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Mohammadi M, Peyrovi H, Fazeli N, Parsa Yekta Z. Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241240902. [PMID: 38876482 DOI: 10.1177/10497323241240902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.
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Affiliation(s)
- Marziyeh Mohammadi
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Hamid Peyrovi
- Nursing and Midwifery Care Research Center/School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Parsa Yekta
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
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Pollock JR, Mujahed T, Smith JF, Arthur JR, Brinkman JC, Atkinson CM, Pollock NT, Renfree KJ. What Patients Say About Their Orthopaedic Hand and Wrist Surgeons: A Qualitative Analysis of Negative Reviews on Yelp. J Wrist Surg 2024; 13:202-207. [PMID: 38808180 PMCID: PMC11129890 DOI: 10.1055/s-0043-1768924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/03/2023] [Indexed: 05/30/2024]
Abstract
Background Patients often turn to online reviews as a source of information to inform their decisions regarding care. Existing literature has analyzed factors associated with positive online patient ratings among hand and wrist surgeons. However, there is limited in-depth analysis of factors associated with low patient satisfaction for hand and wrist surgeons. The focus of this study is to examine and characterize extremely negative reviews of hand and wrist surgeons on Yelp.com. Methods A search was performed using the keywords "hand surgery" on Yelp.com for eight major metropolitan areas including Washington DC, Dallas, New York, Phoenix, Los Angeles, San Francisco, Boston, and Seattle. Only single-star reviews (out of a possible 5 stars) of hand and wrist surgeons were included. The complaints in the 1-star reviews were then categorized into clinical and nonclinical categories. Result A total of 233 single-star reviews were included for analysis, which resulted in 468 total complaints. Of these complaints, 81 (18.8%) were clinically related and 351 (81.3%) were nonclinical in nature. The most common clinical complaints were for complication (24 complaints, 6%), misdiagnosis (16 complaints, 4%), unclear treatment plan (16 complaints, 4%), and uncontrolled pain (15 complaints, 3%). The most common nonclinical complaints were for physician bedside manner (93 complaints, 22%), financially related (80 complaints, 19%), unprofessional nonclinical staff (61 complaints, 14%), and wait time (46 complaints, 11%). The difference in the number of complaints for surgical and nonsurgical patients was statistically significant ( p < 0.05) for complication and uncontrolled pain. Clinical Relevance Patient satisfaction is dependent on a multitude of clinical and nonclinical factors. An awareness of online physician ratings is essential for hand and wrist surgeons to maintain and improve patient care and patient satisfaction. We believe the results of our study could be used to further improve the quality of care provided by hand and wrist surgeons.
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Affiliation(s)
- Jordan R. Pollock
- Department of Orthopedic Surgery, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Tala Mujahed
- Department of Orthopedic Surgery, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Jacob F. Smith
- Department of Orthopedic Surgery, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Jaymeson R. Arthur
- Department of Life Sciences, Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Joseph C. Brinkman
- Department of Life Sciences, Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | | | | | - Kevin J. Renfree
- Department of Life Sciences, Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
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Cho MK, Kim MY. Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis. BMC Nurs 2024; 23:319. [PMID: 38734606 PMCID: PMC11088026 DOI: 10.1186/s12912-024-01944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND This study aimed to secure and analyze evidence regarding the enhancement of nursing students' empathy through simulation-based interventions. It comprehensively analyzed self-reported emotions and reactions as primary outcomes, along with the results reported by nursing students who experienced simulation-based interventions, including empathy. METHODS This systematic literature review and meta-analysis investigated the effects of simulation-based interventions on enhancing empathy among nursing students. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for the systematic review and meta-analysis. The following details were considered: population, nursing students; intervention, simulation-based interventions targeting empathy enhancement; comparators, control groups without intervention or those undergoing general non-simulation-based classes; and outcomes, self-reported empathy. RESULTS In the systematic review of 28 studies, it was found that the use of simulation-based interventions among nursing students led to an increase in empathy, albeit with a small effect size. This was demonstrated through a pooled, random-effects meta-analysis, yielding an effect size (Hedge's g) of 0.35 (95% CI: 0.14, 0.57, p = 0.001). The results of meta-regression and subgroup analysis significantly increased in empathy for studies published after 2019 (Hedge's g = 0.52, 95% CI: 0.31 to 0.73, p < 0.001), quasi-experimental research design (Hedge's g = 0.51, 95% CI: 0.27 to 0.74, p < 0.001), more than 60 participants (Hedge's g = 0.31, 95% CI: 0.02 to 0.59, p = 0.034), and simulation-based interventions in nursing education (Hedge's g = 0.43, 95% CI: 0.22 to 0.65, p < 0.001). CONCLUSIONS Considering factors such as variations in sample size, research approaches, and the effects of independent studies on empathy, this systematic literature review and meta-analysis suggests that simulation-based education can significantly improve nursing students' overall empathy skills.
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Affiliation(s)
- Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Korea
| | - Mi Young Kim
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea.
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Ahmed Z, Ellahham S, Soomro M, Shams S, Latif K. Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review. BMJ Open Qual 2024; 13:e002651. [PMID: 38719520 PMCID: PMC11086414 DOI: 10.1136/bmjoq-2023-002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership. METHODS This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines. RESULTS The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention. CONCLUSION Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.
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Affiliation(s)
- Zakiuddin Ahmed
- Institute of Innovation Leadership in Medicine, Karachi, Pakistan
- Riphah Institute of Healthcare Improvement and Safety (RIHIS), Islamabad, Pakistan
| | | | | | - Sohaima Shams
- Institute of Innovation Leadership in Medicine, Karachi, Pakistan
| | - Kanwal Latif
- Health Research Advisory Board, Karachi, Pakistan
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Lains I, Johnson TJ, Johnson MW. Compassionomics: The Science and Practice of Caring. Am J Ophthalmol 2024; 259:15-24. [PMID: 37923101 DOI: 10.1016/j.ajo.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To summarize the scientific evidence that compassion can measurably improve patient outcomes, health care quality and safety, and the well-being of health care providers, and to consider specific strategies for cultivating compassion and better communicating it to patients. DESIGN Perspective. METHODS We selectively reviewed the literature on compassion in health care, including obstacles to its expression and the demonstrated effects of provider compassion on patient outcomes, health care quality and cost, and provider well-being. We also review evidence regarding the trainability of compassion, discuss proven methods for cultivating individual compassion, and recommend strategies for incorporating it into routine medical practice. RESULTS Compassion is the emotional response to another's pain or suffering, accompanied by a desire to alleviate it. Review of the literature shows that compassionate health care measurably improves physical and psychological patient outcomes, increases patient adherence, improves health care quality and safety, increases financial margins, and prevents physician burnout. Psychophysiological research shows that empathy and compassion can be actively cultivated through intentional practice. Validated models of compassion-based interactions can facilitate the consistent expression of compassion in daily medical practice. CONCLUSIONS Given its many proven benefits to patients, health care organizations, and providers, compassion should be cultivated by health care providers and systems and considered an essential component of optimal medical care.
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Affiliation(s)
- Ines Lains
- From the Massachusetts Eye and Ear (I.L.), Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Taylor J Johnson
- University of Utah School of Medicine (T.J.J.), Salt Lake City, Utah
| | - Mark W Johnson
- W.K. Kellogg Eye Center (M.W.J.), Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.
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Liu JYW, Mak PY, Chan K, Cheung DSK, Cheung K, Fong KNK, Kor PPK, Lai TKH, Maximo T. The Effects of Immersive Virtual Reality-Assisted Experiential Learning on Enhancing Empathy in Undergraduate Health Care Students Toward Older Adults With Cognitive Impairment: Multiple-Methods Study. JMIR MEDICAL EDUCATION 2024; 10:e48566. [PMID: 38358800 PMCID: PMC10905348 DOI: 10.2196/48566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Immersive virtual reality (IVR)-assisted experiential learning has the potential to foster empathy among undergraduate health care students toward older adults with cognitive impairment by facilitating a sense of embodiment. However, the extent of its effectiveness, including enhancing students' learning experiences and achieving intended learning outcomes, remains underexplored. OBJECTIVE This study aims to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment as the primary outcome (objective 1) and on their learning experience (objective 2) and their attainment of learning outcomes as the secondary outcomes (objective 3). METHODS A multiple-methods design was used, which included surveys, focus groups, and a review of the students' group assignments. Survey data were summarized using descriptive statistics, whereas paired 2-tailed t tests were used to evaluate differences in empathy scores before and after the 2-hour IVR tutorial (objective 1). Focus groups were conducted to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment (objective 1). Descriptive statistics obtained from surveys and thematic analyses of focus groups were used to explore the students' learning experiences (objective 2). Thematic analysis of group assignments was conducted to identify learning outcomes (objective 3). RESULTS A total of 367 undergraduate nursing and occupational therapy students were recruited via convenience sampling. There was a significant increase in the students' empathy scores, measured using the Kiersma-Chen Empathy Scale, from 78.06 (SD 7.72) before to 81.17 (SD 8.93) after (P<.001). Students expressed high satisfaction with the IVR learning innovation, with a high satisfaction mean score of 20.68 (SD 2.55) and a high self-confidence mean score of 32.04 (SD 3.52) on the Student Satisfaction and Self-Confidence scale. Students exhibited a good sense of presence in the IVR learning environment, as reflected in the scores for adaptation (41.30, SD 6.03), interface quality (11.36, SD 3.70), involvement (62.00, SD 9.47), and sensory fidelity (31.47, SD 5.23) on the Presence Questionnaire version 2.0. In total, 3 major themes were identified from the focus groups, which involved 23 nursing students: enhanced sympathy toward older adults with cognitive impairment, improved engagement in IVR learning, and confidence in understanding the key concepts through the learning process. These themes supplement and align with the survey results. The analysis of the written assignments revealed that students attained the learning outcomes of understanding the challenges faced by older adults with cognitive impairment, the importance of providing person-centered care, and the need for an age-friendly society. CONCLUSIONS IVR-assisted experiential learning enhances students' knowledge and empathy in caring for older adults with cognitive impairment. These findings suggest that IVR can be a valuable tool in professional health care education.
