Health professionals’ perception of distress in cancer patients and family members : measuring accuracy and examining the role of empathic skills

Dealing with cancer and its treatment is an important life challenge for patients and family members, who must adapt to a variety of psychosocial consequences related to the illness. Managing psychological distress in persons affected by cancer is an important aspect of whole-patient and family-centred care. Recent advances in cancer care research and policy have allowed for more accurate detection of distress. Routine administration of screening tests is now common practice. However, many avenues are left unexploited. The principal aim of the present thesis was to examine empathic skills such as perspective taking as a complementary strategy for improving the detection of distress in adults affected by cancer.  The objective of the first study was to examine physicians’ natural empathic ability to detect depression and general distress in adults with advanced cancer. Previous findings suggested that oncology professionals often struggle to accurately detect patient distress. We verified this phenomenon by employing more reliable and valid measures of patient-physician agreement than those most commonly reported in the literature. Analyses of agreement were conducted at both global and symptom levels in an effort to provide more detailed information on physicians’ performance. In addition, regression analyses were performed to examine variables of empathic ability as possible correlates of patient-physician agreement on depressive symptoms. The results suggest that physicians have difficulty detecting depressive symptoms, particularly those that are more subtle in nature. Physicians’ self-reported ability to provide compassionate care, quality of relationship with the patient, and self-efficacy in detecting patient distress, were all associated with higher patient-physician agreement on at least one depressive symptom.   The main objective of the second study was to compare two types of perspective taking on clinician ability to detect distress in parents of children with cancer. A quasi-experimental study was designed through the integration of basic theory and methodology from social psychology research. Oncology professionals were randomly assigned to one of two groups, and were then shown a video featuring parents of children with cancer. In the imagine-self group, they were instructed to imagine the feelings and life consequences which they would experience if they were in each parent’s situation. In the imagine-other group, they were instructed to imagine the feelings and life consequences experienced by the parents. No significant group differences were found for parent-clinician agreement on parents’ negative thoughts and feelings. However, clinicians who, in accordance with the imagine-self perspective, reported being more concentrated on their own feelings tended to show lower agreement. Clinicians who were instructed to adopt an imagine-self perspective reported significantly more distress than those instructed to adopt an imagine-other perspective. No association was found between clinician distress and parent-clinician agreement.  The findings of this thesis suggest that empathic skills could significantly contribute to accurate detection of distress in persons affected by cancer. This new line of research could have important implications for communication training, management of psychosocial resources, and possibly prevention professional burnout. More experimental research is needed before evidence-based guidelines can be elaborated.

Keyphrases: Cancer, Parents, Detection of distress, Perspective taking, Patient-centered care, Health care professionals