were smaller than for oncologists.
CONCLUSION: Responses of clinicians which provide room for further disclosure do not occur at random and are systematically dependent on the source, explicitness and timing of the cue or concern. PRACTICE IMPLICATIONS: Knowledge on which factors influence responses to cues and concerns may be useful in communication skills training.