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Affiliation(s)
- Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Pui Ying Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Patrick Pui Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Timothy Kam Hung Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Tulio Maximo
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Yannamani P, Gale NK. The ebbs and flows of empathy: a qualitative study of surgical trainees in the UK. BMC MEDICAL EDUCATION 2024; 24:131. [PMID: 38336765 PMCID: PMC10858458 DOI: 10.1186/s12909-024-05105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Empathy is widely recognised as an important element of medical practice contributing to patient outcomes and satisfaction. It is also an important element of collaborative work in a healthcare team. However, there is evidence to suggest that empathy towards patients declines over time, particularly in surgical specialities. There is little qualitative research on this decline in surgical trainees, particularly in the UK. Therefore, the aim of this study was to explore how trainee surgeons experience empathy over the course of their career, both towards patients and colleagues and how they perceive it in others. METHODS 10 semi-structured interviews were carried out with surgical trainees of different grades and specialties in January and February 2022. Framework analysis was used to interpret the data. RESULTS Participants experienced an evolution in empathy over their career as their personal and professional experience was added to. They drew a distinction between desensitisation and actual decline in empathy and identified more with experiencing the former in their careers. Participants also felt interprofessional relationships require empathy, and this could be improved upon. Finally, they highlighted specific impacts of the COVID-19 pandemic upon their training, including reduced theatre time. CONCLUSIONS Participants felt training could be improved in regard to accessing training opportunities and relationships with colleagues, although many felt empathy between colleagues is better than it has been in the past. This project highlighted areas for future research, such as with surgeons in later stages of their careers, or mixed-methods projects.
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Affiliation(s)
| | - Nicola Kay Gale
- Health Policy and Sociology, Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
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He S, Sultana R, Anantham D, Loh HP, Zhou JX, Tang JY, Sim M, Ayre TC, Fong KY, Tan KH. Empathy Levels Among Healthcare Professionals: An Asian Multi-professional Cross-Sectional Study. Cureus 2024; 16:e53750. [PMID: 38465054 PMCID: PMC10921128 DOI: 10.7759/cureus.53750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The aim of the study was to measure empathy in healthcare professionals in Singapore and to compare the scores between the different professions: doctors, nurses, and allied health professionals. METHODS An online survey questionnaire was conducted using the Jefferson Scale of Empathy (JSE) from July 2019 to January 2020. The total JSE score was calculated and compared among the different groups. Multiple linear regression was performed to assess predictors of total empathy scores for groups with statistically lower scores. RESULTS The survey was completed by 4,188 healthcare professionals (doctors (n=569, 13.6%), nurses (n=3032, 72.4%), and allied health professionals (n=587, 14.0%)) out of the 9,348-strong survey population, with a response rate of 44.8%. The study revealed a mean empathy score (SD) of 103.6 (15.6) for the cohort. The mean empathy score (SD) was 112.3 (14.7), 101.3 (15.2), and 107.0 (15.0), respectively for doctors, nurses, and allied health professionals. These were statistically significantly different among the groups (p< 0.0001), with nurses scoring significantly lower than either doctors (p< 0.0001) or allied health professionals (p< 0.0001). Multiple linear regression showed that age < 30 years old, male gender, Malay ethnicity, and working in a hospital setting were associated with significantly lower empathy scores in the nursing group. CONCLUSION Nurses in Singapore had significantly lower empathy scores compared to doctors and allied health professionals. Further research on the underlying causes should be undertaken and measures to improve empathy among Singapore nursing staff should be explored and implemented.
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Affiliation(s)
- Song He
- Department of Obstetrics and Gynaecology, KK (Kandang Kerbau) Women's and Children's Hospital, Singapore, SGP
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS (National University of Singapore) Medical School, Singapore, SGP
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, SGP
| | - Huey Peng Loh
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Jamie X Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, SGP
| | - Joo Ying Tang
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Mabel Sim
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | | | - Kok Yong Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, SGP
| | - Kok Hian Tan
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
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Keshtkar L, Madigan CD, Ward A, Ahmed S, Tanna V, Rahman I, Bostock J, Nockels K, Wang W, Gillies CL, Howick J. The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Ann Intern Med 2024; 177:196-209. [PMID: 38285985 DOI: 10.7326/m23-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. PURPOSE To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials. DATA SOURCES Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023. STUDY SELECTION Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale. DATA EXTRACTION Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus. DATA SYNTHESIS Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size. LIMITATIONS Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence. CONCLUSION Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction. PRIMARY FUNDING SOURCE Stoneygate Trust. (PROSPERO: CRD42023412981).
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Affiliation(s)
- Leila Keshtkar
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | - Claire D Madigan
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (C.D.M.)
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Vinay Tanna
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom (V.T.)
| | - Ismail Rahman
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Keith Nockels
- Library and Learning Services, University of Leicester, Leicester, United Kingdom (K.N.)
| | - Wen Wang
- School of Business, University of Leicester, Leicester, United Kingdom (W.W.)
| | - Clare L Gillies
- Leicester Real World Evidence Unit, University of Leicester, Leicester, United Kingdom (C.L.G.)
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
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Suhaiba A, Choubey AS, Drake B, Kerns J, Gonzalez MH. From Bedside Manner to Surgical Excellence: A Historical Exploration and Contemporary Importance of Empathy in Orthopaedic Surgery. J Bone Joint Surg Am 2024:00004623-990000000-00994. [PMID: 38252709 DOI: 10.2106/jbjs.23.00992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Aisha Suhaiba
- University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Apurva S Choubey
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - Brett Drake
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - James Kerns
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - Mark H Gonzalez
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Gill GK, Ng SL, Kangasjarvi E, Crukley J, Kumagai A, Simpson JS. From skillful to empathic: evaluating shifts in medical students' perceptions of surgeons through a combined patient as teacher and arts-based reflection program. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:14-21. [PMID: 38045079 PMCID: PMC10690007 DOI: 10.36834/cmej.76536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Introduction The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods A novel, single question evaluation tool was created. Third year medical-students were asked to "list the top 5 attributes of a surgeon, in order of perceived importance" both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either "humanistic" or "non-humanistic," which were then analyzed using generalized linear regression models under a Bayesian framework. Results After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.
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Affiliation(s)
- Gurjot K Gill
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Stella L Ng
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, University of Toronto at St. Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Jeff Crukley
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Arno Kumagai
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Hospital, University of Toronto, Ontario, Canada
| | - Jory S Simpson
- Department of Surgery, University of Toronto Faculty of Medicine, Ontario, Canada
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Pierson SR, Ngoue M, Lam R, Rajagopalan D, Ring D, Ramtin S. When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy? Clin Orthop Relat Res 2023; 481:1771-1780. [PMID: 36853843 PMCID: PMC10427050 DOI: 10.1097/corr.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/05/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care. QUESTIONS/PURPOSES Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities? METHODS This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses. RESULTS After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01). CONCLUSION Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience. CLINICAL RELEVANCE Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.
