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Crowe A, Koch MK, Bluck S, Amin T, Thomas L, Fitchett G, Wilkie DJ, Bylund CL. Factors and topics associated with empathic self-disclosure in dignity therapy of cancer patients. PEC INNOVATION 2024; 4:100289. [PMID: 38799259 PMCID: PMC11126944 DOI: 10.1016/j.pecinn.2024.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
Objective During Dignity Therapy a trained provider guides a patient to share their life story and legacy. Providers can demonstrate empathy through empathic self-disclosure (ESD), sharing something substantial and personal about themselves in response to the patient. The current study aims to identify the topics of ESDs and determine whether ESD frequency varied by patient and/or provider characteristics. Methods Two coders analyzed 203 audio-recorded, transcribed Dignity Therapy sessions of palliative care patients (M = 65.78 years; SD = 7.43 years, 65.69% women) for ESD. Topic modeling characterized themes of ESD and multilevel modeling examined ESD frequency based on several patient and provider characteristics. Results ESD occurred in 37% of interviews (M = 0.59, SD = 1.21). Topic modeling revealed five main themes: family, memory, school, geographical experiences, and values/beliefs. Multilevel modeling indicated patient-level differences, including greater rates of ESD when patients were men and older. Conclusion ESD seems to be dependent on the context of the patient rather than individual communication style differences. Providers may use ESD in multiple instances, including when similar and different from patients. Innovation This study introduces and defines the novel concept of ESD. It is among the first to examine patient-provider communication during Dignity Therapy, and the first to specifically examine self-disclosure.
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Affiliation(s)
- Alyssa Crowe
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - Mary Kate Koch
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, United States of America
| | - Susan Bluck
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, United States of America
| | - Tithi Amin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - Lyndsey Thomas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - George Fitchett
- Department of Religion, Health & Human Value, College of Health Sciences, Rush University Medical Center, United States of America
| | - Diana J. Wilkie
- Department of Nursing, College of Medicine, University of Florida, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
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2
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Schöps AM, Skinner TC, Fosgerau CF. Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention. PATIENT EDUCATION AND COUNSELING 2024; 127:108370. [PMID: 38996574 DOI: 10.1016/j.pec.2024.108370] [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: 11/02/2023] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To explore the relationship between health coaches' responses to emotional cues/concerns and women's subsequent engagement with the health coaching mHealth platform. METHODS 24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. RESULTS In interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. CONCLUSION High goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. PRACTICE IMPLICATIONS Findings can draw coaches' attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective.
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Affiliation(s)
- Antje Maria Schöps
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy Charles Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, La Trobe University, Bendigo, Australia; Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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Zhang X, Zhang D, Liu Y, Tian Y, Yu F, Cao Y, Su Y. The effects of psychological interventions on suicide for cancer patients: a systematic review and network meta-analysis. PSYCHOL HEALTH MED 2024; 29:1377-1399. [PMID: 38785256 DOI: 10.1080/13548506.2024.2356026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
Numerous psychological interventions are available for suicidal and death ideation (SDI) and suicidal behavior among cancer patients. To identify the optimal psychological interventions for reducing SDI and suicidal behavior in cancer patients. However, it remains unclear which psychological intervention is the most effective. We performed a pairwise and network meta-analysis by searching seven databases from the date of inception until 8 April 2022. An important focus of this network meta-analysis was the comparison of the effects of various psychological interventions on the reduction of SDI and suicidal behavior among cancer patients. For determining efficacy, we used standardized mean differences (SMDs) and 95% confidence intervals (CIs). Besides, a pairwise meta-analysis, inconsistency test, network meta-analysis, the surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot, subgroup analysis, and sensitivity analysis were also carried out. A total of 8 studies involving 1,350 patients were searched in this study. It showed that empathy therapy (SUCRA = 95.3%) has the best effect among the six interventions. Comprehensive psychological intervention (SUCRA = 77.6%) was ranked in the top two positions, followed by meaning-centered therapy (SUCRA = 40.7%). Comparison-adjusted funnel plots revealed no significant publication bias. In addition, our conclusions have not changed significantly after the sensitivity analysis. In this network meta-analysis, empathy therapy was identified as the optimal choice for reducing SDI and suicidal behaviors in cancer patients. Further multi-center and high-quality RCT studies should be conducted to make our conclusion more rigorous.
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Affiliation(s)
- Xinyue Zhang
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Dan Zhang
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
| | - Yuqi Liu
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Yinong Tian
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| | - Feiping Yu
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Yingjuan Cao
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong, China
- Nursing Theory & Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yonggang Su
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong, China
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
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4
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de Graaff E, Bennett C, Dart J. Empathy in Nutrition and Dietetics: A Scoping Review. J Acad Nutr Diet 2024; 124:1181-1205. [PMID: 38677364 DOI: 10.1016/j.jand.2024.04.013] [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: 07/09/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care. OBJECTIVE This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics. METHODS Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table. RESULTS Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies. CONCLUSIONS This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.
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Affiliation(s)
- Emma de Graaff
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - Janeane Dart
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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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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Salmi L, Hubbard J, McFarland DC. When Bad News Comes Through the Portal: Strengthening Trust and Guiding Patients When They Receive Bad Results Before Their Clinicians. Am Soc Clin Oncol Educ Book 2024; 44:e433944. [PMID: 38848509 DOI: 10.1200/edbk_433944] [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: 06/09/2024]
Abstract
Communication in oncology was challenging long before the emergence of the US 21st Century Cures Act. Before 2021, a growing body of evidence had demonstrated the benefits of patients' access to and review of the clinical notes in their charts (open notes); however, studies examining the benefits of immediate access to test results were scarce until the implementation of the Cures Act's Information Blocking Rule. Individuals grappling with cancer today now possess immediate access to their laboratory results, imaging scans, diagnostic tests, and progress notes as mandated by law. To many clinicians, the implementation of the Cures Act felt sudden and presented new challenges and concerns for oncologists surrounding patients' potential emotional reactions to medical notes or lack of control over the careful delivery of potentially life-changing information. Despite data that show most patients want immediate access to information in their records before it is communicated directly by a health care professional, surveys of oncologists showed trepidation. In this chapter, perspectives from a patient with cancer, an oncologist, and a cancer psychiatrist (in that order) are shared to illuminate the adjustments made in clinician-patient communication amid the era of nearly instantaneous results within the electronic health record.
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Affiliation(s)
- Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Daniel C McFarland
- Department of Psychiatry/Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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Shoji K, Noguchi N, Waki F, Saito T, Kitano M, Edo N, Koga M, Toda H, Kobayashi N, Sawamura T, Nagamine M. Empathy and Coping Strategies Predict Quality of Life in Japanese Healthcare Professionals. Behav Sci (Basel) 2024; 14:400. [PMID: 38785891 PMCID: PMC11117590 DOI: 10.3390/bs14050400] [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: 04/09/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Burnout and secondary traumatic stress (STS), also referred to as compassion fatigue, are undeniable negative consequences experienced by healthcare professionals when working with patients. As frontline healthcare professionals are essential to communities, it is crucial to understand their mental health and how they cope with negative psychological responses. This study investigated the relationships between burnout, STS, compassion satisfaction, dispositional empathy, and stress management among Japanese healthcare professionals and students taking care of patients in clinical practice. The participants were 506 Japanese healthcare professionals and students (doctors, nurses, medical students, and nursing students) affiliated with Japanese Ministry of Defense Hospitals. The data were collected from March 2020 to May 2021. We assessed burnout, STS, and compassion satisfaction using the Professional Quality of Life Scale, dispositional empathy using the Interpersonal Reactivity Index, and coping with stress using the Coping Orientation to Problems Experienced Inventory (Brief-COPE). Exploratory factor analysis of the Brief-COPE yielded three factors: active coping; support-seeking; and indirect coping. Personal distress, a self-oriented emotional empathy index, was related to higher burnout and STS scores and lower compassion satisfaction. Empathic concern, an other-oriented emotional empathy index, was associated with lower burnout and higher compassion satisfaction. Active coping strategies were associated with lower burnout and higher compassion satisfaction, whereas indirect coping strategies were associated with higher burnout and STS scores. In a comparison of empathy in professional categories, nurses presented higher personal distress than nursing students, and medical doctors showed lower fantasy tendencies than medical students. These results imply the complex relationships between empathy, coping strategies, and psychological responses among healthcare professionals. Further longitudinal study is needed to explore these complex relationships and to develop more precise and effective psycho-educational interventions to prevent burnout and STS.
