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For Cancer Patients, Empathy Goes a Long Way
By _DENISE GRADY_
(http://topics.nytimes.com/top/reference/timestopics/people/g/denise_grady/index\
.html?inline=nyt-per)
Four years ago, my sister found out she had two types of _cancer_
(http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt\
-classifie
r) at the same time. It was like being hit by lightning â twice.
She needed _chemotherapy_
(http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/che\
motherapy/index.html?inline=nyt-classifier) and
radiation, a huge operation, more chemotherapy and then a smaller operation.
All in all, the treatment took about a year. Thin to begin with, she lost 30
pounds. The chemo caused cracks in her fingers, _dry eyes_
(http://health.nytimes.com/health/guides/symptoms/dry-eyes/overview.html?inline=\
nyt-classifier)
, _anemia_
(http://health.nytimes.com/health/guides/disease/anemia/overview.html?inline=nyt\
-classifier) and _mouth sores_
(http://health.nytimes.com/health/guides/symptoms/mouth-sores/overview.html?inli\
ne=nyt-classifier) so painful
they kept her awake at night. A lot of her hair fell out. The radiation
burned her skin. Bony, red-eyed, weak and frightfully pale, she tied scarves on
her head, plastered her fingers with Band-Aids and somehow toughed it out.
She saw two doctors quite often. The radiation oncologist would sling her arm
around my sisterâs frail shoulders and walk her down the corridor as if they
were old friends. The medical oncologist kept a close watch on the side
effects, suggested remedies, reminded my sister she had good odds of beating
the
cancer and reassured her that the hair would grow back. (It did.)
People in my family arenât huggy-kissy types, but my sister greatly
appreciated the warmth and concern of those two women. She trusted them
completely,
and their advice. Now healthy, she says their compassion played a big part in
helping her get through a difficult and frightening time.
Research supports the idea that a few kind words from an oncologist â what
used to be called bedside manner â can go a long way toward helping people
with
cancer understand their treatment, stick with it, cope better and maybe even
fare better medically.
âIt is absolutely the role of the oncologistâ to provide a bit of emotional
support, said Dr. James A. Tulsky, director of the Center for Palliative Care
at Duke University Medical Center.
But in a _study_ (http://jco.ascopubs.org/cgi/content/abstract/25/36/5748)
published last month in the Journal of Clinical Oncology, Dr. Tulsky and other
researchers found that doctors and patients werenât communicating all that
well about emotions.
The researchers recorded 398 conversations between 51 oncologists and 270
patients with advanced cancer. They listened for moments when patients expressed
negative emotions like fear, anger or sadness, and for the doctorsâ replies.
A response like âI can imagine how scary this must be for youâ was
considered empathetic â a âcontinuerâ that would allow patients to keep
expressing
their emotions. But a comment like âGive us time; we are getting thereâ was
labeled a âterminatorâ that could shut the patient down.
The team found that doctors used continuers only 22 percent of the time. Male
doctors were worse at it than female ones: 48 percent of the men never used
continuers, as opposed to 20 percent of the women.
Surprisingly, Dr. Tulsky said, the patients didnât bring up emotions that
often â in only 37 percent of the conversations.
âThatâs extraordinary,â he said. âThese are advanced cancer patients.â
The reason is not clear, but he said the patients might not expect emotional
support from doctors. Feelings were most often discussed when both doctor and
patient were female, and younger doctors who considered themselves more â
socioemotionalâ than âtechnicalâ gave empathetic replies more often.
One doctor who was especially good with patients, and who often consulted on
very serious cases, opened discussions with new patients by saying, âTell me
what you understand about your illness,â Dr. Tulsky said. And when patients
wept, this doctor would pause and wait until they were ready to continue the
discussion.
By contrast, with other doctors, Dr. Tulsky said, âThere were a number of
times when patients brought up emotional content and it went right by the
doctors.â
For instance, a patient would say, âIâm scared,â and the doctor would go
off
on a âscientific riffâ about the disease, Dr. Tulsky said, adding, âWe
saw
that a lot.â
The doctors donât lack empathy, he said. They just have trouble expressing
it.
âOncologists care deeply for their patients,â said Kathryn I. Pollak, the
first author of the study and a social psychologist at Duke. âItâs clear
from
listening to the tapes.â
Cancer patients and oncologists have unique, intense relationships, she said,
because the patients are fighting for their lives.
Even so, oncologists sometimes miss signs of distress, particularly if those
signs are indirect, she said. For example, a patient may ask how big the
_tumors_
(http://health.nytimes.com/health/guides/disease/tumor/overview.html?inline=nyt-\
classifier) are, and the doctor may answer in millimeters â when the
patient really wants to know: âIs the cancer getting worse? Am I dying?â
The good news, she and Dr. Tulsky said, is that most doctors can be taught to
respond in more helpful ways. Brief, empathetic responses will suffice, the
researchers said; they are not recommending extensive counseling or endless
dialogue.
Patients may benefit from some coaching, too. Itâs perfectly reasonable, Dr.
Tulsky said, to talk to an oncologist about sadness or fears about treatment,
and to ask for help.
âYouâre vulnerable when you express your emotions,â Dr. Pollak said.
âBut I
would advise patients to be as direct as possible.â
Gail
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