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Affiliation(s)
- S. Ryan Pierson
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Marielle Ngoue
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ryan Lam
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Dayal Rajagopalan
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - David Ring
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sina Ramtin
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Brown LE, Chng E, Kortlever JTP, Ring D, Crijns TJ. There is Little or No Association Between Independently Assessed Communication Strategies and Patient Ratings of Clinician Empathy. Clin Orthop Relat Res 2023; 481:984-991. [PMID: 36417406 PMCID: PMC10097532 DOI: 10.1097/corr.0000000000002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Quality of care is increasingly assessed and incentivized using measures of patient-reported outcomes and experience. Little is known about the association between measurement of clinician communication strategies by trained observers and patient-rated clinician empathy (a patient-reported experience measure). An effective independent measure could help identify and promote clinician behaviors associated with good patient experience of care. QUESTIONS/PURPOSES (1) What is the association between independently assessed clinician communication effectiveness and patient-rated clinician empathy? (2) Which factors are associated with independently assessed communication effectiveness? METHODS One hundred twenty adult (age > 17 years) new or returning patients seeking musculoskeletal specialty care between September 2019 and January 2020 consented to video recording of their visit followed by completion of questionnaires rating their perceptions of providers' empathy levels in this prospective study. Patients who had operative treatment and those who had nonoperative treatment were included in our sample. We pooled new and returning patients because our prior studies of patient experience found no influence of visit type and because we were interested in the potential influences of familiarity with the clinician on empathy ratings. We did not record the number of patients or baseline data of patients who were approached, but most patients (> 80%) were willing to participate. For 7% (eight of 120 patients), there was a malfunction with the video equipment or files were misplaced, leaving 112 records available for analysis. Patients were seen by one provider among four attending physicians, four residents, or four physician assistants or nurse practitioners. The primary study question addressed the correlation between patient-rated clinician empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and clinician communication effectiveness, independently rated by two communication scholars using the Liverpool Communication Skills Assessment Scale. Based on a subset of 68 videos (61%), the interrater reliability was considered good for individual items on the Liverpool Communication Skills Assessment Scale (intraclass correlation coefficient [ICC] 0.78 [95% confidence interval (CI) 0.75 to 0.81]) and excellent for the sum of the items (that is, the total score) (ICC = 0.92 [95% CI 0.87 to 0.95]). To account for the potential association of personal factors with empathy ratings, patients completed measures of symptoms of depression (the Patient-Reported Outcome Measurement Information System depression computerized adaptive test), self-efficacy in response to pain (the two-item Pain Self-Efficacy Questionnaire), health anxiety (the five-item Short Health Anxiety Inventory), and basic demographics. RESULTS Accounting for potentially confounding variables, including specific clinicians, marital status, and work status in the multivariable analysis, we found higher independent ratings of communication effectiveness had a slight association (odds ratio [OR] 1.1 [95% CI 1.0 to 1.3]; p = 0.02) with higher (dichotomized) ratings of patient-rated clinician empathy, while being single was associated with lower ratings (OR 0.40 [95% CI 0.16 to 0.99]; p = 0.05). Independent ratings of communication effectiveness were slightly higher for women (regression coefficient 1.1 [95% CI 0.05 to 2.2]); in addition, two of the four attending physicians were rated notably higher than the other 10 participants after controlling for confounding variables (differences up to 5.8 points on average [95% CI 2.6 to 8.9] on a 36-point scale). CONCLUSION The observation that ratings of communication effectiveness by trained communication scholars have little or no association with patient-rated clinician empathy suggests that either effective communication is insufficient for good patient experience or that the existing measures are inadequate or inappropriate. This line of investigation might be enhanced by efforts to identify clinician behaviors associated with better patient experience, develop reliable and effective measures of clinician behaviors and patient experience, and use those measures to develop training approaches that improve patient experience. LEVEL OF EVIDENCE Level I, prognostic study .
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Affiliation(s)
- Laura E. Brown
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, Texas, USA
| | - Emmin Chng
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, Texas, USA
| | - Joost T. P. Kortlever
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, Gelderland, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, Texas, USA
| | - Tom J. Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, Texas, USA
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Versluijs Y, Fatehi A, Gonzalez AI, Reichel L, Laverty D, Ring D. Factors Associated With Patient Satisfaction Measured Using an Iterative Scale. Qual Manag Health Care 2023; 32:69-74. [PMID: 35714285 DOI: 10.1097/qmh.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores. METHODS In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales. RESULTS There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05). CONCLUSION An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.
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Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin (Drs Versluijs, Fatehi, Gonzalez, Reichel, Laverty, and Ring); and Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands (Dr Versluijs)
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16
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Hobby J, Ring D, Larson D. The mind and the hand. J Hand Surg Eur Vol 2023; 48:269-275. [PMID: 36638068 DOI: 10.1177/17531934221143502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery.
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Affiliation(s)
- Jonathan Hobby
- Department of Trauma and Orthopaedics, North Hampshire Hospital, Basingstoke, UK
| | - David Ring
- University of Texas at Austin Dell Medical School, Austin, TX, USA
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17
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Gage W. Understanding the importance of kindness in nursing practice. Nurs Stand 2023; 38:27-34. [PMID: 36545764 DOI: 10.7748/ns.2022.e12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
The word 'kindness' stems from the concept of kinship and how people relate to and work with others in society. This article outlines how kindness is a vital element of nursing practice, including how kindness is linked to the related concepts of compassion and civility. It explores kindness from the patient's or service user's perspective as one of the qualities they value most in nurses, as well as considering why kindness within a healthcare team is important to the delivery of safe and effective care. The author also discusses the concept of 'self-kindness' and the importance of leadership in developing an organisational culture that supports the provision of high-quality person-centred care.
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18
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Ryan C, Miner H, Ramachandran S, Ring D, Fatehi A. General Anxiety Is Associated with Problematic Initial Recovery After Carpal Tunnel Release. Clin Orthop Relat Res 2022; 480:1576-1581. [PMID: 35023866 PMCID: PMC9278949 DOI: 10.1097/corr.0000000000002115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Carpal tunnel release can stop the progression of idiopathic median neuropathy at the wrist (carpal tunnel syndrome). Intermittent symptoms tend to resolve after surgery, but loss of sensibility can be permanent. Both pathophysiology (severe neuropathy) and mental health (symptoms of despair or worry) contribute to problematic recovery after carpal tunnel release, but their relative associations are unclear. QUESTION/PURPOSE Is problematic initial recovery after carpal tunnel release associated with psychologic distress rather than with disease severity? METHODS We retrospectively studied 156 patients who underwent in-office carpal tunnel release between November 2017 and February 2020, and we recorded their symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD]) and depression (Patient Health Questionnaire), signs of severe median neuropathy (loss of sensibility, thenar muscle atrophy, and palmar abduction weakness), and problematic recovery. The initial recovery (first 2 weeks) was categorized as problematic if the patient was upset about persistent numbness, experienced unsettling postoperative pain, developed hand stiffness, or experienced wound issues-all of which are routinely recorded in the medical record by the treating surgeon along with signs of severe median neuropathy. Twenty-four percent (38 of 156) of patients had a problematic initial recovery characterized by distress regarding persistent numbness (16% [25 of 156]), unsettling pain (8% [12 of 156]), hand stiffness (5% [8 of 156]), or wound issues (1% [2 of 156]); 6% (9 of 156) of patients had more than one issue. Associations between problematic initial recovery and age, gender, symptoms of anxiety and depression, disease severity, specific exam findings, and insurance were evaluated using t-tests, Mann-Whitney tests, and chi-square tests, with the plan to perform logistic regression if at least two variables had an association with p < 0.10. RESULTS The only factor associated with problematic initial recovery was greater symptoms of anxiety (median GAD score 1.5 [interquartile range 0 to 7.8] for problematic initial recovery compared with a median score of 0 [IQR 0 to 2] for nonproblematic recovery; p = 0.04), so we did not perform a logistic regression. Physical examination findings consistent with severe median neuropathy were not associated with problematic initial recovery. CONCLUSION The finding that problematic initial recovery after carpal tunnel release was related to symptoms of anxiety and not to the severity of median neuropathy highlights the need to study the ability of efforts to ameliorate anxiety symptoms before carpal tunnel release as an effective intervention to reduce unplanned visits and additional tests, therapy, and repeat surgery, while improving patient-reported outcomes and experience. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Claire Ryan
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Harrison Miner
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Shyam Ramachandran
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Investigating the Relationship between Facial Mimicry and Empathy. Behav Sci (Basel) 2022; 12:bs12080250. [PMID: 35892350 PMCID: PMC9330546 DOI: 10.3390/bs12080250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 12/30/2022] Open
Abstract
Facial expressions play a key role in interpersonal communication when it comes to negotiating our emotions and intentions, as well as interpreting those of others. Research has shown that we can connect to other people better when we exhibit signs of empathy and facial mimicry. However, the relationship between empathy and facial mimicry is still debated. Among the factors contributing to the difference in results across existing studies is the use of different instruments for measuring both empathy and facial mimicry, as well as often ignoring the differences across various demographic groups. This study first looks at the differences in the empathetic abilities of people across different demographic groups based on gender, ethnicity and age. The empathetic ability is measured based on the Empathy Quotient, capturing a balanced representation of both emotional and cognitive empathy. Using statistical and machine learning methods, this study then investigates the correlation between the empathetic ability and facial mimicry of subjects in response to images portraying different emotions displayed on a computer screen. Unlike the existing studies measuring facial mimicry using electromyography, this study employs a technology detecting facial expressions based on video capture and deep learning. This choice was made in the context of increased online communication during and after the COVID-19 pandemic. The results of this study confirm the previously reported difference in the empathetic ability between females and males. However, no significant difference in empathetic ability was found across different age and ethnic groups. Furthermore, no strong correlation was found between empathy and facial reactions to faces portraying different emotions shown on a computer screen. Overall, the results of this study can be used to inform the design of online communication technologies and tools for training empathy team leaders, educators, social and healthcare providers.