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Affiliation(s)
- Kotaro Shoji
- College of Nursing, University of Human Environments, 3-220 Ebata, Obu 474-0035, Aichi, Japan;
| | - Norihito Noguchi
- Department of Nursing, National Defense Medical College, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Fumiko Waki
- Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Taku Saito
- Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Masato Kitano
- Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Naoki Edo
- Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Minori Koga
- Department of Psychiatry, National Defense Medical College, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, National Defense Medical College, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
| | - Nobuhisa Kobayashi
- Department of Psychiatry, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo 154-8532, Japan
| | - Takehito Sawamura
- Department of Psychiatry, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo 154-8532, Japan
| | - Masanori Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa 395-8513, Saitama, Japan
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Gao Q, Zhang B, Zhou Q, Lei C, Wei X, Shi Y. The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study. BMC Health Serv Res 2024; 24:579. [PMID: 38702670 PMCID: PMC11069204 DOI: 10.1186/s12913-024-11020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. METHODS Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. RESULTS The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. CONCLUSION This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.
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Affiliation(s)
- Qiufeng Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Bin Zhang
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Qian Zhou
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Cuiyao Lei
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Xiaofei Wei
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China.
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Gerger H, Munder T, Kreuzer N, Locher C, Blease C. Lay Perspectives on Empathy in Patient-Physician Communication: An Online Experimental Study. HEALTH COMMUNICATION 2024; 39:1246-1255. [PMID: 37219394 DOI: 10.1080/10410236.2023.2210380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Research indicates that patients consider empathy as a key factor contributing to the quality-of-care. However, ambiguities in the definition of this multidimensional construct complicate definite conclusions to-date. Addressing the challenges in the literature, and using a hypothetical physician-patient interaction which explored patient-perceived differences between expressions of affective empathy, cognitive empathy, compassion and no empathy, this study aimed to test whether lay participants' evaluations of the quality-of-care depend on the type of empathic physician behavior, and on the physician's gender. We conducted a randomized web-based experiment using a 4 (type of empathy) by 2 (physician gender) between-subjects design. Empathy was subdivided into three concepts: first, affective empathy (i.e. feeling with someone); second, cognitive empathy (i.e. understanding); and third, compassion (i.e. feeling for someone and offering support). Perceived quality-of-care was the primary outcome. Compared with non-empathic interactions, quality-of-care was rated higher when physicians reacted cognitively empathic or compassionate (d = 0.71; 0.43 to 1.00 and d = 0.68; 0.38 to 0.98). No significant difference was found between affective empathy and no empathy (d = 0.13; -0.14 to 0.42). The physician's gender was not related with quality-of-care. Aspects of participants' personality but not their age, gender or the number of physician visits were associated with quality-of-care. No interactions were observed. In showing that patients rated quality-of-care higher when physician reactions were described as cognitively empathic and compassionate, as compared with affectively empathic or non-empathic, our findings refine views about the kinds of empathy that are important in patient care with implications for clinical practice, education and communication trainings.
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Affiliation(s)
- Heike Gerger
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University
- Department of General Practice, Erasmus University Medical Center
- Department of Clinical Psychology and Psychotherapy, University of Basel
| | - Thomas Munder
- Department of Psychology, University of Zurich
- Department of Psychology, University of Kassel
| | - Nicole Kreuzer
- Department of Clinical Psychology and Psychotherapy, University of Basel
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich
| | - Charlotte Blease
- Department of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
- Department of Women's and Children's Health, Uppsala University
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Yao H, Gomes de Siqueira A, Rogers ML, Bloch-Elkouby S, Lawrence O, Sarli G, Foster A, Mitelman SA, Galynker I, Lok B. The impact of scaffolded and non-scaffolded suicidal virtual human interaction training on clinician emotional self-awareness, empathic communication, and clinical efficacy. BMC MEDICAL EDUCATION 2024; 24:413. [PMID: 38622653 PMCID: PMC11017492 DOI: 10.1186/s12909-024-05371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes. METHODS This study investigated the impact of virtual human interaction (VHI) training on clinicians' self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians' verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians' empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians' negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions. RESULTS Clinician participants' negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group. CONCLUSION Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.
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Affiliation(s)
- Heng Yao
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA.
| | - Alexandre Gomes de Siqueira
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, 78666, TX, USA
| | - Sarah Bloch-Elkouby
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, 10033, NY, USA
| | - Olivia Lawrence
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Giuseppe Sarli
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Department of Mental Health and Addiction, ASST Brianza, Vimercate, Italy
| | - Adriana Foster
- Healthcare Corporation of America (HCA) Florida, Woodmont Hospital, Tamarac, 33321, FL, USA
| | - Serge A Mitelman
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Igor Galynker
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Benjamin Lok
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA.
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Shetty VA, Durbin S, Weyrich MS, Martínez AD, Qian J, Chin DL. A scoping review of empathy recognition in text using natural language processing. J Am Med Inform Assoc 2024; 31:762-775. [PMID: 38092686 PMCID: PMC10873831 DOI: 10.1093/jamia/ocad229] [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: 08/03/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To provide a scoping review of studies on empathy recognition in text using natural language processing (NLP) that can inform an approach to identifying physician empathic communication over patient portal messages. MATERIALS AND METHODS We searched 6 databases to identify relevant studies published through May 1, 2023. The study selection was conducted through a title screening, an abstract review, and a full-text review. Our process followed the PRISMA-ScR guidelines. RESULTS Of the 2446 publications identified from our searches, 39 studies were selected for the final review, which summarized: (1) definitions and context of empathy, (2) data sources and tested models, and (3) model performance. Definitions of empathy varied in their specificity to the context and setting of the study. The most common settings in which empathy was studied were reactions to news stories, health-related social media forums, and counseling sessions. We also observed an expected shift in methods used that coincided with the introduction of transformer-based models. DISCUSSION Aspects of the current approaches taken across various domains may be translatable to communication over a patient portal. However, the specific barriers to identifying empathic communication in this context are unclear. While modern NLP methods appear to be able to handle empathy-related tasks, challenges remain in precisely defining and measuring empathy in text. CONCLUSION Existing work that has attempted to measure empathy in text using NLP provides a useful basis for future studies of patient-physician asynchronous communication, but consideration for the conceptualization of empathy is needed.
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Affiliation(s)
- Vishal Anand Shetty
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA 01003, United States
| | - Shauna Durbin
- Center for Evidence-based Policy, Oregon Health & Science University, Portland, OR 97201, United States
| | - Meghan S Weyrich
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA 95616, United States
| | - Airín Denise Martínez
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA 01003, United States
| | - Jing Qian
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003, United States
| | - David L Chin
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA 01003, United States
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Benz CI, Wolanski C, Piefke M, Campus G, Piwowarczyk A, Wolf TG. A double-blind randomized clinical trial on the suggestive effect of anxiety management questionnaires in dental emergencies. Front Psychol 2024; 15:1333594. [PMID: 38577123 PMCID: PMC10994379 DOI: 10.3389/fpsyg.2024.1333594] [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] [Received: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Dental anxiety is widespread among both children and adults. To diagnose dental anxiety, standardized anxiety questionnaires are recommended. Based on the suggestive nature of the questionnaires, the study aimed to find out whether asking respondents about personal coping strategies before dental treatment influences their anxiety. Methods This prospective, double-blind, randomized controlled clinical trial included a total of 158 patients of a university dental clinic on emergency service. The intervention group (n = 82) received the Coping with Anxiety Questionnaire (CAQ) and the control group (n = 76) the Hierarchical Anxiety Questionnaire (HAF). State anxiety scores were assessed by using the State-Trait Anxiety Inventory (STAI) before and after the completion of each questionnaire. Results Anxiety decreased in the intervention group (CAQ) (p < 0.001) and increased in the control group (HAF) (p < 0.001). Conclusion Within the limitations of the current study, a diagnostic tool of a standardized questionnaire for the assessment to assess personal coping strategies decreased state anxiety in comparison to a questionnaire assessing anxiety. Clinical trial registration https://www.drks.de, German Trials Register (DRKS00032450).
