Between empathy and grief: The mediating effect of compassion fatigue among oncologists

Empathic pain: Exploring the multidimensional impacts of biological and social aspects in pain

Empathic pain refers to an individual's perception, judgment, and emotional response to others' pain. This complex social cognitive ability is crucial for healthy interactions in human society. In recent years, with the development of multidisciplinary research in neuroscience, psychology and sociology, empathic pain has become a focal point of widespread attention in these fields. However, the neural mechanism underlying empathic pain remain a controversial and unresolved area. This review aims to comprehensively summarize the history, influencing factors, neural mechanisms and pharmacological interventions of empathic pain. We hope to provide a comprehensive scientific perspective on how humans perceive and respond to others' pain experiences and to provide guidance for future research directions and clinical applications.

Nurses' Perception of Caring and Attitudes toward Caring for Dying Patients: Exploring the Relationship Using a Descriptive Cross-Sectional Design

This study examines the association between nurses' perception of caring and attitudes toward caring for dying patients in end-of-life care units. We used a descriptive cross-sectional design with convenience sampling. Data were collected from May to June 2021 through self-reported questionnaires from 303 Spanish nurses (mean age = 48 years, 78.9% female). Participants completed the Caring Dimension Inventory (CDI-25) and the Frommelt Attitudes Toward Care of the Dying scale. Demographic and training information were collected. Data were analyzed using Stata 16.0. Attitudes toward Care of the Dying Patient were significantly higher in nurses with palliative care training (β = 2.829, p = 0.018) and those who scored higher on the psychosocial (β = 0.789, p = 0.0001) and technical dimensions (β = 0.487, p = 0.011) of the CDI-25. Multivariate analysis identified the psychosocial dimension of the CDI-25 scale (β = 0.783, p = 0.0001) and palliative care training (β = 2.686, p = 0.017) as the only significant variables associated with Attitudes toward Care of the Dying Patient. Overall, nurses exhibited a positive attitude toward caring for dying patients. Our results could potentially help nursing directors identify those with the necessary qualities and training for optimal end-of-life care and to further plan training courses to provide optimal care in end-of-life situations.

The effect of top-down attention on empathy fatigue

Prolonged exposure to others' suffering can lead to empathy fatigue, especially when individuals struggle to effectively regulate their empathic capacity. Shifting active attention away from emotional components toward cognitive components of others' suffering is an effective strategy for mitigating empathy fatigue. This research investigated how top-down attentional manipulation modulates empathy fatigue in both auditory (Study 1) and visual (Study 2) modalities. Participants completed two tasks in both studies: (i) the attention to cognitive empathy task (A-C task) and (ii) the attention to emotional empathy task (A-E task). Each task included three blocks (Time Block 1, Time Block 2, and Time Block 3) designed to induce empathy fatigue. Study 1 revealed that the A-C task reduced empathy fatigue and N1 amplitudes than the A-E task in Time Block 3, indicating that attention to cognitive empathy might decrease auditory empathy fatigue. Study 2 indicates that the A-C task caused a longer N2 latency than the A-E task, signifying a decelerated emotional empathic response when attention was on cognitive empathy in the visual modality. Overall, prioritizing cognitive empathy seems to conserve mental resources and reduce empathy fatigue. This research documented the relationship between top-down attention and empathy fatigue and the possible neural mechanism.

The Mediating Role of Parenting Style in the Relationship between Parents' Openness to Different Ways of Thinking and Child Anxiety

The quality of parent-child relationships plays a significant role in the development of child anxiety, especially regarding aspects of parental control, intrusive behavior, and a lack of warmth. Nevertheless, the underlying mechanisms of these parenting behaviors that are associated with the risk of child anxiety have yet to be revealed. The present study aims to examine the contribution of a cognitive aspect of parenting, i.e., openness to different ways of thinking, to the development of child anxiety through its impact on parenting style. A sample of 300 Israeli parents (72% women) over the age of 18 (M = 38.8, SD = 6.2), with at least one child over the age of 6 (M = 13.3, SD = 5.5 of oldest child), was recruited through social media platforms. Participants provided demographic information and filled out self-reported questionnaires dealing with child anxiety (using the Child Behavior Checklist), openness to different ways of thinking (using the Interpersonal Reactivity Index), and parenting style (using the Parental Behavior Inventory). The analysis confirmed the mediation role of hostile/coercive parenting style in the association between parental openness to different ways of thinking and child anxiety. However, the association between supportive/engaged parenting and child anxiety was non-significant. Apparently, openness to different ways of thinking allows for parents to consolidate parenting that does not resort to coercive and hostile behaviors, control, obedience, and severe strictness. As a result, the child develops self-regulation and coping mechanisms that reduce the risk for developing anxiety.

