Empathy and emotional support in communication with patients with differentiated thyroid cancer: importance in therapeutic decisions

In recent years, recommendations regarding thyroid surgery as an initial treatment for differentiated thyroid cancer have undergone significant changes. Two of the most notable developments include, first, a preference for less aggressive procedures when clinically appropriate—thus avoiding overtreatment—and second, an equally important emphasis on patient involvement in clinical decision-making, respecting their autonomy and capacity to choose. In this context, the recently published clinical guidelines by the American Thyroid Association (ATA) introduce a novel approach that promotes individualized decision-making and patient-centered management throughout the course of the disease. Compared to previous guidelines, this document assigns a greater role to active surveillance in selected patients and reinforces the indication of lobectomy as a valid option for low-risk, small tumors, thereby acknowledging the possibility of avoiding total thyroidectomy in a larger proportion of patients (1).

The article by Jensen et al., published in Medical Decision Making (2), addresses, through an elegant randomized clinical trial, the issue of patient preferences regarding the extent of initial surgery. Specifically, it evaluates the effect of increased emotionally supportive surgeon communication on patients’ treatment preferences. To this end, the authors selected a group of patients with a benign fine-needle aspiration result for a thyroid nodule ≤4 cm, who did not require surgery. Participants viewed a virtual clinic visit depicting a patient-surgeon treatment discussion. Following random assignment, patients in the intervention group were exposed to isolated elements of verbal and non-verbal communication demonstrating empathy and emotional support. This emotionally supportive communication was not provided to patients in the control group. Patients were instructed to imagine that their recent biopsy indicated thyroid cancer and to reflect on how they would feel, after which they completed a questionnaire assessing the study objectives.

The primary outcome of the study was that most patients chose lobectomy as their preferred treatment with no significant difference between groups (88% in the intervention and 90% in the control group). Secondary outcomes showed that patients who viewed the video with increased emotional support reported higher levels of perceived physician empathy and physician trust compared to controls. Conversely, both groups reported similar levels of decisional confidence and disease-specific knowledge. These findings compel us to reflect on the emotional aspects and empathy in doctor-patient communication as key aspects for improving psychological well-being, decision-making, and trust in treatment among patients newly diagnosed with thyroid cancer.

Emotionally supportive communication is essential for mitigating anxiety and improving the emotional experience of patients newly diagnosed with thyroid cancer. The trial by Jensen et al. (2), as well as some previous studies, suggests that empathetic communication by surgeons enhances patient trust and perceived empathy, which translates into greater confidence in the medical team and better readiness for treatment (3). The ATA explicitly recommends that clinicians be prepared to address the psychosocial implications of thyroid cancer diagnosis and treatment, acknowledging that distress and concern may persist for years and that many patients report unmet supportive care needs (1). On the other side, qualitative evidence indicates that patients value when surgeons take time to answer questions, validate their emotions, and treat them as individuals rather than merely as carriers of a disease. When surgeons minimize concerns or focus exclusively on technical information, patient anxiety tends to increase (4,5). Furthermore, patient-centered communication, which incorporates brief sequences of empathy and emotional support, significantly reduces anxiety and negative affect during the delivery of bad news, while also increasing trust in the physician (6). Interventions such as supportive psychological nursing and continuous follow-up have been shown to reduce levels of anxiety and depression, improve quality of life, and enhance satisfaction with care among patients undergoing surgery for thyroid cancer (7).

From a clinical standpoint, the findings of the trial under discussion highlight the importance of empathetic communication within the medical setting. Although the intervention of viewing a video designed to enhance emotional support did not alter the hypothetical treatment choice, it significantly improved the physician-patient relationship by fostering empathy and trust in the surgeon. In real-world clinical practice, such improvements may translate into better adherence to follow-up, higher patient satisfaction, and more effective shared decision-making. As the authors note, emphasizing emotional support promotes patient trust and the perception of empathy during the consultation. This is particularly relevant in the context of low-risk thyroid cancer, where multiple treatment options exist (active surveillance, lobectomy, total thyroidectomy), and the objective is to ensure informed patient participation (8). Greater empathy and trust might facilitate the information exchange process and mitigate patient anxiety, even though, in this specific study, the hypothetical treatment decision remained unchanged.