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De Ridder WA, Wouters RM, Hoogendam L, Vermeulen GM, Slijper HP, Selles RW. Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis. Clin Orthop Relat Res 2022; 480:1287-1301. [PMID: 34982052 PMCID: PMC9191327 DOI: 10.1097/corr.0000000000002107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Satisfaction with treatment results is an important outcome domain in striving for patient-centered and value-based healthcare. Although numerous studies have investigated factors associated with satisfaction with treatment results, most studies used relatively small samples. Additionally, many studies have only investigated univariable associations instead of multivariable associations; to our knowledge, none have investigated the independent association of baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health with satisfaction with treatment results. QUESTIONS/PURPOSES (1) What factors are independently associated with satisfaction with treatment results at 3 months post-treatment in patients treated for common hand and wrist conditions? (2) What factors are independently associated with the willingness to undergo the treatment again at 3 months post-treatment in patients treated for common hand and wrist conditions? Among the factors under study were baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health. METHODS Between August 2018 and May 2020, we included patients who underwent carpal tunnel release, nonsurgical or surgical treatment for thumb-base osteoarthritis, trigger finger release, limited fasciectomy for Dupuytren contracture, or nonsurgical treatment for midcarpal laxity in one of the 28 centers of Xpert Clinics in the Netherlands. We screened 5859 patients with complete sociodemographics and data at baseline. Thirty-eight percent (2248 of 5859) of these patients had complete data at 3 months. Finally, participants were eligible for inclusion if they provided a relevant answer to the three patient-reported experience measure (PREM) items. A total of 424 patients did not do this because they answered "I don't know" or "not applicable" to a PREM item, leaving 31% (1824 of 5859) for inclusion in the final sample. A validated Satisfaction with Treatment Result Questionnaire was administered at 3 months, which identified the patients' level of satisfaction with treatment results so far on a 5-point Likert scale (research question 1, with answers of poor, moderate, fair, good, or excellent) and the patients' willingness to undergo the treatment again under similar circumstances (research question 2, with answers of yes or no). A hierarchical logistic regression model was used to identify whether baseline sociodemographics, quality of life, change in outcome (patient-reported outcome measures for hand function and pain), baseline measures of mental health (including treatment credibility [the extent to which a patient attributes credibility to a treatment] and expectations, illness perception, pain catastrophizing, anxiety, and depression), and PREMs were associated with each question of the Satisfaction with Treatment Result Questionnaire at 3 months post-treatment. We dichotomized responses to our first question as good and excellent, which were considered more satisfied, and poor, moderate, and fair, which were considered less satisfied. After dichotomization, 57% (1042 of 1824) of patients were classified as more satisfied with the treatment results. RESULTS The following variables were independently associated with satisfaction with treatment results, with an area under the curve of 0.82 (95% confidence interval 0.80 to 0.84) (arranged from the largest to the smallest standardized odds ratio [SOR]): greater decrease in pain during physical load (standardized odds ratio 2.52 [95% CI 2.18 to 2.92]; p < 0.001), patient's positive experience with the explanation of the pros and cons of the treatment (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 1.83 [95% CI 1.41 to 2.38]; p < 0.001), greater improvement in hand function (SOR 1.76 [95% CI 1.54 to 2.01]; p < 0.001), patients' positive experience with the advice for at-home care (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.57 [95% CI 1.21 to 2.04]; p < 0.001), patient's better personal control (determined with the question: "How much control do you feel you have over your illness?") (SOR 1.24 [95% CI 1.1 to 1.40]; p < 0.001), patient's more positive treatment expectations (SOR 1.23 [95% CI 1.04 to 1.46]; p = 0.02), longer expected illness duration by the patient (SOR 1.20 [95% CI 1.04 to 1.37]; p = 0.01), a smaller number of symptoms the patient saw as part of the illness (SOR 0.84 [95% CI 0.72 to 0.97]; p = 0.02), and less concern about the illness the patient experiences (SOR 0.84 [95% CI 0.72 to 0.99]; p = 0.04). For willingness to undergo the treatment again, the following variables were independently associated with an AUC of 0.81 (95% CI 0.78 to 0.83) (arranged from the largest to the smallest standardized OR): patient's positive experience with the information about the pros and cons (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 2.05 [95% CI 1.50 to 2.80]; p < 0.001), greater improvement in hand function (SOR 1.80 [95% CI 1.54 to 2.11]; p < 0.001), greater decrease in pain during physical load (SOR 1.74 [95% CI 1.48 to 2.07]; p < 0.001), patient's positive experience with the advice for at home (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.52 [95% CI 1.11 to 2.07]; p = 0.01), patient's positive experience with shared decision-making (determined with the question: "Did you decide together with the care providers which care or treatment you will receive?") (SOR 1.45 [95% CI 1.06 to 1.99]; p = 0.02), higher credibility the patient attributes to the treatment (SOR 1.44 [95% CI 1.20 to 1.73]; p < 0.001), longer symptom duration (SOR 1.27 [95% CI 1.09 to 1.52]; p < 0.01), and patient's better understanding of the condition (SOR 1.17 [95% CI 1.01 to 1.34]; p = 0.03). CONCLUSION Our findings suggest that to directly improve satisfaction with treatment results, clinicians might seek to: (1) improve the patient's experience with healthcare delivery, (2) try to influence illness perception, and (3) boost treatment expectations and credibility. Future research should confirm whether these suggestions are valid and perhaps also investigate whether satisfaction with treatment results can be predicted (instead of explained, as was done in this study). Such prediction models, as well as other decision support tools that investigate patient-specific needs, may influence experience with healthcare delivery, expectations, or illness perceptions, which in turn may improve satisfaction with treatment results. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Willemijn Anna De Ridder
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
- Center for Hand Therapy, Xpert Handtherapie, Utrecht, the Netherlands
| | - Robbert Maarten Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | | | - Harm Pieter Slijper
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Ruud Willem Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Ring DC. CORR Insights®: Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis. Clin Orthop Relat Res 2022; 480:1302-1304. [PMID: 35020684 PMCID: PMC9191383 DOI: 10.1097/corr.0000000000002113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Affiliation(s)
- David C Ring
- Associate Dean for Comprehensive Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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22
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Engler ID, Ahrendt GM, Curley AJ, Musahl V. Surgeon Personality, Time Spent With the Patient, and Quality of Facilities Are the Most Important Factors to Patients in Selecting an Orthopaedic Sports Medicine Surgeon. Arthrosc Sports Med Rehabil 2022; 4:e1023-e1029. [PMID: 35747634 PMCID: PMC9210365 DOI: 10.1016/j.asmr.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the most important factors to patients across the United States in selecting an orthopaedic sports medicine surgeon. Methods In this cross-sectional survey study, adult U.S. residents were surveyed using Amazon Mechanical Turk, a validated survey tool. Data included demographics and the relative importance of both pre-office and in-office factors that determine how patients select an orthopaedic sports medicine surgeon. Results were compiled, and factors were compared by patient demographics. Results Of 1,074 respondents, 56.3% were male, and 60.0% were 25 to 40 years old. Responses were geographically diverse. The most important factors in selecting a sports medicine surgeon (graded on a 0-10 scale) were surgeon professionalism and personality (6.6), quality of the hospital/office facilities (6.4), and how much time the surgeon spends with the patient (6.4). Each of these in-office factors were more important than pre-office factors, the most important of which were reputation of the surgeon’s hospital or group (6.3), surgeon’s reviews on medical review websites (6.2), and surgeon’s educational background (6.0). The least important factors were surgeon’s sex (3.7), marketing of the surgeon (4.2), and surgeon’s social media accounts (4.3). A social media account was taken into consideration at least “a little” by nearly two-thirds of respondents. The most preferred surgeon personality was a balance of professional and lighthearted (66.9%), with strictly professional (27.6%) or largely lighthearted (5.6%) less preferred. Conclusions The most important factors to patients in selecting their orthopaedic sports medicine surgeon, regardless of patient sex, race, or geography, are related to the patient’s in-office experience, including surgeon’s professionalism/personality, how much time the surgeon spends with the patient, and quality of the hospital/office facilities. Surgeons should consider prioritizing a professional office environment and taking the time to get to know patients for the benefit of their patients and their practice. Clinical Relevance The market for orthopaedic sports medicine surgeons is competitive. It is important to know what qualities of a surgeon and his or her practice are important to patients.
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Bakhshaie J, Doorley J, Reichman M, Mace R, Laverty D, Matuszewski PE, Elwy AR, Fatehi A, Bowers LC, Ly T, Vranceanu AM. Optimizing the implementation of a multisite feasibility trial of a mind-body program in acute orthopedic trauma. Transl Behav Med 2022; 12:642-653. [PMID: 35195266 PMCID: PMC9154268 DOI: 10.1093/tbm/ibac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Toolkit for Optimal Recovery (TOR) is a mind-body program for patients with acute orthopedic injuries who are at risk for persistent pain/disability. In preparation for a multisite feasibility trial of TOR at three orthopedic trauma centers, we aim to qualitatively identify barriers and facilitators to study implementation and strategies to mitigate the implementation barriers and leverage facilitators.We conducted 18 live video focus groups among providers and three one-on-one interviews with department chiefs at Level 1 trauma centers in three geographically diverse sites (N = 79 participants). Using a content analysis approach, we detected the site-specific barriers and facilitators of implementation of TOR clinical trial. We organized the data according to 26 constructs of the Consolidated Framework for Implementation Research (CFIR), mapped to three Proctor implementation outcomes relevant to the desired study outcomes (acceptability, appropriateness, and feasibility). Across the three sites, we mapped six of the CFIR constructs to acceptability, eight to appropriateness, and three to feasibility. Prominent perceived barriers across all three sites were related to providers' lack of knowledge/comfort addressing psychosocial factors, and organizational cultures of prioritizing workflow efficiency over patients' psychosocial needs (acceptability), poor fit between TOR clinical trial and the fast-paced clinic structure as well as basic needs of some patients (appropriateness), and limited resources (feasibility). Suggestions to maximize the implementation of the TOR trial included provision of knowledge/tools to improve providers' confidence, streamlining study recruitment procedures, creating a learning collaborative, tailoring the study protocol based on local needs assessments, exercising flexibility in conducting research, dedicating research staff, and identifying/promoting champions and using novel incentive structures with regular check-ins, while keeping study procedures as nonobtrusive and language as de-stigmatizing as possible. These data could serve as a blueprint for implementation of clinical research and innovations in orthopedic and other medical settings.
