Editor's Correspondence:  COMMENTS AND OPINIONS

In reply

We appreciate the opportunity to respond to Dr Merlo's comments regarding our article¹ on missed opportunities for empathy in lung cancer communication. We agree that physician-provided empathy is important and may benefit patients.

Regarding the rationale for selecting the transcripts that were analyzed for the study, it is standard in qualitative studies to perform an in-depth analysis of a representative portion of a sample to address questions not fully answered from quantitative methods.² A prior analysis of data from these medical encounters demonstrated decreased trust³ and decreased patient participation⁴ in African American compared with white patients. These analyses indicated that lower trust among African American patients was associated with lower perceptions of physicians' provision of information and with lower affective communication.³ Hence, we chose a sample that included equal numbers of African Americans and whites and that included patients using very low levels and very high levels of active communication behaviors. The transcripts were coded for active communication behaviors in a previous study.⁴ We chose at the outset to review 20 transcripts and did not review more because we were able to achieve saturation—new themes did not emerge—after reviewing a subset of these 20.