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Tomozawa C, Kaneko M, Sasaki M, Miyake H. Clients' experiences of empathy in genetic counseling for hereditary breast and ovarian cancer: A qualitative study in Japan. J Genet Couns 2024. [PMID: 38773682 DOI: 10.1002/jgc4.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/24/2024]
Abstract
Empathy is a significant element in genetic counseling for building relationships with the clients and addressing their issues. However, there are few reports on the experiences of the clients about their perceived empathy in genetic counseling. Cancer genetic counseling needs have been rapidly evolving with the expansion of clinical comprehensive genomic profiling and genetic diagnosis approaches for hereditary cancers. Therefore, this study aimed to reveal empathy perceptions of the clients during cancer genetic counseling. Semi-structured interviews were conducted, and a grounded theory approach was used for data analysis. A total of 13 participants were recruited from organizations for patients with cancer, among whom 11 were patients with hereditary breast and ovarian cancer (HBOC) and two were relatives of patients with HBOC. Data analysis was organized into five categories related to experiences with empathy: (i) prior context to perceive empathy (ii) understanding and consideration, (iii) bedside manner, and (iv) impacted area of perceived empathy; and (v) no empathy. This study highlights the fact that empathy experiences of the clients differ depending on the situation and state of mind. Taken together, this study provides new insights on how to deliver empathic care.
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Affiliation(s)
- Chikako Tomozawa
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Mikiko Kaneko
- Department of Clinical Genetics, The Jikei University Hospital, Tokyo, Japan
| | - Motoko Sasaki
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
- Genetics Division, Institute for Human Life Science, Ochanomizu University, Tokyo, Japan
| | - Hidehiko Miyake
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
- Genetics Division, Institute for Human Life Science, Ochanomizu University, Tokyo, Japan
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Basirun M, Haryono S, Mustofa Z, Prajoogo W. The Influence of Organizational Justice and Prosocial Behavior toward Empathy on the Care of Islamic Religious Patients with Welfare Moderators. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Individuals in organizations behave and empathize in several studies can be influenced by organizational policies, including their welfare; this has indeed been widely studied. Even so, a firm answer is needed as to whether empathy is affected by organizational justice along with well-being and also whether empathy is influenced by prosocial behavior to increase empathy? This research unequivocally answers this question.
AIM: The aim of this study is to know the effect of organizational justice on empathy, knowing whether welfare moderates the influence of organizational justice variables on empathy, knowing whether prosocial behavior affects empathy, and knowing whether welfare moderates the effect of prosocial behavior on empathy.
METHODS: This study uses a quantitative survey research method and data collection by cross-sectional research with a sample of 226 inpatient nurses at Muhammadiyah Hospital type B throughout Indonesia. The sample used is a probability sampling model. Data analysis is done using Structural Equation Modeling (SEM) AMOS 22.00.
RESULTS: Ha1 test results, p = 0.032; this has a significant meaning. Ha2 is the interaction value 1: p = 0.001, which means that 1 is significant interaction, Ha3 p = 0.011 with welfare moderation, which has a significant meaning, and Ha4 interaction 2, welfare on the effect of prosocial behavior on empathy the value is p = 0.001, which means it is significant.
CONCLUSIONS: (1). Organizational justice has a positive effect on empathy, (2). welfare moderates the positive effect of organizational justice on empathy, (3). prosocial behavior has a positive effect on empathy, (4). welfare moderates the effect of prosocial behavior on empathy.
