Doctors, look up! Lack of eye contact reduces trust

Trust between breast cancer patients and their oncologist is crucial for good quality breast cancer care. It is associated with beneficial outcomes, such as a decrease in patients’ fear and better adherence. Patients’ trust was earlier shown to be influenced by the physicians’ verbal message. However, how physicians convey the message—their nonverbal communication—is likely as important as the information’s verbal content. Three nonverbal behaviors that may be beneficial for breast cancer patients’ trust in their physician are eye contact, body posture and smiling. Additionally, patients’ socio-demographic and personality characteristics may determine how they perceive nonverbal communication and, consequently, their 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.
Eye contact
We used a so-called ‘video-vignette’ study. Both women with breast cancer and healthy women participated as ‘analogue patients’. They first filled out a questionnaire assessing their background characteristics. Next, they viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment, while imagining themselves as the patient. 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). After viewing, participants rated their level of trust in the observed oncologist.

In total, 214 women participated. Consistent eye contact by the oncologist led to stronger trust. This effect was largely explained by lower educated patients – for them, the effect of consistent eye contact was stronger than for higher educated patients. A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly and caring. Older and lower educated women were more trusting.

We demonstrated that it is important for breast cancer patients’ trust that oncologists maintain consistent eye contact. This is especially true among lower educated patients. These findings need to be translated into training for oncologists. Such training should focus on ways to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation. We also showed that for certain subgroups of patients, trust is less evident than for others. For oncologists, it is important to realize that younger and higher educated breast cancer patients are less inclined to fully trust them, at least initially. We should identify communication strategies to enhance trust among these specific subgroups.



All eyes on the patient: the influence of oncologists’ nonverbal communication on breast cancer patients’ trust.
Hillen MA, de Haes HC, van Tienhoven G, Bijker N, van Laarhoven HW, Vermeulen DM, Smets EM
Breast Cancer Res Treat. 2015 Aug;153(1)


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