The impact of patient death experiences early in training on resident physicians: a qualitative study

BACKGROUND

Patient death is an inevitability during medical training, with subsequent psychologic distress, decreased empathy and worse learning outcomes. We aimed to explore resident experiences with patient death early in training, including the immediate and delayed impacts of these experiences, preparedness of trainees for these events and coping strategies used, potentially identifying gaps and opportunities to further support trainees during difficult or traumatic events.

METHODS

We performed a qualitative study using phenomenology methodology to understand trainees' personal experiences with patient death. Resident physicians who had completed an internal medicine rotation at McMaster University, Hamilton, Ontario, were invited to participate from December 2020 to April 2021. Semistructured interviews were conducted to understand circumstances, emotional responses, support, coping mechanisms and preparedness regarding the patient death experience. Interviews were transcribed and coded to identify emerging themes with the use of thematic and interpretive analysis.

RESULTS

Eighteen participants were interviewed. On average, the interviews were 40 minutes in length. The participants' mean age was 27 years. The majority of trainees (10 [56%]) were in their first year of residency, with 5 (28%) from family medicine and 4 (22%) from internal medicine. Most participants (13 [72%]) had experienced their first patient death during medical school. Three themes were identified: patient death circumstances, immediate and delayed emotional impact, and preparedness and coping mechanisms. Unexpected death, pronouncing death, cardiopulmonary resuscitation and communicating with families were common challenges. Feelings of guilt, helplessness and grief followed the events. Feeling underprepared contributed to emotional consequences, including difficulties sleeping, intrusive thoughts and emotional distancing; however, these experiences were consistently normalized by participants.

INTERPRETATION

Patient death during medical training can be traumatic for trainees and may perpetuate loss of empathy, changes to practice and residual emotional effects. Educational initiatives to prepare trainees for patient death and teach adaptive coping strategies may help mitigate psychologic trauma and loss of empathy; further research is required to explore these strategies.

Unmasking grief: Reflections on the complicated relationship between moral distress and grief

Perinatal loss often occurs in the context of discovery of a medical condition that presents patients and healthcare providers (HCPs) with difficult choices. Treatment choices are influenced by medical technology, however inescapable prognostic uncertainty, coupled with shared decision-making can lead to ethical dilemmas (Graf et al., 2023) [1]. When patients experience perinatal loss HCPs must grapple with their own emotions. Their sense of grief arises from their empathic connection with patients, bearing witness to their grief. This grief may compound HCP moral distress. Moral distress has an element of emotion, however it is more than distress in tragic situations. Moral distress is linked to HCPs feeling responsible to take action (Dudzinski, 2016) [2]. In situations of perinatal loss, it is essential to acknowledge the grief and explore how it influences the experience of moral distress. This article will reflect on the impact of HCP grief in ethically complex situation of perinatal loss.

Hospital-Based Interventions to Address Provider Grief: A Narrative Review

CONTEXT

Provider grief, i.e., grief related to the death of patients, often forms an ongoing and profound stressor impacting healthcare providers' ability to maintain their sense of well-being, avoid feeling overwhelmed, and sustain quality and compassionate patient care over time.

OBJECTIVES

This narrative review presents findings on the types of interventions hospitals have offered to physicians and nurses to address provider grief.

METHODS

Searches of PubMed and PsycINFO were conducted for articles (e.g., research studies, program descriptions and evaluations) focused on hospital-based interventions to help physicians and nurses cope with their own grief.

RESULTS

Twenty-nine articles met inclusion criteria. The most common adult clinical areas were oncology (n = 6), intensive care (n = 6), and internal medicine (n = 3), while eight articles focused on pediatric settings. Nine articles featured education interventions, including instructional education programs and critical incident debriefing sessions. Twenty articles discussed psychosocial support interventions, including emotional processing debriefing sessions, creative arts interventions, support groups, and retreats. A majority of participants reported that interventions were helpful in facilitating reflection, grieving, closure, stress relief, team cohesion, and improved end-of-life care, yet mixed results were found related to interventions' effects on reducing provider grief to a statistically significant degree.

CONCLUSION

Providers largely reported benefits from grief-focused interventions, yet research was sparse and evaluation methodologies were heterogenous, making it difficult to generalize findings. Given the known impact provider grief can have on the individual and organizational levels, it is important to expand providers' access to grief-focused services and to increase evidence-based research in this field.

