All eyes on the patient: the influence of oncologists’ nonverbal communication on breast cancer patients’ trust

Abstract

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients’ trust. We were the first to experimentally examine (1) how the oncologist’s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients’ trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist’s amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = −.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (rs = .31, p < .001) and caring (rs = .18, p = .01). Older (β = .17, p = .01) and lower educated APs (β = −.25, p < .001) were more trusting. Trust was weaker for more avoidantly attached APs (β = −.16, p = .03). We experimentally demonstrated the importance of maintaining consistent eye contact for breast cancer patients’ trust, especially among lower educated patients. These findings need to be translated into training for oncologists in how to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3486-0) contains supplementary material, which is available to authorized users.

Oncologists’ non-verbal behavior and analog patients’ recall of information

“…data were taken together for patients and healthy women. Previous analyses showed comparable results between the two subgroups, justifying this decision [21].…”

“…Data for this study were collected in the context of a larger research project, investigating the influence of non-verbal communication on trust [21]. Women with a breast cancer diagnosis and healthy women of comparable age were recruited to participate as analog patients (APs), i.e.…”

“…After the video, a second survey asked participants how friendly they perceived the oncologist to be (T1). Other measures assessed at T1 are reported in Hillen et al [21]. Afterwards, participants were asked permission to be contacted by phone one or two days after participation, for some final questions.…”

“…Of the total sample of 248 participants in the larger study [21], 194 women (78%) consented to participate in recall testing (Table 1): 68% breast cancer patients or survivors (50% outpatients and 18% patient organization respondents) and 32% healthy women. Mean age was 54 years (range 31-85); 82% were younger and 18% older than 65.…”

Patient and family engaged care—going beyond tactical buzzwords

“…Making the clinical visit longer and moving the computer out of the way could help clinicians and patients notice each other, communicate better, and co-produce more effective care plans. 3 Patients and caregivers who need help finding and using their voice could be partnered with others who are already taking control of their healthcare. Practical responses like these show that patients are powerful and that their voice is integral to successful care.…”