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Affiliation(s)
- Jafar Bakhshaie
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - James Doorley
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Mira Reichman
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Ryan Mace
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - David Laverty
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02912, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| | - Lucy C Bowers
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Thuan Ly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
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Murasko MJ, Ivanov DV, Roe AK, Kamal RN, Amanatullah DF. Patient Satisfaction Scores Are a Poor Metric of Orthopedic Care. Orthopedics 2022; 45:e127-e133. [PMID: 35201936 DOI: 10.3928/01477447-20220217-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patient satisfaction scores are a popular metric used to evaluate orthopedic care. There is little consistency with how satisfaction is described in the orthopedic literature. Online physician reviews are a growing trend that directly and indirectly affect a surgeon's reputation. There is little correlation of higher satisfaction with improved surgical outcomes, so rating surgical care may be misguided and possibly dangerous. Patient satisfaction is an important part of the patient-centered care model, so rating systems should directly reflect quality. More research is needed to determine the relationship between patient satisfaction and the delivery of quality care. [Orthopedics. 2022;45(3):e127-e133.].
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McDonald CB, Heydenrych I. The Importance of Functional Quality in Patient Satisfaction: Cosmetic Injectable Patient Experience Exploratory Study-Part 2. Aesthet Surg J Open Forum 2022; 4:ojac044. [PMID: 35795885 PMCID: PMC9252022 DOI: 10.1093/asjof/ojac044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Quality assessment comprises 2 distinct forms: technical quality (TQ) and functional quality (FQ). On the one hand, TQ describes accuracy and excellence, the degree to which procedures are done "correctly." On the other hand, FQ is the way services are delivered and represents how the customer perceives and experiences the treatment or service. Objectives To determine the relative importance of functional quality factors in the care of cosmetic injectable patients and return patronage. Methods The Cosmetic Injectable Patient Experience Exploratory Study (CIPEES) survey assessed reasons for return patronage to a specific cosmetic injector and the correlation between satisfaction with cosmetic results (patient assessment of TQ) and respondents' trust level in their practitioner, a marker for FQ. Results The CIPEES survey collected 1488 responses across 75 countries, with 66% of participants completing all 15 questions. The respondents were 95.6% female and 4.4% male, with ages ranging from 18 years to >65 years old (median 33 years old). The number one ranked reason for returning to a previous cosmetic injector (return patronage) was "Trust in my practitioner's action and ability," closely followed by "Cosmetic result/outcome from the previous treatment/s." Respondents' level of satisfaction with their cosmetic results also correlated highly with trust in their practitioners. Conclusions In order to maximize patient satisfaction and return patronage, healthcare practitioners should focus on improving FQ care and value it at least as high as TQ in the delivery of cosmetic injectable treatments.
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Affiliation(s)
- Cara B McDonald
- Corresponding Author:Dr Cara B. McDonald, 39 Station Street, Sunbury 3429, Victoria, Australia. E-mail: ; Instagram: @drcara_dermatologist
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Martikainen S, Falcon M, Wikström V, Peltola S, Saarikivi K. Perceptions of Doctors' Empathy and Patients' Subjective Health Status at an Online Clinic: Development of an Empathic Anamnesis Questionnaire. Psychosom Med 2022; 84:513-521. [PMID: 35100186 PMCID: PMC9071034 DOI: 10.1097/psy.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Medical doctors' empathy is known to support patients' health status after face-to-face clinical visits. However, the role of doctors' empathy in chat-based encounters is not yet well understood. This study investigates whether patients' evaluations of doctors' empathy are associated with their health perceptions after a meeting at an online clinic and whether experiences of empathy could be enhanced by augmenting an automated anamnesis questionnaire completed before the visit. METHODS A total of 209 adult patients agreed to participate in the study. First 103 patients filled out the regular version of the questionnaire (June-August 2019) and then 106 filled out the augmented version of the online anamnesis questionnaire (August-November 2019). Patients' perceptions of doctors' empathy were measured with the Consultation and Relational Empathy questionnaire. Patients' self-perceived health status, potential confounders, and demographic background information were measured via questionnaires. RESULTS Patients' perceptions of doctors' empathy during a chat-based encounter were associated with patients being less concerned about their symptoms (estimated odds ratios varied between 0.45 and 0.55 depending on the model, p values < .003) and considering their symptoms as less severe (estimated odds ratios = 0.54-0.61, p values < .007), as well as a higher probability of alleviation of symptoms as rated by the patients (estimated odds ratios = 2.16-2.24, p values < .001). Augmenting the anamnesis questionnaire did not affect patient reports on doctors' overall empathy, but it did have positive effects on specific areas of doctors' empathy covered by the questionnaire. CONCLUSIONS These results show that patients' experience of doctors' empathy not only is important during face-to-face encounters but also supports patients' perceptions of health when the interaction is text based. The results also encourage further development of means to support patients' experiences of empathy during online interaction with medical doctors.
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Serrada-Tejeda S, Martínez-Piedrola RM, Huertas-Hoyas E, Máximo-Bocanegra N, Trugeda-Pedrajo N, Rodríguez-Pérez MP, Sánchez-Herrera Baeza P, Pérez-de-Heredia-Torres M. Empathy in occupational therapy students: a cross-sectional study at a Spanish university. BMJ Open 2022; 12:e058821. [PMID: 35473733 PMCID: PMC9045041 DOI: 10.1136/bmjopen-2021-058821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Empathy is an important interpersonal skill and a fundamental component in the professional-patient relationship, being the basis for implementing person-centred practice. In several studies, a decrease in empathy levels throughout training in medicine, nursing or dentistry, among others, has been shown. There are few studies on the occupational therapy branch of healthcare. The aim was to determine the degree of empathy perceived by students of occupational therapy at a Spanish university, as well as to analyse the differences between empathy levels according to the different degree courses and gender. METHODS A descriptive cross-sectional study was designed with a sample of 221 occupational therapy students from a Spanish university. The Davis Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy-Health Profession Student's Spanish version (JSPE-HPS-S) were used as outcome measures. RESULTS According to the results found, high level of empathy was found on all dimension of the IRI (69.84 (9.80)) and the JSPE-HPS-S (122 (94-140)). Although high levels of empathy among occupational therapy students are observed in all degree courses, no significant differences were found between them. Statistically significant differences and a moderate effect size (r) were found between the variables according to the gender of the participants, with females showing greater empathy in the overall scores of the IRI as well as in the JSPE-HPS-S (p=0.002, r=0.212; p=0.001, r=0.327, respectively). CONCLUSIONS Empathy is an essential competence for the development of quality occupational therapy practice. According to the results and although occupational therapy students showed high levels of empathy, it is important to pay attention to the evolution of empathy and to provide students with learning experiences that prevent its possible decline.
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Singleton IM, Garfinkel RJ, Malone JB, Temkit MH, Belthur MV. Perceived Physician Empathy in Pediatric Orthopedics: A Cross-Sectional Study. J Patient Exp 2022; 9:23743735221092607. [PMID: 35450088 PMCID: PMC9016577 DOI: 10.1177/23743735221092607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Empathy is the cornerstone of the patient–physician relationship and is
consistently ranked by patients as one of the most important factors in the
quality of their care. In this paper we examine the degree to which perceived
physician empathy is associated with the characteristics of the caregiver
(parent or legal guardian) and physician in pediatric orthopedic surgery. This
was a cross-sectional survey study of 200 English-speaking caregivers of
pediatric patients at a large children's hospital. The Consultation and
Relational Empathy (CARE) Measure was used to measure perceived physician
empathy. Only if the caregiver felt carefully listened to by the physician
(p-value < 0.001), and if the physician showed respect
for what the caregiver had to say (p-value = 0.007) were
statistically significant and positively associated with perceived physician
empathy. The most significant determinant of perceived physician empathy is
whether the caregiver felt listened to during the encounter. Other factors such
as caregiver demographics, health literacy, self-rated mental health, wait time,
and time spent with the physician do not significantly affect perceived
physician empathy.
