A new Rutgers study seeking to better understand how anxiety experienced by breast cancer patients affects their communication during surgical oncology consultations has found that patients who had more anxiety before their appointments also had more uncertainty about their cancer and communicated to the provider differently than those who had less anxiety.

The research sought to identify how and why these patterns of communication differ when patients experience pre-appointment anxiety, so clinicians can be trained to recognize the patterns (expressions of fear, worry, and emotion) and provide appropriate support.

The study, “Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient–provider communication,” by SC&I Ph.D. Candidate Liesl Broadbridge and Associate Professor of Communication Maria Venetis, was published in Cancer Medicine in July 2024.

This research primarily focused on two new areas of study, Broadbridge and Venetis said. First, they examined the extent to which preexisting anxiety or uncertainty (any anxiety breast cancer patients may have experienced before their oncology appointments) impacted effective patient–provider communication. Past studies, they said, have mostly examined post-appointment anxiety as an outcome of provider communication, but not the impact of preexisting anxiety on the conversations breast cancer patients had with their clinical teams.

Broadbridge and Venetis examined the extent to which preexisting anxiety or uncertainty (any anxiety breast cancer patients may have experienced before their oncology appointments) impacted effective patient–provider communication.

Second, Broadbridge and Venetis studied the communication patterns of oncologists when they met with patients who arrived at their appointments already feeling anxious, to see whether the oncologists interrupted anxious patients more often and how these behaviors impacted their patients’ treatment experiences and outcomes.

They found that regardless of how the oncologists responded to the patient’s emotion statements (e.g., positively, dismissively, or by interrupting the patients etc.), patients who made more statements about their emotions had less uncertainty about their illness after the appointments. Although there may be additional factors contributing to this decrease in uncertainty, Broadbridge and Venetis said they posited that the mere act of voicing one’s emotions during a cancer appointment may help to relieve some uncertainty.

Understanding these communication patterns is critical, Broadbridge said, because “breast cancer patients who have symptoms of anxiety have a higher risk for both morbidity and all-cause mortality. Illness uncertainty is a cognitive and emotional state in which patients dealing with novel, complex, and/or ambiguous health events are unable to make meaning of these events. Breast cancer patients experience this throughout the illness trajectory, from diagnosis to treatment and beyond. Uncertainty about the diagnosis, cancer-related symptoms, illness prognosis, and treatment decisions all contribute to a worse quality of life for breast cancer patients. Moreover, illness uncertainty is positively correlated with anxiety during diagnosis and is associated with worse psychological well-being during both the treatment and post-treatment stages.”

A second major finding of this study showed when oncologists are made aware of patients who experience anxiety before appointments, they and other healthcare providers can be trained to create more empathetic opportunities (opportunities to provide empathy and support to  anxious patients) and be more cautious of their own communication behaviors.

A major finding of this study showed when oncologists are made aware of patients who experience anxiety before appointments, they and other healthcare providers can be trained to create more empathetic opportunities (opportunities to provide empathy and support to  anxious patients) and be more cautious of their own communication behaviors.

Explaining how they define “empathetic opportunity,” Venetis said, “One form of patient information sharing includes ‘empathic opportunities’ in which patients offer statements that express an emotion such as fear, worry, or relief, and explicitly give medical providers opportunities to respond empathically and with support.Thus, this form of communication allows patients to share information and can elicit provider responses, contributing to the overall patient–provider relationship. How providers respond to patient communication is consequential to patient well-being, with expressions such as hopefulness associated with more satisfaction with care. Cancer care providers often miss these opportunities, which may hinder patient comfort and participation.”

The study results provide evidence for the effects of positive provider responses to emotion statements (empathic openings). “Although not significant in our data,” Broadbridge and Venetis said, “positive responses to empathic openings trended towards reducing post-appointment uncertainty. Previous research from our research team has shown that reducing patient uncertainty about their cancer diagnosis and treatment is associated with better psychological outcomes. We suggest in the paper that future research should clarify the effects of providers positively responding to empathic openings to address patient uncertainty versus the effects of providing an empathic opening on its own (i.e., an indication of feeling comfortable with the provider).”

The results of this study provide a new understanding for how patients' pre-appointment anxiety influences effective patient–provider communication and post-appointment uncertainty. Assessing the psychological well-being of breast cancer patients is crucial for identifying those at high risk of negative health outcomes and providing holistic care, Broadbridge and Venetis said.

Learn more about the Ph.D. Program and the Communication Department at the Rutgers School of Communication and Information on the website.