Sc30.06 Empathy And Boundary Management In Clinical Encounters: The Communicative Behaviour Of Oncologists And Family Physicians Delivering Bad News

Conference: 
Author(s): 
S. P. Reis1, D. S. Morse2, E. A. Edwardsen2, M. G. Gurnsey2, A. Taupin2, C. G. Shields3, J. Griggs4, S. H. McDaniel2;
1Bar Ilan University Faculty of Medicine, Safed, Israel, 2University of Rochester School of Medicine, Rochester, NY, United States, 3Purdue University, West Lafayette, IN, United States, 4University of Michigan, Ann Arbor, MI, United States.
Shmuel P Reis
Bar Ilan University
Post Misgav
Zip: 20170
Israel
Email: reis@netvision.net.il
Phone: 972-4-9909360
Fax: 972-4-9800210
Text: 
Context: Advanced cancer engenders complex dialogues between physicians and patients. Patient centredness and empathy are both important and potentially difficult. Previous studies show that self-disclosure is frequent and empathy infrequent in primary care encounters.
Objective: to examine physicians?? communication patterns in first visits of undetected standardized patients (SPs) portraying stage IV lung cancer.
Methods
Design: Qualitative, grounded theory informed thematic analysis to describe the emergent physician communication categories in an existing dataset.
Setting: Community-based family physician and oncologist practices
Participants: 23 oncologists and 23 family physicians; SPs successfully audio-recorded 19 oncologists and 20 family physicians, 34 undetected visits were used in this study.
Outcome measures--Analysis and text management: A thematic analysis of transcripts, using an iterative process to create a coding system. Two team researchers, randomly paired, coded each transcript until saturation; Team members then reviewed all coded elements in context, using sequence analysis to examine physician categories and their relationship to each other.
Results-
Emergent categories distinguished Acknowledgement and Affirmation from Empathy. Transparency and Projection were also distinguished from Self-disclosure. 31 of 34 (91%) of the encounters had a (focused kind of?) physician Self-disclosure, or Transparency. 24 (71%) of the encounters included an empathic response, although only 1 in 5 empathic cues from patients earned an empathic response. Exploratory analyses showed that Not Helpful Self-Disclosure, Helpful and Not Helpful Transparencies, Projection, and Empathy correlate with each other. These categories can be arrayed along a Patient-centred Care continuum from Respect (Empathy, Acknowledgement, and Affirmation) to Distraction (Transparency, Self-Disclosure) to Intrusion (Projection).
Conclusions-
In encounters where physicians deliver bad news, most include physician Self-disclosure but few in this study were helpful to the patient. Physicians? opinions about the patient?s previous physicians were surprisingly frequent but typically unhelpful to patients, with patients? responses often making their discomfort clear. Altogether, distracting, physician-centred statements are common. The anxiety of the situation may fuel boundary turbulence. Sensitive patient-centred physicians who use empathic statements and helpful transparency are also likely to use projection and unhelpful transparency. Training in boundary management and empathy should be an important aspect of physician-patient communication.
Literature: 
SC30.06
Empathy and Boundary Management in clinical encounters: the communicative behaviour of oncologists and family physicians delivering bad news