Physicians’ Empathic and Uncertainty-Reframing Communication in Active Surveillance: Boosting Patient Acceptance and Mitigating Professional Risks

Active surveillance (AS) is a viable, yet underutilized option for managing low-risk cancers. Patients struggle psychologically with the inherent uncertainty, and physicians are hesitant to recommend AS due to concerns about professional risks should the disease progress. This online experimental study examined whether and how physicians' empathic and uncertainty-reframing communication increases patients' immediate AS acceptance at the point of clinical decision and reduces their intentions to engage in medical litigation and to spread negative word-of-mouth (N-WOM). Using a 2 × 2 × 2 between-subjects factorial design, 968 South Korean adults were randomly assigned to one of eight vignettes that manipulated empathic communication (low vs. high) and uncertainty-reframing communication (absent vs. present), and hospital setting (local general hospital vs. top-tier tertiary hospital). Results showed that empathic communication significantly improved AS acceptance and reduced litigation and N-WOM intentions. Mediation analyses revealed that reduced anxiety and increased trust in the AS plan mediated its beneficial effect on AS acceptance; enhanced physician credibility mediated the effect on litigation intention; and decreased anxiety mediated the effect on N-WOM intention. Uncertainty-reframing was beneficial only when empathic communication was absent, indicating a compensatory effect. These core patterns were consistent across different hospital settings (a local general hospital vs. a top-tier tertiary hospital in the capital city). These findings provide empirical evidence that physician communication can bridge the gap between evidence and current practice by attenuating key barriers for both patients and physicians.