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Affiliation(s)
- Carla Irene Benz
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Prosthodontics and Dental Technology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Celina Wolanski
- Department of Prosthodontics and Dental Technology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Martina Piefke
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Cariology, Saveetha Dental College and Hospitals, SIMATS, Chennai, India
| | - Andree Piwowarczyk
- Department of Prosthodontics and Dental Technology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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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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14
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Armstrong MJ, Bedenfield N, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Galvin JE, Lachner C, Grant Smith A, de Los Ángeles Ortega M, Mohiuddin Y, Shatzer J, Marasco D, Willis D, Bylund CL. Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process. Neurol Clin Pract 2024; 14:e200223. [PMID: 38152063 PMCID: PMC10750429 DOI: 10.1212/cpj.0000000000200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. Methods We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. Results The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Discussion Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Noheli Bedenfield
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Monica Rosselli
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Rosie E Curiel Cid
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Marcela Kitaigorodsky
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - James E Galvin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Christian Lachner
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Amanda Grant Smith
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - María de Los Ángeles Ortega
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Yasmin Mohiuddin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Julie Shatzer
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Deann Marasco
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Dianna Willis
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Carma L Bylund
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
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Tranberg M, Ekedahl H, Fürst CJ, Engellau J. The influence of "bad news" and "neutral/good news" on patients' perception of physician empathy during oncology consultations. Cancer Med 2024; 13:e6903. [PMID: 38164055 PMCID: PMC10807689 DOI: 10.1002/cam4.6903] [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: 09/10/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a "bad news" consultation using the consultation and relational empathy (CARE) measure. METHODS A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the "bad news" group, or the "neutral/good news" group along with information about the patient and the consultation. The patient was given the CARE measure after the visit. RESULTS The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11 min longer. CONCLUSIONS Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient.
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Affiliation(s)
- Mattias Tranberg
- Division of Palliative Care, Department of Clinical Sciences LundLund UniversityLundSweden
- The Institute for Palliative Care at Lund University and Region SkåneLundSweden
| | - Henrik Ekedahl
- Department of OncologySkåne University HospitalLundSweden
| | - Carl Johan Fürst
- Division of Palliative Care, Department of Clinical Sciences LundLund UniversityLundSweden
- The Institute for Palliative Care at Lund University and Region SkåneLundSweden
| | - Jacob Engellau
- Department of OncologySkåne University HospitalLundSweden
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Eijkelboom MCL, de Kleijn RAM, Baten L, Frenkel J, van der Schaaf MF. Perspective-Taking and Perspective-Sharing in Pediatric Education: Exploring Connections Between Strategies of Medical Students and Patients' Caregivers. PERSPECTIVES ON MEDICAL EDUCATION 2023; 2:372-384. [PMID: 37810548 PMCID: PMC10558030 DOI: 10.5334/pme.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/07/2023] [Indexed: 10/10/2023]
Abstract
Introduction In pediatric education, caregivers are increasingly involved to share their perspective. Yet, an in-depth understanding of the perspective-taking process between medical students and caregivers is lacking. This study explored: 1) Which strategies do medical students use to take a caregiver's perspective and which facilitators and constraints do they perceive? 2) Which strategies do caregivers use to share their perspective with students? and 3) How do students' perspective-taking strategies relate to caregivers' perspective-sharing strategies? Methods In an online lesson: two caregivers of pediatric patients, shared their story with 27 fourth-year Dutch medical students. After the session, students undertook an assignment where they individually reflected on how they took perspective. Students' reflections were collected via audio recordings. Caregivers were individually interviewed. Data were analyzed through thematic and cross-case analysis. Results Students used eight perspective-taking strategies, in various combinations. Students used inferential strategies, where they made inferences from available information, and cultivating strategies, where they attempted to elicit more information about the caregiver. Students perceived individual-, contextual- and caregiver-related facilitators and constraints for taking perspective. Caregivers shared their perspective by adopting multiple strategies to share their story and create a trusting learning environment. We visualized connections between students' perspective-taking strategies, facilitators/constraints, and caregivers' perspective-sharing strategies. Discussion By combining data from both perspective-takers (students) and perspective-sharers (caregivers), this study provides a foundation for future research to study perspective-taking between students and patients in an educational context. On a practical level, our findings provide tools for students, patients, and educators to enhance perspective-taking processes.
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Affiliation(s)
- M. C. L. Eijkelboom
- Faculty of Medicine, Utrecht University, the Netherlands
- Department of Pediatrics, University Medical Center Utrecht, the Netherlands
| | - R. A. M. de Kleijn
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, the Netherlands
| | - L. Baten
- Faculty of Medicine, Utrecht University, the Netherlands at the time she contributed to the research
| | - J. Frenkel
- Department of Pediatrics, University Medical Center Utrecht, the Netherlands
| | - M. F. van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, the Netherlands
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Malik Z, Ahn J, Schwartz A, Blackie M. Narrative medicine workshops for emergency medicine residents: Effects on empathy and burnout. AEM EDUCATION AND TRAINING 2023; 7:e10895. [PMID: 37485471 PMCID: PMC10357272 DOI: 10.1002/aet2.10895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023]
Abstract
Background Emergency medicine (EM) residents face unique affective challenges and barriers to interpersonal connection in their clinical environment which may contribute to decreased empathy and increased burnout. Narrative medicine (NM) might address these barriers and has had beneficial impacts in various populations but has never been studied in EM residents. In this study, we sought to evaluate the effect of NM workshops on burnout and empathy and to assess resident perceptions of the workshops. Methods We performed a quasi-experimental study at two EM residencies from June to October 2020. Residents at the intervention site participated in two NM workshops led by EM faculty that were composed of a close reading of a literary text, reflective writing, and group discussion. Residents were asked to complete the abbreviated Interpersonal Reactivity Index (IRI) and a single-item burnout measure pre- and postintervention. We fitted linear regression models to IRI subscores; we treated burnout as an ordinal variable and fitted a conditional logistic regression model. Residents completed a postintervention survey that we analyzed using summary statistics. Results A total of 46.7% of control (28/60) and 100% of intervention (48/48) residents responded (n = 76). While all respondents demonstrated worsening burnout with time (p = 0.001), residents at the intervention site exhibited less severe increases (interaction p < 0.001). Empathy remained unchanged. A total of 50% of intervention residents (24/48) responded to the postintervention survey; most (n = 20, 83.3%) agreed that the workshops should be a standard part of EM didactics. Conclusions These findings establish the feasibility and desirability of NM in residency education and offers a model for EM-centered narrative workshops. Additionally, while our outcomes are limited, we found that exposure to an NM curriculum may be protective against worsening burnout.
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Affiliation(s)
- Zayir Malik
- Department of Emergency MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - James Ahn
- Section of Emergency Medicine in the Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Alan Schwartz
- Department of Medical EducationUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Michael Blackie
- Department of Medical EducationUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Bylund CL, Thompson LA, Hansen M, Staras SAS. A Pilot Test of a Workshop for Pediatric Clinicians About Communicating with Parents About the HPV Vaccine Using the C-LEAR Approach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:798-804. [PMID: 35941410 PMCID: PMC9360739 DOI: 10.1007/s13187-022-02188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 06/02/2023]
Abstract
Low HPV vaccinations rates lead to missed opportunities to prevent cancer. Specifically, some parents (12-76%) report never receiving a recommendation for their child to receive the vaccine. Current models for talking about HPV vaccination fall short in that they focus primarily on how to introduce the vaccine with limited guidance on how to follow through with the conversation, particularly with those parents who may be hesitant. We developed the C-LEAR approach, an easy to remember, evidence-informed mnemonic to guide clinicians through the process of introducing and discussing the HPV vaccine with parents. We pilot tested this approach with a total of 20 pediatric clinicians (n = 13 residents; n = 7 attendings) in 60-min Zoom workshops that included a short didactic session, a demonstration of skills, and a small group, facilitator-led role play session. On an immediate post-training survey, all participants stated that the training was helpful and easy to understand. Ninety-four percent responded that they would implement what they had learned in their clinic. Participants reported appreciation for the small group sessions. While not specifically asked or required to incorporate the material into their practice, 1 year following the training, 8/9 (88%) participants reported using the C-LEAR approach in their clinics "most" or "all of the time." We are further testing this model through teaching our workshop in a large, randomized trial across the state of Florida.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Hansen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Keller F, Ludwig U, Huber-Lang M. Enemy or friend: the personal and the factual patient-physician relationship. Front Med (Lausanne) 2023; 10:1098305. [PMID: 37305141 PMCID: PMC10248471 DOI: 10.3389/fmed.2023.1098305] [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] [Received: 11/14/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Physicians are expected to place the patient's interests above their own. Such prioritization has worldwide consent. It constitutes the difference between medicine and other professions. The present conceptual opinion paper summarizes the authors' clinical experience with patient care and student teaching during the last 45 years. The authors comment on their own conception by referring to present debates and prominent statements from the past. Fundamental changes in medicine have taken place over the last five decades. New diseases have emerged while diagnostic and therapeutic options for patients have grown steadily - along with healthcare costs. At the same time, economic and legal constraints for physicians have increased, as has moral pressure. The interaction of physicians with patients has gradually shifted from a personal to a factual relationship. In the factual, more formal relationship, the patient and physician represent equal partners of a legal contract, which jeopardizes the prioritization of the patient's interests. The formal relationship implies defensiveness. By contrast, in the personal relationship, the physician adopts an existentialist commitment while simultaneously enabling and respecting the patient's autonomous decision-making. The authors argue for the personal relationship. However, the patient and physician are no friends. Consequently, the physician in effect competes with the patient from a knowledge-based but opposite position. Both need to make efforts to consent and maintain the relationship even when they dissent. This implies that the physician does not simply comply with the patient's wishes.