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Affiliation(s)
- Ian M Singleton
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Rachel J Garfinkel
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jason B Malone
- Department of Orthopedic Surgery, Nemours Children's Health System, Jacksonville, FL, United States
| | - M’Hamed H Temkit
- Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mohan V Belthur
- Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA
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Loewenstein SN, Pittelkow E, Kukushliev VV, Hadad I, Adkinson J. The Effects of Postoperative Physician Phone Calls for Hand and Wrist Fractures: A Prospective, Randomized Controlled Trial. Cureus 2022; 14:e22202. [PMID: 35308675 PMCID: PMC8925981 DOI: 10.7759/cureus.22202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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Abdulkader RS, Venugopal D, Jeyashree K, Al Zayer Z, Senthamarai Kannan K, Jebitha R. The Intricate Relationship Between Client Perceptions of Physician Empathy and Physician Self-Assessment: Lessons for Reforming Clinical Practice. J Patient Exp 2022; 9:23743735221077537. [PMID: 35128044 PMCID: PMC8814954 DOI: 10.1177/23743735221077537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives: Clinical empathy is an important predictor of patient outcomes. Several factors affect physician’s empathy and client perceptions. We aimed to assess the association between physician and client perception of clinical empathy, accounting for client, physician, and health system factors. Methods: We conducted a hospital-based cross-sectional study in 3 departments (family medicine, internal medicine, and surgery) of King Saud Medical City in Riyadh, Saudi Arabia. We interviewed 30 physicians and 390 clients from 3 departments. Physicians completed the Jefferson Scale of Empathy (JSE) and the clients responded to the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). We used a hierarchical multilevel generalized structural equation approach to model factors associated with JSE and JSPPPE and their inter-relationship. Results: Mean (SD) score of client-rated physician empathy was 26.6 (6) and that of physician self-rated was 111 (12.8). We found no association between the 2 (b = 0.06; 95% confidence intervals CI: −0.1, 0.21), even after adjusting for client, physician, and health system factors. Physician's nationality (0.49; 0.12, 0.85), adequate consultation time (1.05; 0.72, 1.38), and trust (1.33; 0.9, 1.75) were positively associated whereas chronic disease (−0.32; −0.56, −0.07) and higher waiting times (−0.26; −0.47, −0.05) were negatively associated. Conclusion: A physician's self-assessed empathy does not correlate with clients’ perception. We recommend training and monitoring to enhance clinical empathy.
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Affiliation(s)
- Rizwan Suliankatchi Abdulkader
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India.,ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - R Jebitha
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India
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Smith RN, Tracy BM, Smith S, Johnson S, Martin ND, Seamon MJ. Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP306-NP326. [PMID: 32370593 DOI: 10.1177/0886260520914557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma (N = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, n = 327) and practiced at urban (84.3%, n = 360), academic (88.3%, n = 377), Level 1 trauma centers (72.8%, n = 311). Only 14.5% (n = 62) of surgeons had institutional policies for bullet removal and 5.6% (n = 24) were likely to remove bullets. Half of the surgeons (52.0%, n = 222) preferred to remove bullets after the index hospitalization and pain (88.1%, n = 376) and a palpable bullet (71.2%, n = 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], p = .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], p = .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], p = .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.
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Affiliation(s)
- Randi N Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | - Brett M Tracy
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sean Johnson
- University of Pennsylvania, Philadelphia, PA, USA
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van Maren K, Brown LE, Cremers T, Khatiri MZ, Ring D, Fatehi A. In Orthopaedic Speciality Care, Longer Explanations Are Not More Caring or More Satisfying. Clin Orthop Relat Res 2021; 479:2601-2607. [PMID: 34114977 PMCID: PMC8726551 DOI: 10.1097/corr.0000000000001860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research consistently documents no correlation between the duration of a musculoskeletal specialty care visit and patient experience (perceived empathy of the specialist and satisfaction with care). Based on a combination of clinical experience and other lines of research, we speculate that longer visits are often related to discordance between specialist and patient interpretation of symptoms and weighting of available test and treatment options. If this is true, then the specific duration of time discussing the specialist's interpretations and options with the patient (expertise transfer) might correlate with satisfaction with care and perceived empathy of the clinician even if the total visit time does not. QUESTIONS/PURPOSES (1) What demographic or mental health factors are associated with the duration of expertise transfer? (2) What factors, including the duration of expertise transfer, are associated with the patient's satisfaction with the visit and perceived clinician empathy? METHODS In a cross-sectional study, 128 new and returning English-speaking adult outpatients seeking care from one of three orthopaedic specialists in two urban practices between September and November 2019 were enrolled and agreed to audio recording of the visit. A total of 92% (118) of patients completed the questionnaire and had a usable recording. Participants completed a sociodemographic survey, the Patient-Reported Outcome Measure Information System Depression computer adaptive test (PROMIS Depression CAT; a measure of symptoms of depression), the Short Health Anxiety Index (SHAI-5; a measure of symptoms of hypochondriasis, a form of symptoms misinterpretation), the Pain Catastrophizing Scale (PCS-4; a measure of misinterpretation of symptoms), an ordinal measure of patient satisfaction (dichotomized into satisfied or not because of strong ceiling effects), and the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE; a measure of perceived clinician empathy). The duration of expertise transfer and the total duration of the visit were measured by two raters with acceptable reliability using software that facilitates segmentation of the visit audio recording. To determine factors associated with the duration of expertise transfer, satisfaction, and empathy, we planned a multivariable analysis controlling for potential confounding variables identified in exploratory bivariable analysis. However, there were insufficient associations to merit multivariable analysis. RESULTS A longer duration of expertise transfer had a modest correlation with catastrophic thinking (r = 0.24; p = 0.01). Complete satisfaction with the visit was associated with less health anxiety (6 [interquartile range 5 to 7] for complete satisfaction versus 7 [5 to 7] for less than complete satisfaction; p = 0.02) and catastrophic thinking (4 [1 to 7] versus 5 [3 to 11]; p = 0.02), but not with the duration of expertise transfer. Greater perceived clinician empathy had a slight correlation with less health anxiety (r = -0.19; p = 0.04). CONCLUSION Patients with greater misinterpretation of symptoms experience a slightly less satisfying visit and less empathetic relationship with a musculoskeletal specialist despite a longer duration of expertise transfer. This supports the concept that directive strategies (such as teaching healthy interpretation of symptoms) may be less effective then guiding strategies (such as nurturing openness to alternative, healthier interpretation of symptoms using motivational interviewing tactics, often over more than one visit or point of contact). LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Koen van Maren
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Laura E. Brown
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - Teun Cremers
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Michael Zoulfi Khatiri
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release: A patient reported outcome study. Orthop Traumatol Surg Res 2021; 109:103134. [PMID: 34715390 DOI: 10.1016/j.otsr.2021.103134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/03/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
HYPOTHESIS Wide awake local anesthesia with no tourniquet (WALANT) and office-based procedures are used in hand surgery. There are limited literature data on patient satisfaction when comparing methods of anesthesia and location of surgery. METHODS We conducted a retrospective single-surgeon study with patient reported satisfaction in three groups. We compared patient impressions of anesthesia type; WALANT vs locoregional anesthesia plus sedation. We also compared satisfaction in three surgery settings; office surgery vs hospital ambulatory minor procedure room vs main operating room. Group 1 office surgery patients had ultrasound guided surgery with WALANT. Group 2 main operating room surgery patients also had ultrasound guided surgery with WALANT. Group 3 main operating room patients had endoscopic surgery with sedation and a tourniquet. Each group had 30 patients with a minimum follow up of 2 months. We measured overall satisfaction, satisfaction with the organization of care, satisfaction with the administration of anesthesia, and satisfaction with the quality of anesthesia. We also collected secondary data on the resolution of the neuropathic symptoms. RESULTS Procedures performed in an office-based setting showed higher rates of patient satisfaction when compared to the ambulatory day surgery setting. WALANT anesthesia also showed significantly higher rates of patient satisfaction on a numerical analog scale when compared to sedation based on, irrespective of the surgical setting. All patients had resolution of their neuropathic symptoms regardless of the technique performed. CONCLUSION We found that carpal tunnel releases performed in an office-based setting produces superior patient satisfaction. WALANT anesthesia also provides improved patient satisfaction when compared to sedation and monitoring techniques, irrespective of the surgical setting and location. Carpal tunnel release with WALANT in an office-based setting is better for patient comfort and satisfaction, with no evidence of lesser clinical outcomes at a short term follow-up. LEVEL OF EVIDENCE III.
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Siegrist V, Mata R, Langewitz W, Gerger H, Furger S, Hertwig R, Bingisser R. Does information structuring improve recall of discharge information? A cluster randomized clinical trial. PLoS One 2021; 16:e0257656. [PMID: 34662341 PMCID: PMC8523048 DOI: 10.1371/journal.pone.0257656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. METHODS For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship. RESULTS Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. CONCLUSIONS AND PRACTICE IMPLICATIONS Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED.
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Affiliation(s)
- Victoria Siegrist
- Emergency Department, University Hospital Basel, Basel, Switzerland
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Rui Mata
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Department of Psychosomatic Medicine–Communication in Medicine, University Hospital Basel, Basel, Switzerland
| | - Heike Gerger
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephan Furger
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
- * E-mail:
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van Hoorn BT, Menendez ME, Mackert M, Donovan EE, van Heijl M, Ring D. Missed Empathic Opportunities During Hand Surgery Office Visits. Hand (N Y) 2021; 16:698-705. [PMID: 31526045 PMCID: PMC8461197 DOI: 10.1177/1558944719873395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Empathy (conveyance of an understanding of a patient's situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = -0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.
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Affiliation(s)
| | | | | | | | | | - David Ring
- The University of Texas at Austin, USA,David Ring, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1400 Barbara Jordan Blvd, Suite 2.834; MC: R1800, Austin, TX 78723, USA.
