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Talking About Feelings and Worries in Cancer Consultations: The Effects of an Interactive Tailored Symptom Assessment on Source, Explicitness, and Timing of Emotional Cues and Concerns

Heyn, Lena PhD(c), MNSc, RN; Finset, Arnstein PhD; Ruland, Cornelia M. PhD, RN

doi: 10.1097/NCC.0b013e318254af66
Articles: Online Only

Background: Patients are experts of their own symptoms and worries, but tend not to express their concerns spontaneously in the consultation. Even when emotions are brought up, they are discussed briefly.

Objective: The objective of this study was to examine the impact of an interactive tailored patient assessment (Choice) on communication of emotional cues and concerns expressed by cancer patients in terms of source of initiation of cues/concern, explicitness, timing during the consultation, and consultation type (inpatient/outpatient).

Methods: We audiotaped and coded consultations between cancer patients and nurses or physicians in 1 control group (n = 99) with standard consultations and 1 intervention group (n = 97) where patients used Choice prior to the consultation. Direct and interaction effects were tested using multilevel analyses.

Results: In the Choice intervention group, there were significantly more frequent and more explicit expressions of cues and concerns; more clinician-initiated concerns occurred during the first 10 minutes; and it was more likely for any cue or concern to be succeeded by a subsequent one. In consultations with many cues/concerns, these were on average more emotionally descriptive or explicit and occurred somewhat earlier in the consultation in the Choice group. Furthermore, more cues/concerns were expressed in inpatient consultations with nurses than in outpatient consultations with physicians.

Conclusion: Cancer patients’ expressions of cues and concerns do not occur at random. More cues/concerns are expressed early in the consultation, in consultations with nurses, and in the Choice intervention group.

Implication for Practice: Choice may be a useful clinical tool. Use of Choice might aid cancer patients in handling their emotions.

Author affiliations: Center for Shared Decision Making, Oslo University Hospital Rikshospitalet (Ms Heyn and Dr Ruland), and Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences (Dr Finset), and Institute of Clinical Medicine (Dr Ruland), University of Oslo, Norway.

This study was funded by the Research Council of Norway grant no. 177500/V50 and will result in a doctoral thesis submitted to the Medical Faculty, University of Oslo. The funding source had no involvement in designing the study, data collection, analysis, or the preparation of this article.

The authors have no conflicts of interest to disclose.

Correspondence: Lena Heyn, PhD(c), MNSc, RN, Center for Shared Decision Making, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway (,

Accepted for publication March 6, 2012.

© 2013 Lippincott Williams & Wilkins, Inc.