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Affiliation(s)
- Frieder Keller
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, University Hospital, Ulm, Germany
| | - Ulla Ludwig
- Department of Internal Medicine, University Hospital, Ulm, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, University Hospital, Ulm, Germany
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20
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Kelly A, Carey J, Powell M, McColl E. Top tips for effective clinical communication. Br Dent J 2023; 234:716-718. [PMID: 37237190 DOI: 10.1038/s41415-023-5920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Aengus Kelly
- Clinical Lead, Devonport Dental Education Facility, Peninsula Dental Social Enterprise, Plymouth, PL1 4JZ, United Kingdom.
| | - Jim Carey
- Associate Professor Honorary Consultant Oral Surgeon, Peninsula Dental School (University of Plymouth), Derriford Dental Education Facility, Plymouth Science Park, Research Way, Plymouth, PL6 8BT, United Kingdom.
| | - Morag Powell
- Dental Therapist, Lecturer in Dental Therapy & Hygiene, Peninsula Dental School (University of Plymouth), Derriford Dental Education Facility, Plymouth Science Park, Research Way, Plymouth, PL6 8BT, United Kingdom.
| | - Ewen McColl
- Director of Clinical Dentistry, Peninsula Dental School (University of Plymouth), Derriford Dental Education Facility, Plymouth Science Park, Research Way, Plymouth, PL6 8BT, United Kingdom.
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21
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Bylund CL, Mullis MD, Alpert J, Markham MJ, Onega T, Fisher CL, Johnson SB. Clinician Communication With Patients About Cancer Misinformation: A Qualitative Study. JCO Oncol Pract 2023; 19:e389-e396. [PMID: 36626708 DOI: 10.1200/op.22.00526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on clinician-patient conversations about cancer-related misinformation. As a first step, the objective of this study was to describe how cancer clinicians report communicating with patients about online cancer misinformation. METHODS We used convenience and snowball sampling to contact 59 cancer clinicians by e-mail. Contacted clinicians predominately worked at academic centers across the United States. Clinicians who agreed participated in semistructured interviews about communication in health care. For this study, we focused specifically on clinicians' experiences discussing online cancer-related misinformation with patients. We conducted a thematic analysis using a constant comparative approach to identify how clinicians address misinformation during clinical visits. RESULTS Twenty-one cancer clinicians participated in the study. Nineteen were physicians, one was a physician assistant, and one was a nurse practitioner. The majority (62%) were female. We identified four themes that describe how cancer clinicians address misinformation: (1) work to understand the misinformation; (2) correct misinformation through education; (3) advise about future online searches, and (4) preserve the clinician-patient relationship. CONCLUSION Our study identified four strategies that clinicians use to address online cancer-related misinformation with their patients. These findings provide a foundation for future research, allowing us to test these strategies in larger samples to examine their effectiveness.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Michaela D Mullis
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Jordan Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Tracy Onega
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Skyler B Johnson
- Department of Radiation Oncology, School of Medicine, University of Utah, Salt Lake City, UT
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22
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Kagawa Y, Ishikawa H, Son D, Okuhara T, Okada H, Ueno H, Goto E, Tsunezumi A, Kiuchi T. Using patient storytelling to improve medical students' empathy in Japan: a pre-post study. BMC MEDICAL EDUCATION 2023; 23:67. [PMID: 36707818 PMCID: PMC9881337 DOI: 10.1186/s12909-023-04054-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Empathy for patients is now internationally accepted as one of the competencies of physicians for patient-centered medical practice and an essential component of medical education. Recently, "patient storytelling" has attracted attention in empathy education for medical students to understand patients' experiences, feelings, and perspectives. This study aimed to quantitatively evaluate how patient storytelling enhanced undergraduate medical students' empathy in Japan to the extent that they sustained it for six months. METHODS Participants were 159 fourth-year undergraduate medical students in Tokyo in academic years 2018 and 2019. The questionnaire surveys were conducted three times: at the beginning of the class, immediately after the class, and six months after the class. The Japanese version of the Jefferson Scale of Empathy-Student Version was used in this study. Gender, age, and clinical orientation were also obtained through the self-reported questionnaire. We invited a male patient storyteller who was diagnosed with chronic kidney disease to the classes on "Professionalism." The title of his storytelling was "The Power of Medical Professionals' Words." RESULTS JSE-S scores improved significantly immediately after listening to patient storytelling. The scores remained improved six months after the class. Interest of specialty was significantly positively associated with an immediate change in JSE-S scores. However, gender had no significant association with changes in JSE-S scores either immediately or six months after education. CONCLUSIONS Our findings may suggest that patient storytelling would be useful to cultivate empathy among undergraduate medical students. It is to be expected that more medical schools will use patient storytelling to educate medical students in humanistic and communication education.
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Affiliation(s)
- Yumi Kagawa
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | | | - Daisuke Son
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruka Ueno
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Eiko Goto
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Aiko Tsunezumi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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23
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Winter R, Ward A, Norman RI, Howick J. A survey of clinical empathy training at UK medical schools. BMC MEDICAL EDUCATION 2023; 23:40. [PMID: 36658502 PMCID: PMC9850684 DOI: 10.1186/s12909-022-03993-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The benefits of enhancing practitioner empathy include better patient outcomes and improved job satisfaction for practitioners. Evidence suggests empathy can be taught and empathy is listed as an outcome for graduates in the General Medical Council requirements. Despite this, empathy training is not mandatory on medical school curricula and the extent to which medical students are given empathy-specific training is unknown. AIM To conduct a survey of empathy training currently offered to medical students in UK medical schools. METHODS An invitation to participate in an online survey was sent to all UK medical schools (n = 40). The survey was developed through a consultancy and pilot process to ensure validity and reliability. Questions explored what empathy-focused training is offered, and asked educators whether or not they believed that current provision of empathy training is sufficient. In parallel, medical school websites were searched to identify what information regarding empathy-focused training is described as being part of the degree course. Descriptive statistics were used to describe empathy training delivery from the results of the online materials survey and closed survey questions. Thematic analysis was used to explore free text comments. RESULTS Response rate was 70% (28/40), with 28 medical schools included in the analysis. Twenty-six schools reported that their undergraduate curriculum included some form of empathy-focused training with variation in what, when and how this is delivered. Thematic analysis revealed two overarching themes with associated sub-themes: (i) empathy-focused training and development (considering where, when and how empathy training should be integrated); (ii) challenges presented by including empathy on the curriculum (considering the system, students and faculty). All schools agreed empathy training should be on the undergraduate curriculum. CONCLUSION This is the first nationwide survey of empathy-focused training at UK medical schools. While some form of empathy-focused training appears to be provided on the undergraduate curriculum at most UK medical schools, empathy is rarely specifically assessed. Most medical educators do not feel their school does enough to promote empathy and the majority would like to offer more.
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Affiliation(s)
- Rachel Winter
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, George Davies Centre, University of Leicester, University Road, LE1 7RH, Leicester, England.