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Chua JYX, Ang E, Lau STL, Shorey S. Effectiveness of simulation-based interventions at improving empathy among healthcare students: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2021; 104:105000. [PMID: 34146845 DOI: 10.1016/j.nedt.2021.105000] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students. DESIGN A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials. DATA SOURCES Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020. REVIEW METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots. RESULTS Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective. CONCLUSION Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Siew Tiang Lydia Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
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Käthner I, Eidel M, Häge AS, Gram A, Pauli P. Observing physicians acting with different levels of empathy modulates later assessed pain tolerance. Br J Health Psychol 2021; 27:434-448. [PMID: 34374180 DOI: 10.1111/bjhp.12553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/22/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The patient-physician relationship is essential for treatment success. Previous studies demonstrated that physicians who behave empathic in their interaction with patients have a positive effect on health outcomes. In this study, we investigated if the mere perception of physicians as empathic/not empathic modulates pain despite an emotionally neutral interaction with the patients. METHODS N = 60 women took part in an experimental study that simulated a clinical interaction. In the paradigm, each participant watched two immersive 360° videos via a head-mounted display from a patient's perspective. The physicians in the videos behaved either empathic or not empathic towards a third person. Importantly, these physicians remained emotionally neutral in the subsequent virtual interaction with the participants. Finally, participants received a controlled, painful pressure stimulus within the narratives of the videos. RESULTS The physicians in the high compared with the low empathy videos were rated as more empathic and more likable, indicating successful experimental manipulation. In spite of later neutral behaviour of physicians, this short observation of physicians' behaviour towards a third person was sufficient to modulate pain tolerance of the participants. CONCLUSIONS The finding of this study that the mere observation of physicians' behaviour towards a third person modulates pain, despite a neutral direct interaction with the participants, has important clinical implications. Further, the proposed paradigm enables investigating aspects of patient-physician communication that are difficult to examine in a clinical setting.
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Affiliation(s)
- Ivo Käthner
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Germany
| | - Matthias Eidel
- Department of Psychology I, Psychological Intervention, Behaviour Analysis and Regulation of Behaviour, University of Würzburg, Germany
| | - Anne-Sophie Häge
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Germany
| | - Annika Gram
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Germany
| | - Paul Pauli
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Germany.,Center of Mental Health, Medical Faculty, University of Würzburg, Germany
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Singleton IM, Garfinkel RJ, Malone JB, Temkit MH, Belthur MV. Determinants of caregiver satisfaction in pediatric orthopedics. J Pediatr Orthop B 2021; 30:393-398. [PMID: 32694425 DOI: 10.1097/bpb.0000000000000778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study investigates determinants of pediatric orthopedic surgery patients' parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors' institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)]. After logistic regression, the caregiver's gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver's satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.
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van Hoorn BT, van Rossenberg LX, Jacobs X, Sulkers GSI, van Heijl M, Ring D. Clinician Factors Rather Than Patient Factors Affect Discussion of Treatment Options. Clin Orthop Relat Res 2021; 479:1506-1516. [PMID: 33626027 PMCID: PMC8208442 DOI: 10.1097/corr.0000000000001664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shared decision-making aims to combine what matters most to a patient with clinician expertise to develop a personalized health strategy. It is a dialogue between patient and clinician in which preferences are expressed, misconceptions reoriented, and available options are considered. To improve patient involvement, it would help to know more about specific barriers and facilitators of patient-clinician communication. Health literacy, the ability to obtain, process, and understand health information, may affect patient participation in decision-making. If the patient is quiet, deferential, and asks few questions, the clinician may assume a more paternalistic style. A patient with greater agency and engagement could be the catalyst for shared decisions. QUESTIONS/PURPOSES We assessed (1) whether effective clinician communication and effort is related to patient health literacy, and (2) if there are other factors associated with effective clinician communication and effort. METHODS We combined a prospective, cross-sectional cohort of 86 audio-recorded visits of adult patients seeking specialist hand care for a new problem at an urban community hospital in the Netherlands with a cohort of 72 audio-recorded hand surgery visits from a tertiary hospital in the United States collected for a prior study. The American cohort represents a secondary use of data from a set of patients from a separate study using audio-recorded visits and administering similar questionnaires that assessed different endpoints. In both cohorts, adult patients seeking specialist hand care for a new problem were screened. In total, 165 patients were initially screened, of which 96% (158) participated. Eight percent (13) of visits were excluded since the final diagnosis remained unclear, 8% (12) since it was not the first consultation for the current problem, 5% (8) in which only one treatment option was available, and < 1% (1) since there was a language barrier. A total of 123 patients were analyzed, 68 from the Netherlands and 55 from the United States. The Newest Vital Sign (NVS) health literacy test, validated in both English and Dutch, measures the ability to use health information and is based on a nutrition label from an ice cream container. It was used to assess patient health literacy on a scale ranging from 0 (low) to 6 (high). The 5-item Observing Patient Involvement (OPTION5) instrument is commonly used to assess the quality of patient-clinician discussion of options. Scores may be influenced by clinician effort to involve patients in decision-making as well as patient engagement and agency. Each item is scored from 0 (no effort) to 4 (maximum effort), with a total maximum score of 20. Two independent raters reached agreement (kappa value 0.8; strong agreement), after which all recordings were scored by one investigator. Visit duration and patient questions were assessed using the audio recordings. Patients had a median (interquartile range) age of 54 (38 to 66) years, 50% were men, 89% were white, 66% had a nontraumatic diagnosis, median (IRQ) years of education was 16 (12 to 18) years, and median (IQR) health literacy score was 5 (2 to 6). Median (IQR) visit duration was 9 (7 to 12) minutes. Cohorts did not differ in important ways. The number of visits per clinician ranged from 14 to 29, and the mean overall communication effectiveness and effort score for the visits was low (8.5 ± 4.2 points of 20 points). A multivariate linear regression model was used to assess factors associated with communication effectiveness and effort. RESULTS There was no correlation between health literacy and clinician communication effectiveness and effort (r = 0.087 [95% CI -0.09 to 0.26]; p = 0.34), nor was there a difference in means (SD) when categorizing health literacy as inadequate (7.8 ± 3.8 points) and adequate (8.9 ± 4.5 points; mean difference 1.0 [95% CI -2.6 to 0.54]; p = 0.20). After controlling for potential confounding variables such as gender, patient questions, and health literacy, we found that longer visit duration (per 1 minute increase: r2 = 0.31 [95% CI -0.14 to 0.48]; p < 0.001), clinician 3 (compared with clinician 1: OR 33 [95% CI 4.8 to 229]; p < 0.001) and clinician 5 (compared with clinician 1: OR 11 [95% CI 1.5 to 80]; p = < 0.02) were independently associated with more effective communication and effort, whereas clinician 6 was associated with less effective communication and effort (compared with clinician 1: OR 0.08 [95% CI 0.01 to 0.75]; p = 0.03). Clinicians' communication strategies (the clinician variable on its own) accounted for 29% of the variation in communication effectiveness and effort, longer visit duration accounted for 11%, and the full model accounted for 47% of the variation (p < 0.001). CONCLUSION The finding that the overall low mean communication effectiveness and effort differed between clinicians and was not influenced by patient factors including health literacy suggests clinicians may benefit from training that moves them away from a teaching or lecturing style where patients receive rote directives regarding their health. Clinicians can learn to adapt their communication to specific patient values and needs using a guiding rather than directing communication style (motivational interviewing).Level of Evidence Level II, prognostic study.
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Affiliation(s)
- Bastiaan T. van Hoorn
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Luke X. van Rossenberg
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - George S. I. Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Bovonratwet P, Shen TS, Islam W, Sculco PK, Padgett DE, Su EP. Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty? J Arthroplasty 2021; 36:2016-2023. [PMID: 33551144 DOI: 10.1016/j.arth.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data. METHODS The records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments. CONCLUSION The present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Chu A. CORR Insights®: Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain's Tenosynovitis? Clin Orthop Relat Res 2021; 479:1156-1157. [PMID: 33704096 PMCID: PMC8051962 DOI: 10.1097/corr.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/19/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Alice Chu
- A. Chu, Department of Orthopaedic Surgery, Rutgers NJ Medical School, Newark, NJ, USA
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Too A, Gatien C, Cormier S. Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain. PATIENT EDUCATION AND COUNSELING 2021; 104:1213-1221. [PMID: 33059949 DOI: 10.1016/j.pec.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE While the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism. METHODS A community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses. RESULTS Results revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates. CONCLUSION Chronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction. PRACTICE IMPLICATIONS Clinical training and practice should promote empathetic components of health communication within chronic pain treatment.
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Affiliation(s)
- Andrea Too
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Catherine Gatien
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Stéphanie Cormier
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
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Analysis of Online Reviews of Orthopaedic Surgeons and Orthopaedic Practices Using Natural Language Processing. J Am Acad Orthop Surg 2021; 29:337-344. [PMID: 32796371 DOI: 10.5435/jaaos-d-20-00288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is growing interest in measuring and improving patient experience. Machine learning-based natural language processing techniques may help identify instructive themes in online comments written by patients about their healthcare provider. Separating individual surgeon and orthopaedic office reviews, we analyzed themes that are discussed based on the rating category, the association with review length, the number of people posting more than one review for a surgeon or office, the mean number of reviews per rating category, and the difference in review tones. METHODS On Yelp.com, we collected 11,614 free-text reviews-together with a one- to five-star rating-of orthopaedic surgeons. Using natural language processing, we identified the most frequently occurring word combinations among rating categories. Themes were derived by categorizing word combinations. Dominant tones (emotional and language styles) were assessed by the IBM Watson Tone Analyzer. We calculated chi-square tests for linear trend and Spearman's rank correlation coefficients to assess differences among rating category. RESULTS For individual surgeons and orthopaedic offices, themes such as logistics, care and compassion, trust, recommendation, and customer service varied among rating categories. More positive reviews are shorter for individual surgeons and orthopaedic offices, while rating category was comparable among people posting more than one review for both groups. Tones of joy and confidence were associated with higher ratings. Sadness and tentative tones were associated with lower ratings. DISCUSSION For individual orthopaedic surgeons and orthopaedic offices, patient experience may be influenced mostly by the patient-clinician relationship. Training in more effective communication strategies may help improve self-reported patient experience.
