Empathy and boundary turbulence in cancer communication

Susan H. McDaniel, Diane S. Morse, Elizabeth A. Edwardsen, Adam Taupin, Mary Gale Gurnsey, Jennifer J. Griggs, Cleveland G. Shields, Shmuel Reis

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives: To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent. Methods: Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations. Results: We identified patient-centered physician response categories–empathy, affirmation, and acknowledgement; and physician-centered categories—transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered. Conclusions: Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication “boundary turbulence.” Patients may benefit from physicians’ improved use of empathy and boundary management.

Original languageEnglish
Pages (from-to)2944-2951
Number of pages8
JournalPatient Education and Counseling
Issue number12
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Elsevier B.V.


This project was supported by NCI grant R21CA124913 and NCI grant R01CA155376 for Dr. Shields, and NIMH T32 MH18911 PI Eric Caine for Dr. Morse.

FundersFunder number
National Institute of Mental HealthT32 MH18911
National Cancer InstituteR01CA155376, R21CA124913


    • Cancer
    • Communication
    • Empathy
    • Family
    • Patient centered
    • Physicians
    • Self-disclosure


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