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, George Davies Centre, University of Leicester, University Road, LE1 7RH, Leicester, England
| | - Robert I Norman
- Leicester Medical School, College of Life Sciences University of Leicester, George Davies Centre, LE1 7RH, Leicester, England
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, George Davies Centre, University of Leicester, University Road, LE1 7RH, Leicester, England
- The Oxford Empathy Programme, Faculty of Philosophy, University of Oxford, OX2 6GG, Oxford, England
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24
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Samarasekera DD, Lee SS, Yeo JHT, Yeo SP, Ponnamperuma G. Empathy in health professions education: What works, gaps and areas for improvement. MEDICAL EDUCATION 2023; 57:86-101. [PMID: 35790499 DOI: 10.1111/medu.14865] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Developing a physician equipped with both technical and affective skills is crucial in ensuring quality patient care. Of these skills, nurturing empathy is a key skill that has been studied in great detail, particularly among medical undergraduates. Despite numerous studies trending the changes in empathy, the results are often contradictory or confusing. Our study aims to find what interventions are effective to inculcate empathy in both undergraduate and postgraduate medical education and suggest areas for improvement. METHODS A narrative review was conducted on the interventions in nurturing empathy in undergraduate and postgraduate medical education. Original research articles and systematic reviews with clear interventions and outcomes were included in the study. RESULTS A total of 44 articles were reviewed. About 44% (n = 18) of the studies used a mixture of different approaches as their interventions. Some interventions were anchored by specific topics: Seven papers focusing on communication skills, three papers on humanities, and three on arts. A majority of the interventions (60%; n = 26) were implemented over a span of time as compared to studies which suggested a one-off intervention (30%; n = 12). Of the 26 papers in which the interventions were enforced over a period of time, 62% (n = 16) indicated an increase in student empathy whereas 16% (n = 4) indicated no changes in empathy post-intervention. On the contrary, 50% (n = 6) of the one-off interventions revealed no significant change in student empathy. Jefferson Scale of Empathy (JSE) is widely used in measuring student empathy postintervention, but approximately 41% of the studies included measuring tools other than JSE. CONCLUSIONS Pedagogical methods that invoke thought processes related to the affective domain of learning and experiential learning are more effective than the didactic methods of teaching and learning. Multimodal mixed-methods approach that combine different pedagogical interventions is more likely to bring about the desired results.
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Affiliation(s)
- Dujeepa D Samarasekera
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuh Shing Lee
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jillian H T Yeo
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Su Ping Yeo
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gominda Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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25
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Khalid S, Abbas I, Javed S. Psychological Support for Cancer Patients. Cancer Treat Res 2023; 185:255-283. [PMID: 37306913 DOI: 10.1007/978-3-031-27156-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
From the time a person is diagnosed with cancer, a psychological sequalae of intense emotional challenges emerge for the patient as well as family members. Different stages require different types of psychosocial support including those for previvors, survivors, and people who need palliative care. Currently, there is an emphasis on not only providing psychological assistance to cope with emotional, interpersonal, and economic stresses, but training programs specially designed to activate personal and social resources to find happiness and meaning in adversity. Within this perspective, the chapter is divided into three sections, each considering the common mental health issues and positive changes and intervention and therapies for cancer patients, family members, caregivers, onco-staff, and professionals.
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Affiliation(s)
- Shazia Khalid
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
| | - Imran Abbas
- Oncoplastic Breast Surgeon, Royal Cornwall Hospitals, NHS Trust, Cornwall, UK
| | - Saira Javed
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
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26
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Lorenz FJ, Darok MC, Ho L, Holstrom-Mercader MS, Freiberg AS, Dellasega CA. The Impact of an Unconventional Elective in Narrative Medicine and Pediatric Psycho-oncology on Humanism in Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1798-1805. [PMID: 34057696 DOI: 10.1007/s13187-021-02029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
Over the course of medical school, students' optimism and hopefulness often devolve into a cynical view of medicine that continues throughout clinical rotations and beyond (Neumann et al., Acad Med 86(8):996-1009, 2011). Here, we present a qualitative evaluation of a novel immersive elective in pediatric psycho-oncology coupled with narrative medicine and its impact on students. Participants were third- and fourth-year medical students who were relieved of traditional clinical duties. Alternatively, they shadowed pediatric cancer patients, keeping narrative journals of their observations and insights. A trained team of pre-clinical medical students and faculty conducted a retrospective analysis of 120 journals written between 2008 and 2019. They compared recurring concepts to assess how blending experiential learning and reflective writing influenced the attitudes and behaviors of students. Consistent themes emerged related to developing a rich understanding of patient experiences, a humanistic appreciation of the context of illness, the ability to meaningfully reflect on insights to critically ill children, and an appreciation for the unique learning opportunity. Additionally, families expressed gratitude for the students' attentiveness to their emotional needs. By the conclusion of the elective, most students discovered that they had reignited their intrinsic empathic behaviors and were provided with beneficial insights that they believed would continue into future rotations. Experiential teaching methods paired with narrative reflection may be a valuable and therapeutic tool to learn the intricacies of the patient perspective, with the potential to enhance humanism in students during a critical time in their medical training when empathy tends to drift. Longitudinal and quantitative studies are warranted to better understand the degree and duration of specific benefits.
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Affiliation(s)
- F Jeffrey Lorenz
- Penn State College of Medicine, 500 University Drive, Hershey, PA, USA.
| | - Matthew C Darok
- Penn State College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Lisa Ho
- Penn State College of Medicine, 500 University Drive, Hershey, PA, USA
| | | | - Andrew S Freiberg
- Department of Pediatrics, Division of Hematology and Oncology, Penn State College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Cheryl A Dellasega
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA, USA
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Al-Amer RM, Al Weldat K, Ali A, Darwish M, Al Bashtawy M, Mosleh SM, Randall S. Arab nursing students' perception of the emotional experience of patient care: A phenomenological study. Nurs Forum 2022; 57:1176-1183. [PMID: 36315113 DOI: 10.1111/nuf.12818] [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: 02/28/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A shared emotional response helps with understanding what other people are feeling and/or thinking; and it is a vital skill in clinical settings. Collectivist communities place more emphasis on the emotional components of their feelings in comparison to the cognitive aspects of their emotions. PURPOSE This study aimed to explore the emotions experienced by students at their first clinical placement. METHODS A hermeneutic phenomenological approach was used among nine baccalaureate students. RESULTS Three major themes emerged from the data: overwhelming emotions; unbalanced perception of professional identity; and adjustment and adaptation. CONCLUSIONS AND DISCUSSION It is evident that nursing students from collectivist communities encounter challenges in dealing with their emotions and managing their patients' emotions; however, they were capable of empathizing with their patients using the two components of their empathy; affective (emotion) and cognitive (cognition), with prominence given to the affective part. As countries become increasingly multi-cultural, which in turn influences the characteristics of people entering pre-registration nursing programs, nursing leaders are invited to address both dimensions of empathy as part of the nursing curriculum. Attention should also be given in clinical settings to appropriate channeling of clinical empathy to cultivate a professional identity.
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Affiliation(s)
- Rasmieh M Al-Amer
- Mental Health Nursing, Faculty of Nursing, Isra University, Amman, Jordan
- School of Nursing and Midwifery, Western Sydney University, South Penrith, New South Wales, Australia
| | - Kadejeh Al Weldat
- Master in Chronic Disease, Faculty of Nursing, Isra University, Amman, Jordan
| | - Amira Ali
- Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria university, Alexandria, Egypt
| | | | | | - Sultan M Mosleh
- Faculty of Nursing, Mutah University, Karak, Jordan
- Faculty of Health Science, Higher Colleges of Technology, Fujairah, UAE
| | - Sue Randall
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Campbeltown, New South Wales, Australia
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28
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Neumann M, Wirtz MA, Lutz G, Ernesti A, Edelhäuser F. Why context matters when changing the diet: A narrative review of placebo, nocebo, and psychosocial context effects and implications for outcome research and nutrition counselling. Front Nutr 2022; 9:937065. [PMID: 36386910 PMCID: PMC9650541 DOI: 10.3389/fnut.2022.937065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/11/2022] [Indexed: 09/19/2023] Open
Abstract
Placebo (PE) and nocebo effects (NE) have been subjects of systematic research in medicine and psychotherapy for many decades to distinguish between the (specific) pharmacological effect of medication and the (unspecific) effect of the context. Despite this significant research, the awareness, operationalisation, and reflection of the multiplicity of PE, NE, and psychosocial context effects (PSCE) is currently limited when researching outcomes of diet changes in studies without randomisation and placebo control. This neglection is critical as it could systematically influence outcomes by moderating and mediating them and thus reducing the validity and evidence base of these studies. Therefore, we performed a (non-systematic) narrative review (NR) on the following objectives: (1) present a concise overview about the relevance of PE, NE, and PSCE in medicine and nutrition research; (2) review the current state of research on reflecting context effects when studying diet changes; (3) provide useful theoretical foundations via consideration and integration of micro- and macro context effects; (4) operationalise as hypotheses the potential PE, NE, and PSCE which are specific for researching diet changes; and (5) derive their impact for future research as well as for nutrition counselling. The electronic search in this NR for objective (2) identified N = 5 publications and for objective (4) we found N = 61 articles retrieved in the first round of search, additional references were identified by a manual and snowball search among the cited references resulting finally in N = 37. This NR offers a synoptical basis to foster awareness and operationalisation of a variety of PE, NE, and PSCE. Interdisciplinary research teams should monitor these factors using, e.g., qualitative, mixed-method studies, process evaluation, item bank approaches, moderator and mediator analysis that might reveal substantially new insights, and outcomes of relevance to science and nutrition counselling. Nevertheless, the present NR has several limitations, especially as it is non-systematic, because it is a very heterogeneous field of research, in which the topic we are investigating is usually regarded as marginal and subordinate. Therefore, future research should conduct systematic reviews and particularly theory-based primary studies (experimental research) on hypotheses of PE, NE, and PSCE in outcome research in diet changes.