It is noteworthy that 89% of patients opted for lobectomy rather than total thyroidectomy, whereas in most previous studies the proportion of lobectomy selection in low-risk thyroid cancer has been considerably lower (9,10). This finding may have clinical significance, as it appears to reflect greater patient awareness of the risks associated with total thyroidectomy and a positive valuation of functional preservation. Certainly, it is reasonable to assume that the manner in which information is communicated can have a profound impact on patient choice. This underscores the need for patient-centered consultations that provide clear information and emotional support. Moreover, increased use of lobectomy could translate into lower morbidity, reduced long-term costs (due to complications and lifelong medication), and potentially improved quality of life (11). However, it also poses challenges, as it requires more vigilant follow-up to detect recurrences and ensure appropriate patient selection.

Jensen’s study presents a robust design with randomization and rigorous control of the intervention. Furthermore, multiple relevant outcome variables (treatment preference, empathy, trust, knowledge) were measured using validated instruments and complemented by qualitative analysis of open-ended responses, enriching the findings. The use of intention-to-treat analysis and adjustment for sex strengthens the internal validity of the results. Nevertheless, external validity is limited, as the study was conducted at a single center with a sample predominantly composed of young women and White participants, which may limit generalizability to other demographic groups. The intervention can be considered virtual or hypothetical, since participants only viewed a simulated consultation on video rather than being actual patients with an active cancer diagnosis. This hypothetical scenario may not fully reflect how real decisions are made in clinical practice. Long-term impact was not assessed. Finally, although there were significant differences in empathy and trust, the study may have had limited power to detect small differences in treatment preferences. These weaknesses suggest caution when extrapolating the results to everyday practice.

Future research in this area should aim to extend the model to real clinical contexts—for example, studies in which patients with a confirmed diagnosis interact with surgeons trained in empathetic communication, assessing not only preferences but actual decisions, final satisfaction, and clinical outcomes. It would be valuable to include more diverse populations (in terms of sex, age, and ethnicity) and multiple centers to improve representativeness. Exploring different levels or styles of empathetic communication, as well as specific training for surgeons, would also be worthwhile. Another approach would be to measure long-term impact—for instance, whether increased trust translates into better treatment adherence or reduced decisional regret. Furthermore, given that treatment preference did not change, future studies could investigate how communication influences patients facing more complex decisions or greater uncertainty.

Medical practice is not limited to the application of scientific knowledge; it is, above all, a human encounter. When the physician offers emotional support to the patient, a bond is established that transcends a purely technical relationship: trust is built. This trust directly influences the quality of clinical decisions and treatment outcomes. Empathy enables the physician to understand not only the disease but also the patient’s life experience. When patients feel heard and understood, they place greater confidence in medical recommendations, which translates into improved therapeutic adherence and more effective communication. This trust reduces uncertainty, facilitates shared decision-making, and lowers the risk of conflicts or complaints (12,13).

Low-risk differentiated thyroid cancer presents a paradoxical challenge: it is associated with an excellent prognosis, yet surgical management frequently exceeds what is clinically necessary. Although international guidelines recommend lobectomy or even active surveillance in selected cases, routine practice continues to favor total thyroidectomy, with greater long-term morbidity and costs. Why does this gap persist? The answer lies not only in clinical evidence, but also in the patient’s emotional experience and how we communicate the options. Practicing medicine with empathy not only improves the patient relationship but also reduces emotional strain and the risk of burnout among physicians by giving meaning and humanity to their daily work. For the healthcare system, this dynamic generates efficiency: fewer errors resulting from a lack of information, less unnecessary use of resources, and better clinical outcomes (14,15). In conclusion, medicine with emotional support makes us better because it reminds us that healing is not only about intervening, but about accompanying. When science is united with empathy, the patient, the professional, and the healthcare system all benefit. The trust that emerges from this relationship is the bridge that transforms technique into true medicine.

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