The inseparability of emotional and instrumental care in cancer: Towards a more powerful science of clinical communication

ObjectiveClinical communication literature currently distinguishes clinicians’ emotional care of patients from instrumental aspects of clinical care, and regards clinicians’ explicit emotional engagement with patients as the key to emotional care. Here we critically appraise this view.MethodsWe draw on empirical evidence and recent reviews and critiques focusing on cancer care.ResultsPatients and families do not generally seek explicit emotional engagement from their practitioners; nor does such engagement consistently improve patient outcomes. Instead some evidence indicates that anxious patients and families can be comforted by clinicians’ focus on instrumental care.ConclusionsSuch findings can be interpreted according to the view that clinical relationships evoke attachment processes. In the context of mortal illness, patients are comforted by being able to trust clinicians whom they regard as having the expertize to look after them. From this perspective, instrumental and emotional care are inseparable. Clinicians’ clinical authority and expertize are the basis for the emotional comfort they can provide.Practice implicationsFor researchers and educators, a consequence of appreciating the inseparability of emotional and instrumental care will be greater emphasis on learning from, and collaborating with, clinicians. Clinicians, in turn, can benefit by communication scientists developing new approaches to supporting their communication. These approaches will need to recognize that clinicians’ emphasis on their authority and clinical expertize in communicating with patients can be central to providing emotional comfort, and not necessarily a way to avoid doing so.