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Affiliation(s)
- Melanie Neumann
- Department of Medicine, Faculty of Health, Integrated Curriculum for Anthroposophic Medicine (ICURAM) and Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Gabriele Lutz
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Alina Ernesti
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Friedrich Edelhäuser
- Department of Medicine, Faculty of Health, Integrated Curriculum for Anthroposophic Medicine (ICURAM) and Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
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29
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Eijkelboom MCLC, Kalee MM, de Kleijn RAMR, van Wijngaarden JJJ, de Jonge RRR, van der Schaaf MFM, Frenkel JJ. Making knowledge clips with patients: What learning mechanisms are triggered in medical students? PATIENT EDUCATION AND COUNSELING 2022; 105:3096-3102. [PMID: 35725527 DOI: 10.1016/j.pec.2022.06.008] [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: 04/26/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course. METHODS In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis. RESULTS We identified four learning mechanisms: Challenging assumptions about patients' information needs; Becoming aware of the origin of patients' information needs; Taking a patient's perspective; Analyzing language to adapt to patients' needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students. CONCLUSION Collaborating with patients helped students to recognize and understand patients' perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients. PRACTICE IMPLICATION Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients' perspectives.
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Affiliation(s)
- M C L Charlotte Eijkelboom
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands; Faculty of Medicine, Utrecht University, Utrecht, the Netherlands, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - M Melanie Kalee
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R A M Renske de Kleijn
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J Jacqueline van Wijngaarden
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R R Roos de Jonge
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M F Marieke van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Joost Frenkel
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands
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Bylund CL. Understanding and improving empathy and emotion handling skills among medical students. PATIENT EDUCATION AND COUNSELING 2022; 105:2803-2804. [PMID: 35811258 DOI: 10.1016/j.pec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA.
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Assing Hvidt E, Ulsø A, Thorngreen CV, Søndergaard J, Andersen CM. Empathy as a learning objective in medical education: using phenomenology of learning theory to explore medical students' learning processes. BMC MEDICAL EDUCATION 2022; 22:628. [PMID: 35982451 PMCID: PMC9389818 DOI: 10.1186/s12909-022-03696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical empathy has been associated with a range of positive patient- and clinician outcomes. Educating medical students to become empathic physicians has in recent years become a clearly pronounced learning objective in medical education in many countries worldwide. Research knowledge about how medical students experience the learning processes conveyed by empathy-enhancing educational interventions is lacking. Our study aimed to explore Danish medical students' perspectives on which experiences allowed learning processes to take place in relation to empathy and empathic communication with patients. METHODS We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and universities. Braun and Clarke's reflexive thematic analysis (RTA) guided the analytical process, moving on a continuum from inductive to deductive, theoretical approaches. Key concepts in regard to learning processes deriving from Amadeo Giorgi's learning theory were applied to analyse the data. RESULTS Learning processes in relation to clinical empathy occured: 1. when theoretical knowledge about empathy became embodied and contextualied within a clinical context 2. through interpersonal interactions, e.g., with peers, faculty members and clinicians, that conveyed behavior-mobilizing positive and negative affect and 3. when new learning discoveries in 2. and 3. were appropriated as a personalized and adequate behavior that transcends the situational level. CONCLUSION Rather than being an immediate product of knowledge transmission, skill acquisition or training, learning clinical empathy is experienced as a dynamic, temporal process embedded in a daily clinical lifeworld of becoming an increasingly human professional.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
| | - Anne Ulsø
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Christina Maar Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Jacobs A, Flägel K, Werdecker L, Esch T. [Peak moments in physician-patient consultations in general practice: A qualitative study among primary care physicians in Germany]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 172:31-39. [PMID: 35725547 DOI: 10.1016/j.zefq.2022.04.028] [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: 11/17/2021] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Successful therapy is influenced by successful communication and a relationship built on trust. Physician empathy and listening skills appear particularly relevant. Based on their empirical experience, general practitioners report special moments in their patients during their medical consultations. Abraham Maslow coined the term "peak experience" for these special moments, which are rare and deeply moving. The present study examines "peak moments" in terms of existence, origin, characterization, doctor perception, and the overall effect on the doctor-patient relationship. METHOD A qualitative study design was chosen. Interviews with family practitioners were conducted and analyzed using qualitative content analysis by Kuckartz. In order to collect socio-demographic information the participants were asked to complete a short questionnaire. RESULTS The study participants (n=17) confirmed the existence of peak moments in doctor-patient interactions in their GP practices. These moments came about spontaneously, facilitated by specific communication strategies and intervention measures to support a situation in which peak moments become possible. To bring about a peak moment in patients, specific requirements need to be met on the part of both doctors and patients. Primary care physicians participating agreed that a peak moment led to relaxation and a stronger trust in the relationship between doctor and patient. CONCLUSIONS Family physicians perceive peak moments to be an important element to build trust between themselves and their patients, for the patients' increased "self-awareness", and to improve the chances of treatment success. To enable peak moment conditions for general practitioners, a framework of health policy measures such as education and training is recommended, along with an assessment of the time needed for doctor-patient interactions.
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Affiliation(s)
- Anke Jacobs
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten Herdecke, Witten, Deutschland.
| | - Kristina Flägel
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Lena Werdecker
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten Herdecke, Witten, Deutschland
| | - Tobias Esch
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten Herdecke, Witten, Deutschland
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Sahin-Bayindir G, Sukut O, Yilmaz S, Kutlu Y. The Turkish validity and reliability of the Kiersma-Chen empathy scale. Perspect Psychiatr Care 2022; 58:1096-1102. [PMID: 34216006 DOI: 10.1111/ppc.12907] [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: 10/26/2020] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to establish the Turkish validity and reliability of the Kiersma-Chen empathy scale (KCES) and determine its psychometric properties. DESIGN AND METHODS This methodological study was carried out with 227 nursing students between April and May 2019. FINDINGS The Cronbach's alpha coefficient of the total scale is 0.854, the test-retest coefficient was high for the total scale (r = 0.989), and total-item correlations ranged between 0.398 and 0.712. PRACTICE IMPLICATIONS The KCES-TR is a valid and reliable scale to measure empathy in nursing students.
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Affiliation(s)
- Gizem Sahin-Bayindir
- Department of Mental Health and Psychiatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ozge Sukut
- Department of Mental Health and Psychiatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sevil Yilmaz
- Department of Mental Health and Psychiatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yasemin Kutlu
- Department of Mental Health and Psychiatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Bylund CL, Taylor G, Mroz E, Wilkie DJ, Yao Y, Emanuel L, Fitchett G, Handzo G, Chochinov HM, Bluck S. Empathic communication in dignity therapy: Feasibility of measurement and descriptive findings. Palliat Support Care 2022; 20:321-327. [PMID: 35713352 PMCID: PMC9213888 DOI: 10.1017/s1478951521001188] [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: 12/30/2022]
Abstract
OBJECTIVE Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions. METHODS We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts. RESULTS Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units. SIGNIFICANCE OF RESULTS This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.
