BACKGROUND

Addressing emotion is a fundamental part of patient-physician communication, and can lead to stronger relationships with patients, improve satisfaction, unmask fears and concerns, and improve adherence to recommended treatment. Talking about prognosis almost always brings out strong emotions.

STEPS AND EXAMPLE IN VIDEO

Notice how the clinician in this example does the following steps in addressing emotion:

1. Notice the patient expressing emotion. The expression may be either verbal or non-verbal. They may be subtle (“I’m trying to take this one day at a time”) or obvious (“This might be it”).
2. Use an emotional continuer to prompt further exploration of emotion. The NURSE framework may help (Name, Understanding, Respecting, Supporting, Exploring).

Take a minute to think about what worked well in this example and what can be done differently.

PITFALL

Avoid shutting down or terminating the opportunity to address emotion. Clinicians may feel on safer ground retreating to numbers and scientific facts. But this can send a signal to the patient that “this topic is so scary, so threatening, that the doctor can’t even discuss it with me.” Learning to continue rather than shutting down the conversation is a lifelong learning challenge in prognosis communication.

PRACTICE PHRASES

“I can see that this news is upsetting you…”

REFERENCES

Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Skinner CS, Rodriguez KL, Tulsky JA. Oncologist Communication About Emotion During Visits with Patients with Advanced Cancer. J Clin Onc. 2007 Dec 20;25(36):5748-5752.

RESOURCES
Vitaltalk.org