What Mediates the Link Between Foster Parents' Sensitivity Towards Child Posttraumatic Stress Symptoms and Job Satisfaction? The Role of Compassion Fatigue and Foster Parent-Child Relationship

Purpose: It is very likely that many children who enter the foster care system have experienced at least one traumatic event, and can develop symptoms of PTSS. Consequently, foster parents' level of sensitivity towards child symptoms of PTSS plays a significant role in child development, but the link between sensitivity and several professional characteristics is not well understood. The current study aims to explain the effect foster parents' sensitivity towards child trauma exert on their job satisfaction, via foster parents' compassion fatigue and the quality of their relationship with the children in care. This study is one of the few to investigate foster parents' sensitivity towards child trauma, and the direct and indirect effects on other variables. Methods: Structural equation modeling was used to test a mediating model on this sample (N = 165) after using an online survey to collect the cross-sectional data. Results: The model produced good fit (RMSEA = 0.087; CFI = 0.899). The direct effects between variables are significant. The relationship between foster parents' sensitivity towards trauma and their job satisfaction can be better understood with the contribution of compassion fatigue. Conclusion: Findings confirm the mediation effect of compassion fatigue and reveal more aspects of the sensitivity towards trauma concept. These results could be implemented by considering more accurate measurements for the caregiver's sensitivity towards child trauma. The importance of considering interventions for increasing foster parents' trauma knowledge and skills is highlighted.

Are empathy profiles and perceived social support associated with depressive and grief-related symptoms in suicide survivors?

OBJECTIVE

To investigate the link between empathy, perceived social support, and depressive and grieving symptoms in suicide survivors.

METHODS

Scores on the Beck Depression Inventory (BDI), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder (PGD), Interpersonal Reactivity Index (IRI), and the Social Support section of the Interpersonal Questionnaire were collected from 265 survivors. Relations were tested via multivariate regression models.

RESULTS

Lower Perspective Taking (PT) was related with higher levels of BDI score, and higher Personal Distress (PD) was associated with higher BDI, ICG, and PGD scores. Higher levels of Social Support were related with higher BDI and ICG (but not PGD) scores.

CONCLUSION

Empathic PD and PT, and perceived social support are differently associated with depression and grief-related symptoms. Empathy-focused psychotherapies and empowerment of social support may reduce symptoms in suicide survivors.

Oncologists’ Locus of Control, Compassion Fatigue, Compassion Satisfaction, and the Mediating Role of Helplessness

The oncology setting may give rise to significant feelings of helplessness among oncologists via patients’ inevitable deaths or suffering. The current study examines whether and how oncologists’ sense of control (locus of control; LOC) influences their compassion fatigue and satisfaction. Methods: Seventy-three oncologists completed the following questionnaires: the Professional Quality of Life scale; Levenson’s Internal, Powerful Others, and Chance scale; the Guilt Inventory, State Guilt subscale; and the Learned Helplessness scale. Results: Oncologists reported high levels of secondary traumatic stress and burnout and moderate levels of compassion satisfaction. A positive association between oncologists’ external LOC and compassion fatigue, and a negative association between oncologists’ internal LOC and compassion fatigue, were found. Helplessness, but not guilt, had a mediating role in these associations. Internal LOC was also positively associated with compassion satisfaction. Conclusions: The current study highlights oncologists as a population at risk of experiencing compassion fatigue and emphasizes oncologists’ locus of control as a predisposition that plays a role in the development of this phenomenon. Additionally, the cognitive as well as the emotional aspects of control were found to be important factors associated with compassion fatigue.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

Grief as a mediator of the relationship between empathy and compassion fatigue

OBJECTIVE

Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF.

METHODS

Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale.

RESULTS

Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS.

CONCLUSIONS

Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.

The Influence of Family Function on State Anxiety of Chinese College Students During the Epidemic of COVID-19

The Coronavirus Disease 2019 (COVID-19) may affect mental health. There is little research about the influence of family function on the state anxiety of college students in the context of the global pandemic. The study aimed to clarify that generalized anxiety disorder (GAD) and trait anxiety had mediating effects in family function on the state anxiety of Chinese college students following the "stay-at-home" order during the outbreak of COVID-19. This cross-sectional study was conducted online with 1,039 respondents. We analyzed demographics, The State-Trait Anxiety Inventory (ST-AI) and Chinese Family Function Scale (FAD-18), Generalized Anxiety Disorder-7 (GAD-7), and used path analysis to discuss the influence of family function on state and trait anxiety. The results showed that female students' state and trait anxiety was higher than that of male students (P < 0.05). Medical students' state and trait anxiety was lower than that of literature students (P < 0.05). The GAD of the male was lower compared with the female. The score of family function has significant differences in gender, age, education, and region (P < 0.05). Gender, family function, state anxiety, trait anxiety, and GAD relate to others (r = 0.07∼0.85, p < 0.05). The results of fit indices for measurement invariance models showed that the impact of family function among GAD, state and trait anxiety across gender is significantly different (each step p < 0.05). GAD and trait anxiety had a complete meditating effect between family function and state anxiety (the proportion of standard indirect mediating effect was 24.94% in females and 36.79% in males). A healthy family function may alleviate GAD and anxiety of college students during the COVID-19 pandemic.