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Provider Personal and Demographic Characteristics and Patient Satisfaction in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00004. [PMID: 33835991 DOI: 10.5435/jaaosglobal-d-20-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient satisfaction has increasingly been used to assess physician performance and quality of care. Although there is evidence that patient satisfaction is associated with patient-reported health outcomes and communication-related measures, there is debate over the use of patient satisfaction in reimbursement policy. Patient characteristics that influence satisfaction have been studied, but the effects of personal and demographic characteristics of physicians on patient satisfaction have yet to be explored. METHODS Outpatient satisfaction scores from 11,059 patients who rated 25 orthopaedic surgeons from a single institution were studied. In this study, we sought to explore the relationship between nonmodifiable physician characteristics, such as sex and race, and patient satisfaction with outpatient orthopaedic surgery care, as expressed in the Press Ganey Satisfaction Scores. Univariate logistic regression models were used to test the associations between each provider characteristic and patient satisfaction on the Press Ganey patient satisfaction questionnaire. RESULTS Three nonmodifiable physician personal and demographic characteristics were markedly associated with lower patient satisfaction scores across overall satisfaction, communication, and empathy domains: (1) female gender, (2) Asian ethnicity, and (3) being unmarried. Asian ethnicity reduced the odds of receiving a 5-star rating for likelihood to recommend the provider by nearly 40%, but none of these nonmodifiable physician personal and demographic characteristics affected the likelihood to recommend the practice. DISCUSSION Sex, ethnicity, and marital status are nonmodifiable provider characteristics, each associated with markedly lower odds of receiving a 5-star rating on Press Ganey patient satisfaction survey. These data reveal inherent patient biases that negatively affect physician-patient interactions and may exacerbate the lack of diversity in orthopaedic surgery. More research is necessary before using patient satisfaction ratings to evaluate surgeons or as quality measures that affect reimbursement policies.
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Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era. J Natl Med Assoc 2021; 113:405-413. [PMID: 33814179 DOI: 10.1016/j.jnma.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND We used online crowdsourcing to explore public perceptions and attitudes towards virtual orthopaedic care, and to identify factors associated with perceived difficulty navigating telehealth services during the COVID-19 pandemic. METHODS A modified version of the validated Telemedicine Satisfaction and Usefulness Questionnaire was completed by 816 individuals using crowd-sourcing methods. Multivariable logistic regression modelling was used to determine population characteristics associated with perceived difficulty using telehealth technology. RESULTS Most respondents (85%) believed that telehealth visits would be a convenient form of healthcare delivery, and 64% would prefer them over in-person office visits. The majority (92%) agreed that telehealth would save them time, but 81% had concerns regarding the lack of physical contact during a musculoskeletal examination. More respondents would feel comfortable using telehealth for routine follow-up care (81%) compared to initial assessment visits (59%) and first postoperative appointments (60%). Roughly 1 in 15 (7%) expressed difficulty with using telehealth; these respondents were more often unmarried, lower-income, and more medically infirm, and reported greater symptoms of depression. After multivariable adjustment, lower income and poor health were retained as predictors of difficulty with navigating telehealth technology (p = 0.027,p = 0.036, respectively). CONCLUSION The majority of the public appears receptive to telehealth for orthopaedic care for both new patient visits and follow-up appointments. The finding that people with multiple chronic conditions and psychosocial needs struggle to engage with telehealth suggests that those who arguably stand to benefit the most from continued care are the ones being unintentionally left out of this digitization boom.
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- * E-mail:
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Chang M, Russo GS, Canseco JA, Nicholson K, Sharma R, Koomson J, Vaccaro AR. Variations in Patient Satisfaction Scores Between HCAHPS and a Novel Orthopedic Practice-Specific Survey. Am J Med Qual 2021; 36:103-109. [PMID: 32452696 DOI: 10.1177/1062860620926710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.
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Affiliation(s)
- Michael Chang
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA Quinnipiac University, Hamden, CT Drexel University, Philadelphia, PA
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Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:927-934. [PMID: 33127238 DOI: 10.1016/j.arth.2020.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information. METHODS Records of 319 patients who had undergone primary TKA between August 2016 and August 2019 were linked with vendor-supplied patient satisfaction data, which included patient comments and the Press Ganey satisfaction survey. Using machine-learning-based natural language processing, 1048 patient comments were analyzed for sentiment and classified into themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not (positive, neutral, mixed grouped together). Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1048 patient comments, 25% were negative, 58% were positive, 8% were mixed, and 9% were neutral. Top 2 themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in most of the studied outcomes (eg, peak pain intensity, length of stay, or Knee Injury and Osteoarthritis Outcome Score Junior and pain scores at 6-week follow-up) between the 2 cohorts (P > .05). However, patients who made negative comments were less likely to highly recommend their hospital care to peers (P < .001). Finally, patients who had higher American Society of Anesthesiologists Score and those who received a scopolamine patch were more likely to provide negative comments (P < .05). CONCLUSION Although the current study showed that patient satisfaction might not be a proxy for traditional objective perioperative outcomes, efforts to improve the nontechnical aspects of medicine are still crucial in providing patient-centered care.
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Chaudhry H, Nadeem S, Mundi R. How Satisfied Are Patients and Surgeons with Telemedicine in Orthopaedic Care During the COVID-19 Pandemic? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2021; 479:47-56. [PMID: 33009231 PMCID: PMC7899486 DOI: 10.1097/corr.0000000000001494] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has resulted in a rapid pivot toward telemedicine owing to closure of in-person elective clinics and sustained efforts at physical distancing worldwide. Throughout this period, there has been revived enthusiasm for delivering and receiving orthopaedic care remotely. Unfortunately, rapidly published editorials and commentaries during the pandemic have not adequately conveyed findings of published randomized trials on this topic. QUESTIONS/PURPOSES In this systematic review and meta-analysis of randomized trials, we asked: (1) What are the levels of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care delivery? (2) Are there differences in patient-reported outcomes between telemedicine visits and in-person visits? (3) What is the difference in time commitment between telemedicine and in-person visits? METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review with the primary objective to determine patient and surgeon satisfaction with telemedicine, and secondary objectives to determine differences in patient-reported outcomes and time commitment. We used combinations of search keywords and medical subject headings around the terms "telemedicine", "telehealth", and "virtual care" combined with "orthopaedic", "orthopaedic surgery" and "randomized." We searched three medical databases (MEDLINE, Embase, and the Cochrane Library) in duplicate and performed manual searches to identify randomized controlled trials evaluating the outcomes of telemedicine and in-person orthopaedic assessments. Trials that studied an intervention that was considered to be telemedicine (that is, any form of remote or virtual care including, but not limited to, video, telephone, or internet-based care), had a control group that comprised in-person assessments performed by orthopaedic surgeons, and were reports of Level I original evidence were included in this study. Studies evaluating physiotherapy or rehabilitation interventions were excluded. Data was extracted by two reviewers and quantitative and qualitive summaries of results were generated. Methodological quality of included trials was assessed using the Cochrane Risk of Bias tool, which uniformly rated the trials at high risk of bias within the blinding categories (blinding of providers, patients, and outcome assessors). We screened 133 published articles; 12 articles (representing eight randomized controlled trials) met the inclusion criteria. There were 1008 patients randomized (511 to telemedicine groups and 497 to control groups). Subspecialties represented were hip and knee arthroplasty (two trials), upper extremity (two trials), pediatric trauma (one trial), adult trauma (one trial), and general orthopaedics (two trials). RESULTS There was no difference in the odds of satisfaction between patients receiving telemedicine care and those receiving in-person care (pooled odds ratio 0.89 [95% CI 0.40 to 1.99]; p = 0.79). There were also no differences in surgeon satisfaction (pooled OR 0.38 [95% CI 0.07 to 2.19]; p = 0.28) or among multiple patient-reported outcome measures that evaluated pain and function. Patients reported time savings, both when travel time was excluded (17 minutes shorter [95% CI 2 to 32]; p = 0.03) and when it was included (180 minutes shorter [95% CI 78 to 281]; p < 0.001). CONCLUSION Evidence from heterogeneous randomized studies demonstrates that the use of telemedicine for orthopaedic assessments does not result in identifiable differences in patient or surgeon satisfaction compared with in-person assessments. Importantly, the source studies in this review did not adequately capture or report safety endpoints, such as complications or missed diagnoses. Future studies must be adequately powered to detect these differences to ensure patient safety is not compromised with the use of telemedicine. Although telemedicine may lead to a similar patient experience, surgeons should maintain a low threshold for follow-up with in-person assessments whenever possible in the absence of further safety data. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Harman Chaudhry
- H. Chaudhry, S. Nadeem, R. Mundi, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
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Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study. Emerg Med J 2020; 38:290-296. [PMID: 33239313 DOI: 10.1136/emermed-2019-209393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors. METHOD A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis. RESULTS A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined. CONCLUSION Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey A Kline
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hao Wang
- Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA .,JPS Health Network, Fort Worth, Texas, USA
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