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Affiliation(s)
- Carma L Bylund
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | | | - Emily Mroz
- Department of Internal Medicine, Yale University, New Haven, CT
| | - Diana J Wilkie
- Biobehavioral Nursing Science, University of Florida, Gainesville, FL
| | - Yingwei Yao
- Biobehavioral Nursing Science, University of Florida, Gainesville, FL
| | - Linda Emanuel
- The Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL
| | - George Handzo
- Health Services Research and Quality, Healthcare Chaplaincy Network, New York, NY
| | | | - Susan Bluck
- Department of Psychology, University of Florida, Gainesville, FL
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Menstrual Health and Hygiene among Adolescents in the United States. J Pediatr Adolesc Gynecol 2022; 35:277-287. [PMID: 34999229 DOI: 10.1016/j.jpag.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening. DESIGN Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews. SETTING Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center. PARTICIPANTS Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible. INTERVENTION Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health. MAIN OUTCOME MEASURES Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets. RESULTS The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management. CONCLUSION Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.
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Park KY, Shin J, Park HK, Kim YM, Hwang SY, Shin JH, Heo R, Ryu S, Mercer SW. Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure. BMC MEDICAL EDUCATION 2022; 22:403. [PMID: 35614452 PMCID: PMC9134586 DOI: 10.1186/s12909-022-03478-5] [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: 11/25/2021] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No validated tool is available to assess patients' perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure-originally developed in English and widely used internationally-and to examine its reliability and validity. METHODS The CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach's alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure. RESULTS The Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach's alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77-0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett's test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit. CONCLUSION This study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea.
| | - Yu Mi Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | | | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Soorack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
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Yu CC, Tan L, LE MK, Tang B, Liaw SY, Tierney T, Ho YY, Lim BEE, Lim D, Ng R, Chia SC, Low JA. The development of empathy in the healthcare setting: a qualitative approach. BMC MEDICAL EDUCATION 2022; 22:245. [PMID: 35379249 PMCID: PMC8981670 DOI: 10.1186/s12909-022-03312-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/24/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Healthcare professionals' empathetic behaviors have been known to lead to higher satisfaction levels and produce better health outcomes for patients. However, empathy could decrease over time especially during training and clinical practice. This study explored factors that contributed to the development of empathy in the healthcare setting. Findings could be used to improve the effectiveness and sustainability of empathy training. METHOD A qualitative approach, informed by aspects of grounded theory, was utilized to identify factors that enabled the development of empathy from the perspectives of doctors, nurses, allied healthcare workers and students. Twelve sessions of focus group discussions were conducted with 60 participants from two hospitals, a medical school, and a nursing school. Data was analyzed independently by three investigators who later corroborated to refine the codes, subthemes, and themes. Factors which influence the development of empathy were identified and categorized. This formed the basis of the creation of a tentative theory of empathy development for the healthcare setting. RESULTS The authors identified various personal (e.g. inherent characteristics, physiological and mental states, professional identity) and external (e.g. work environment, life experience, situational stressors) factors that affected the development of empathy. These could be further categorized into three groups based on the stability of their impact on the individuals' empathy state, contributed by high, medium, or low stability factors. Findings suggest empathy is more trait-like and stable in nature but is also susceptible to fluctuation depending on the circumstances faced by healthcare professionals. Interventions targeting medium and low stability factors could potentially promote the development of empathy in the clinical setting. CONCLUSIONS Understanding factors that impact the development of empathy allows us to develop measures that could be implemented during training or at the workplace leading to improve the quality of care and higher clinical work satisfaction.
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Affiliation(s)
- Chou Chuen Yu
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
| | - Laurence Tan
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Mai Khanh LE
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
| | - Bernard Tang
- Geriatric Education and Research Institute Ltd, Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tanya Tierney
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yun Ying Ho
- Ministry of Health Holdings, Singapore, Singapore
| | - Beng Eng Evelyn Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | - Daphne Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | - Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | | | - James Alvin Low
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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Oosthuizen I, Saunders GH, Manchaiah V, Swanepoel DW. Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review. Front Public Health 2022; 10:815259. [PMID: 35419343 PMCID: PMC8995421 DOI: 10.3389/fpubh.2022.815259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. Method A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. Results Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. Conclusion Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.
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Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
| | - Gabrielle H. Saunders
- Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester, Manchester, United Kingdom
| | - Vinaya Manchaiah
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Ear Science Institute Australia, Subiaco, WA, Australia
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Mak V, Krishnan S, Chuang S. Students' and Examiners' Experiences of Their First Virtual Pharmacy Objective Structured Clinical Examination (OSCE) in Australia during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:328. [PMID: 35206942 PMCID: PMC8871798 DOI: 10.3390/healthcare10020328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Structured Clinical Examinations (OSCEs) are routinely used in healthcare education programs. Traditionally, students undertake OSCEs as face-to-face interactions to assess competency in soft skills. Due to physical distancing restrictions during COVID-19, alternative methods were required. This study utilized a mixed-method design (online survey and interviews) to evaluate second-year pharmacy students' and examiners' experiences of their first virtual OSCEs in Australia. A total of 196 students completed their first virtual OSCE in June 2020 of which 190 students completed the online survey. However, out of the 190 students, only 88% (n = 167) consented to the use of the data from their online survey. A further 10 students and 12 examiners were interviewed. Fifty-five students (33%) who participated in the online survey strongly agreed or agreed that they preferred the virtual experience to face-to-face OSCEs while 44% (n = 73) neither agreed nor disagreed. Only 20% (n = 33) felt more anxious with the virtual OSCEs. Additionally, thematic analysis found non-verbal communication as a barrier during the OSCE. Positive aspects about virtual OSCEs included flexibility, decreased levels of anxiety and relevance with emerging telehealth practice. The need for remote online delivery of assessments saw innovative ways of undertaking OSCEs and an opportunity to mimic telehealth. While students and examiners embraced the virtual OSCE process, face-to-face OSCEs were still considered important and irreplaceable. Future opportunities for OSCEs to be delivered both face-to-face and virtually should be considered.
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Affiliation(s)
- Vivienne Mak
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia;
| | - Sunanthiny Krishnan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya 47500, Malaysia;
| | - Sara Chuang
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia;
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Shin HS, Park H, Lee YM. The relationship between medical students' empathy and burnout levels by gender and study years. PATIENT EDUCATION AND COUNSELING 2022; 105:432-439. [PMID: 34127334 DOI: 10.1016/j.pec.2021.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the multifaceted factors affecting empathy in medical students. METHODS 1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants. RESULTS A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout. CONCLUSION Academic efficacy was a significant factor influencing both affective and cognitive empathy. PRACTICAL IMPLICATIONS The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.
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Affiliation(s)
- Hyoung Seok Shin
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyunmi Park
- Department of Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea.
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Dorough RJM, Adamuti-Trache M, Siropaides CH. Association of Medical Student Characteristics and Empathy After a Communication Workshop. J Patient Exp 2021; 8:23743735211065273. [PMID: 34926804 PMCID: PMC8671654 DOI: 10.1177/23743735211065273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Medical education values patient-centered communication skills of responding to patient's emotions, however, guidance is limited on how to provide a well-rounded curriculum. This study examines the effect of a 90-minute communication workshop on the level of empathy of the 116 medical students who participated in the workshop. We used three psychometric categories from the Jefferson Scale of Empathy (JSE) as dependent variables. We conducted mixed analysis of variance (ANOVA) analyses to determine the change in empathy scores after the workshop, the main effects for gender and medical specialty, and their interaction with time. We found an increase in perspective taking and compassionate care scales, although no changes on walking in patients' shoes scale. Female and people-oriented specialty students scored higher on all scales. Some gender-specialty groups showed an empathy decrease: people-oriented specialty females on compassionate care scale and people-oriented and other specialty males on walking in patients' shoes scale. We concluded that communication training requires a multidimensional approach to target various areas of building empathy. Standardization of training should be embedded with empathy development within medical education curriculum.
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Liew SC, Fadil Azim DH. In someone else's shoes, are all wearers the same? Empathy in multi-ethnic Asian medical students. J Taibah Univ Med Sci 2021; 17:498-505. [PMID: 35722235 PMCID: PMC9170763 DOI: 10.1016/j.jtumed.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Considerable research interest has been observed in ascertaining the actual pattern of empathy skill acquisition, but this aspect remains largely unexplored in Asian medical students. This study explored the empathy trait in Asian medical students from different levels of seniority and investigated the association between students’ empathy traits and their socio-demographic and socio-economic backgrounds. Methods To explore the empathy trait, the Year 1 to Year 5 medical students completed the students’ socio-demographic/economic and validated Interpersonal Reactivity Index (IRI) questionnaires. Results The participants scored highest in the empathetic concerns (EC) and lowest in the personal distress (PD) subscale. Female participants scored significantly higher on the EC, PD, and fantasy subscales. Participants who went to government high schools scored higher on the PD and EC subscales. Participants who stated a preference for specialisation that required more communication with patients scored higher on the EC and Perspective Taking subscales. Conclusions The empathy traits of Asian medical students may have cultural influences that are determined by their geographical background. Consistent observations regarding the inclination toward cognitive empathy traits in females were observed. This study also found that empathy traits are predictive of choices for postgraduate speciality training and that there is a difference in medical students’ empathy traits during the different phases of study in medical school.
