This qualitative study aims to identify which themes cause the most emotional variation in patients’ decisions about cancer treatment. Patients’ emotional variations are analysed to detect negative and positive variations to certain themes during the consultations. This analysis helps to detect what themes or elements affect patients’ experiences.

A total of 31 clinical consultations from cancer care pathways were recorded, transcribed and analysed. Patients were followed up until they decided and started treatment for their cancer. An inductive content analysis is followed to interpret patients’ emotional variations. All patients were from Hospital Universitario Miguel Servet of Zaragoza, Spain.

Twelve patients participated in the study, consisting of eight with breast cancer and four with melanoma. Of these patients, nine were female and three were male. Eligible participants were required to be new to the care pathways or to have used them more than 10 years ago. Participants were also required to be aged 18 or older, be fluent in Spanish and be available to participate for 3 months. Participants were excluded if the authors or oncologists noticed poor health conditions that could be exacerbated by the stress and additional effort involved in participating in the study.

Patients’ emotional variations identify five main themes: clinical history, cancer diagnosis, discussion of possible treatment choice, side effects (possible side effects of the selected treatment) and next steps (require complementary medical tests and more consultations to decide the treatment). Most of the emotional variations detected were negative and were mostly grouped into the categories of treatment, side effects and next steps. The most pronounced negative variations were related to delays in starting treatment and the possibility of hair loss.

The themes and emotional variations identified in this study can help to understand patients’ experiences during their initial oncology consultations. These results represent a significant step towards enhancing communication and the patient experience within oncology practices. Oncologists could use these data and procedures to identify where patients experience negative emotions and respond appropriately.