A little empathy goes a long way for cancer patients trying to cope with a poor prognosis, but doctors rarely offer it, a new study of recorded interactions shows.

Responding with empathy — the identification with and understanding of another person's situation and feelings — does not make for longer visits to the doctor, may help ease patients concerns and may lead patients to follow the recommended treatment more closely, according to the researchers.

Despite the benefits, when patients commented on the personal impact of cancer, their diagnosis, treatment and problems dealing with the health-care system, doctors responded empathically only 10 per cent of the time, psychiatry professor Dr. Diane Morse of the University of Rochester Medical Center in Rochester, N.Y., and her team reported in Monday's Archives of Internal Medicine.

In one interview, a lung cancer patient mentioned the amount of time he expects to live:

Patient: I don't know what the average person does in just two years, three years, a year? Physician: I think that … you certainly could live two or three years. I think it would be very unlikely … But I would say that an average figure would be several months to a year to a little bit more.

The doctor did not respond to the patient's clue to his concern. In another case, a patient hints at regretting the role that smoking played in his cancer, but the doctor abruptly changes the subject:

Patient: No, sir, I've never had a heart attack, Supposedly, I worked very hard when I was a young man, a young boy. I was doing a man's labour and I was always told I had a good strong heart and lungs. But the lungs couldn't withstand all that cigarettes . . . Physician: Yeah. Patient: Asbestos and pollution and second-hand smoke and all these other things, I guess. Physician: Do you have glaucoma?

Show understanding to build trust

When the researchers analyzed transcripts of consultations between patients with lung cancer or a mass in their lungs that needed to be diagnosed surgically, they found 384 moments when patients stated or alluded to concerns, such as "This is kind of overwhelming."

The three oncologists and six thoracic surgeons, all male, responded emphatically in 39 of the cases. Both the doctors and patients knew they were being recorded, and they were not identified by name.

"When patients are struggling and bring up important issues, doctors don't have to take a lot of time to address them, but they do need to respond," Morse said. "Showing that they understand and giving their patients more of what they need is not that difficult."

A simple phrase, such as "It sounds like you are very concerned about that," may help, Morse said.

The researchers suggested that doctors who have patients with a life-threatening illness consider offering empathy early on and throughout treatment.

"Use of this communication skill may allow increased understanding and progressive rapport and trust with patients. Fortunately, studies indicate that expressing empathy can be taught and that these statements can be brief and powerful, not prolonging the encounter or necessarily changing a physician's style," the study's authors wrote.

As for why doctors may shy away from offering empathic responses, the researchers said they may be busy dealing with other tasks and fail to recognize the opening, consciously avoid it, especially when discussing death is involved, or believe that biomedical information is reassuring.

When a patient is dying and there is little potential for a cure, the physician may feel a sense of failure that it is difficult to acknowledge, the researchers said. It also makes a doctor more aware of his or her own vulnerability to illness and death.

Earlier studies showed similar results among family physicians.