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Menezes P, Guraya SY, Guraya SS. A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students. Front Med (Lausanne) 2021; 8:758377. [PMID: 34820397 PMCID: PMC8606887 DOI: 10.3389/fmed.2021.758377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices. Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome. Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture. Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.
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Affiliation(s)
- Prianna Menezes
- Royal College of Surgeons Ireland, Bahrain RCSI-Medical University of Bahrain (MUB), Busaiteen, Bahrain
| | | | - Shaista Salman Guraya
- Royal College of Surgeons Ireland, Bahrain RCSI-Medical University of Bahrain (MUB), Busaiteen, Bahrain
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ÇINAR TANRIVERDİ E, TAŞTAN K. The Effect of Education with Simulated Patient on the Empathy Attitudes of Medical Students: An Intervention Study. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.990762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Samuels A, Broome ME, McDonald TB, Peterson CH, Thompson JA. Improving self-reported empathy and communication skills through harm in healthcare response training. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211047643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective Communication and Resolution Programs (CRP) were developed to equip healthcare organizations with tools to respond when physical and psychological harm occurs. Our objective was to assess development of empathic behaviors and communication skills through CRP training based upon the Agency for Healthcare Research and Quality (AHRQ) CANDOR toolkit to assess the ability to develop and improve empathic behaviors and communication skills. Methods The Jefferson Scale of Empathy, the CANDOR Communication Assessment Questionnaire and a self-assessment were used pre- and post-intervention to analyze development of empathy, growth of communication, and improvement in confidence and knowledge through 6 h of virtual education over a six-week course. Results Self-reported communication, confidence and knowledge improved with statistical significance and small to moderate effect size in both men and women. A statistically significant improvement of self-reported empathy scores t (22) = 2.23, p = .037; (95% CI = 0.41 to 11.5) for women only represented a small to moderate effect size (Cohen’s d = 0.46). While there was no improvement in Cognitive Complexity, (Cohen’s d = 0.065) mean pre-post .42 (SD = 6.52); Message Design Logic improved with statistical significance in paired pre-and post-assessment (Z = -3.28, p = .001). Notably, previous attendance at CANDOR classes demonstrated no impact on improvement of scores. Conclusions Our findings demonstrate improvement in self-reported empathy and communication skills through harm in healthcare response training. Healthcare organizations should carefully consider investing in CANDOR training for the benefit of patients, their families, and healthcare workforce members.
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Affiliation(s)
- Aimee Samuels
- Samaritan Health Services, Department of Patient Safety and Clinical Risk
| | | | - Timothy B. McDonald
- Chief Patient Safety and Risk Officer, RLDatix, Loyola University, Beazley Institute for Health Law and Policy
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Hayes MM, Cocchi MN. Critical care leadership during the COVID-19 pandemic. J Crit Care 2021; 67:186-188. [PMID: 34635389 PMCID: PMC8499091 DOI: 10.1016/j.jcrc.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic taxed critical care and its leaders in unprecedented ways. Medical directors, nursing directors, division chiefs and department chairs were forced to lead their staff through a pandemic wrought with personal and professional safety concerns, uncertainty, and more death than most critical care practitioners had ever seen. No leader was fully prepared for the COVID-19 pandemic. Herein, we describe what we believe are the three most important qualities of a leader in times of crisis: presence, transparency, and empathy.
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Affiliation(s)
- Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
| | - Michael N Cocchi
- Department of Emergency Medicine, Department of Anesthesia, Division of Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America
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Tan L, Le MK, Yu CC, Liaw SY, Tierney T, Ho YY, Lim E, Lim D, Ng R, Ngeow C, Low J. Defining clinical empathy: a grounded theory approach from the perspective of healthcare workers and patients in a multicultural setting. BMJ Open 2021; 11:e045224. [PMID: 34521657 PMCID: PMC8442049 DOI: 10.1136/bmjopen-2020-045224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting. DESIGN Grounded theory approach using focus group discussions. SETTING A health cluster in Singapore consisting of an acute hospital, a community hospital, ambulatory care teams, a medical school and a nursing school. PARTICIPANTS 69 participants including doctors, nurses, medical students, nursing students, patients and allied health workers. MAIN OUTCOME MEASURES A robust definition of clinical empathy. RESULTS The construct of clinical empathy is consistent across doctors, nurses, students, allied health and students. Medical empathy consists of an inner sense of empathy (imaginative, affective and cognitive), empathy behaviour (genuine concern and empathic communication) and a sense of connection (trust and rapport). This construct of clinical empathy is similar to definitions by neuroscientists but challenges a common definition of clinical empathy as a cognitive process with emotional detachment. CONCLUSIONS This paper has defined clinical empathy as 'a sense of connection between the healthcare worker and the patient as a result of perspective taking arising from imaginative, affective and cognitive processes, which are expressed through behaviours and good communication skills that convey genuine concern'. A clear and multidimensional definition of clinical empathy will improve future education and research efforts in the application and impact of clinical empathy.
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Affiliation(s)
- Laurence Tan
- Department of Geriatic Medicine, Khoo Teck Puat Hospital, Singapore
- Geriatric Education and Research Institute Ltd, Singapore
- Lee Kong Chian School of Medicine, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
- Gericare, Khoo Teck Puat Hospital, Singapore
| | - Mai Khanh Le
- Geriatric Education and Research Institute Ltd, Singapore
| | - Chou Chuen Yu
- Geriatric Education and Research Institute Ltd, Singapore
| | | | | | - Yun Ying Ho
- Lee Kong Chian School of Medicine, Singapore
| | - Evelyn Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore
| | - Daphne Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore
| | - Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
- Lloyds Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore
| | | | - James Low
- Department of Geriatic Medicine, Khoo Teck Puat Hospital, Singapore
- Geriatric Education and Research Institute Ltd, Singapore
- Gericare, Khoo Teck Puat Hospital, Singapore
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Xu H, Xue R, Hao S. Attitudes toward patient-centeredness, personality and empathy of Chinese medical students. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Associations between the severity of medical and surgical complications and perception of surgeon empathy in esophageal and gastric cancer patients. Support Care Cancer 2021; 29:7551-7561. [PMID: 34110486 DOI: 10.1007/s00520-021-06257-y] [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: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the impact of global physician empathy and its three subdimensions (establishing rapport, emotional and cognitive processes) on the severity of postoperative complications in a sample of cancer patients. METHODS We retrospectively analyzed data on 256 patients with esogastric cancer from the French national FREGAT database. Empathy and its subdimensions were assessed using the patient-reported CARE scale and the severity of medical and surgical complications was reported with the Clavien-Dindo classification system. The usual covariates were included in multinomial logistic regression analyses. RESULTS Physician empathy predicted the odds of reporting major complications. When patients perceived high empathy, they were less likely to report major complications compared to no complications (OR = .95, 95% CI = [.91-.99], p = .029). Among the three dimensions, only "establishing rapport" (OR = .84, 95% CI = [.73-.98], p = .019) and the "emotional process" (OR = .85, 95% CI = [.74-.98], p = .022) predicted major complications. CONCLUSIONS Physician empathy is essential before surgery. Further research is needed to understand the mechanisms associating empathy with health outcomes in cancer. Physicians should be trained to establish good rapport with patients, especially in the preoperative period.
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The Paradox of Empathy and Data: Measuring Outcomes of Empathic Communication Education. J Nurses Prof Dev 2021; 37:319-328. [PMID: 34101712 DOI: 10.1097/nnd.0000000000000768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article addresses the nursing professional development practitioner's role in the design and management of the evaluation process used for a large-scale educational intervention developed to improve patient satisfaction with the use of empathic communication skills. The scope of this educational activity and the direct alignment with organizational priorities necessitated that a robust and comprehensive evaluation strategy be implemented to demonstrate the connection from the education to performance and, ultimately, organization-level results.
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