Investigating the Association between Outdoor Environment and Outdoor Activities for Seniors Living in Old Residential Communities

Many seniors live in old residential communities (ORCs) with low-quality outdoor environment (OE), which hinders the residents’ outdoor daily activities (ODAs). This paper empirically investigates the association of OE on ODAs for seniors living in ORCs. A questionnaire was designed and distributed in six central districts of Nanjing city. A total of 258 questionnaires was finally collected, of which 60.08%, 29.46%, 9.69%, and 0.78% respondents were scattered into four age groups (61–69, 70–79, 80–89, and ≥90), respectively. Based on reliability analysis, correlation analysis, and regression analysis, the results show that: (1) social activities are mainly associated with noise; (2) leisure activities are significantly associated with road accessibility, slip-resistance measures, greenery, and staff; (3) utilitarian-type activities are significantly associated with stairway accessibility, slip-resistance measures, greenery, and seating; (4) there is a significant association between nature-exposure activities and layout, greenery, and poor air quality. The findings could guide Chinese officials when renewing ORCs by addressing the most important outdoor environmental factors associated with ODAs.

Professional quality of life, self-compassion, resilience, and empathy in healthcare professionals during COVID-19 crisis in Spain

The coronavirus pandemic has exposed healthcare professionals to suffering and stressful working conditions. The aim of this study was to analyze professional quality of life among healthcare professionals and its relationship with empathy, resilience, and self‐compassion during the COVID‐19 crisis in Spain. A cross‐sectional study was conducted with 506 healthcare professionals, who participated by completing an online questionnaire. A descriptive correlational analysis was performed. A multivariate regression analysis and a decision tree were used to identify the variables associated with professional quality of life. Empathy, resilience, and mindfulness were the main predictors of compassion fatigue, compassion satisfaction, and burnout, respectively.

Extending "Beyond Diversity": Culturally Responsive Universal Design Principles for Medical Education

This commentary follows up on Maduakolam et al. (2020) "Beyond Diversity: Envisioning Inclusion in Medical Education Research and Practice," which introduced Culturally Responsive Universal Design for Learning (CRUDL) as an approach to accounting for learner diversity in educational theory development and curriculum design. We flesh out the principles of CRUDL, using publications in this issue of Teaching and Learning in Medicine as case examples for how the principles work in action. With this scholarly thought exercise, we seek to demonstrate the feasibility and promise of curriculum that is accountable to diverse learners and the impact of historical trauma. We also explore how research inclusive of diverse social identities could inform curriculum design by identifying how social identity, learning environment, educational activities, and learner engagement interact to produce diverse learning experiences and performance. Scholarly thought exercises such as this one may help bridge the gap between professed ideals and action with respect to inclusive medical education; CRUDL principles provide a helpful framework for planning and evaluating accountable curriculum design.

Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review

BACKGROUND

In recent years there has been increasing attention for the prevalence and prevention of burnout among healthcare professionals. There is unclarity about prevalence of burnout in healthcare professionals providing palliative care and little is known about effective interventions in this area.

AIM

To investigate the prevalence of (symptoms of) burnout in healthcare professionals providing palliative care and what interventions may reduce symptoms of burnout in this population.

DESIGN

A systematic literature review based on criteria of the PRISMA statement was performed on prevalence of burnout in healthcare professionals providing palliative care and interventions aimed at preventing burnout.

DATA SOURCES

PubMed, PsycInfo and Cinahl were searched for studies published from 2008 to 2020. Quality of the studies was assessed using the method of Hawkers for systematically reviewing research.

RESULTS

In total 59 studies were included. Burnout among healthcare professionals providing palliative care ranged from 3% to 66%. No major differences in prevalence were found between nurses and physicians. Healthcare professionals providing palliative care in general settings experience more symptoms of burnout than those in specialised palliative care settings. Ten studies reported on the effects of interventions aimed at preventing burnout. Reduction of one or more symptoms of burnout after the intervention was reported in six studies which were aimed at learning meditation, improving communication skills, peer-coaching and art-therapy based supervision.

CONCLUSION

The range of burnout among healthcare professionals providing palliative care varies widely. Interventions based on meditation, communication training, peer-coaching and art-therapy based supervision have positive effects but long-term outcomes are not known yet.