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García Del Barrio L, Rodríguez-Díez C, Martín-Lanas R, Costa P, Costa MJ, Díez N. Reliability and validity of the Spanish (Spain) version of the consultation and relational empathy measure in primary care. Fam Pract 2021; 38:353-359. [PMID: 33340321 DOI: 10.1093/fampra/cmaa135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy is an essential competence in the medical field. There are no validated patient-rated empathy measures in Spanish (Spain). The Consultation and Relational Empathy (CARE) measure is a widely used patient-rated measure of physician empathy. OBJECTIVE To analyse the reliability and validity of the Spanish (Spain) version of the CARE measure in primary care. METHODS After translation, back translation and pilot testing, a convenient sample of 369 patients recruited through 21 primary care physicians in five primary care centres in Pamplona (Navarre, Spain) completed the Spanish (Spain) CARE (Sp-CARE) measure. The number of 'does not apply' or blank responses was calculated to assess acceptability. We analysed internal reliability by means of Cronbach's alpha and ordinal alpha and homogeneity with corrected item-total correlations. The construct validity was examined by confirmatory factor analysis (CFA) and concurrent validity by Spearman's correlation. RESULTS We observed high acceptability; only 37 (1%) responses were marked 'does not apply' and only 3 (0.08%) were left blank. Cronbach's alpha and ordinal alpha for the Sp-CARE measure were 0.953 and 0.970, respectively, and all corrected item-total correlations exceeded the accepted cut of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The Sp-CARE measure total score was significantly correlated with overall patient satisfaction (Spearman's rho 0.45, P < 0.001). CONCLUSION The results support the reliability and validity of the Sp-CARE measure as a patient-rated empathy measure in the primary care setting.
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Affiliation(s)
| | - Cristina Rodríguez-Díez
- Department of Medical Education, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Raquel Martín-Lanas
- Department of Psychiatry and Medical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Patricio Costa
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Manual J Costa
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Nieves Díez
- Department of Medical Education, School of Medicine, Universidad de Navarra, Pamplona, Spain
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Abstract
Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an ‘age of austerity’ purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK. .,The Wellcome Trust Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
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Bernardo MO, Cecilio-Fernandes D, Lima ARDA, Silva JF, Ceccato HD, Costa MJ, de Carvalho-Filho MA. Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil. BMJ Open 2019; 9:e029356. [PMID: 31243037 PMCID: PMC6597646 DOI: 10.1136/bmjopen-2019-029356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. DESIGN A multicentric, observational, cross-sectional study. SETTING This study was conducted in three public teaching hospitals in Brazil. PARTICIPANTS From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. PRIMARY AND SECONDARY OUTCOME MEASURES Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). RESULTS This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments. CONCLUSIONS Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.
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Affiliation(s)
- Mônica Oliveira Bernardo
- Radiology, Pontificia Universidade Catolica de Sao Paulo Faculdade de Ciencias Medicas e da Saude, Sorocaba, São Paulo, Brazil
| | - Dario Cecilio-Fernandes
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Julian Furtado Silva
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Hugo Dugolin Ceccato
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Manuel João Costa
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Marco Antonio de Carvalho-Filho
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
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Bernardo MO, Cecílio-Fernandes D, Costa P, Quince TA, Costa MJ, Carvalho-Filho MA. Physicians' self-assessed empathy levels do not correlate with patients' assessments. PLoS One 2018; 13:e0198488. [PMID: 29852021 PMCID: PMC5979004 DOI: 10.1371/journal.pone.0198488] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/20/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy is a fundamental humanistic component of patient care which facilitates efficient and patient-centered clinical encounters. Despite being the principal recipient of physician empathy little work on how patients perceive/report receiving empathy from their physicians has been undertaken. In the context of doctor-patient interactions, knowledge about empathy has mostly originated from physicians' perspectives and has been developed from studies using self-assessment instruments. In general, self-assessment may not correlate well with the reality observed by others. OBJECTIVES To investigate: 1-the relationship between physicians' self-assessed empathy and patients' measures of physicians' empathy; 2 -Environmental factors that could influence patients' perceptions; and 3 -the correlation between two widely used psychometric scales to measure empathy from the perspective of patients. METHODS This is an observational study which enrolled 945 patients and 51 physicians from radiology, clinical, and surgical specialties. The physicians completed the Jefferson Scale of Physician Empathy (JSE) and the International Reactivity Index (IRI), and patients completed the Consultation and Relational Empathy scale (CARE), and the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE). RESULTS We did not observe any significant correlation between total self-assessed empathy and patients' perceptions. We observed a small correlation (r = 0,3, P<0,05) between the sub-dimension Perspective Taking-JSE and JSPPPE. JSPPPE and CARE had a positive and moderate correlation (0,56; p<0,001). Physicians' gender and sector influenced the JSPPPE score. Sector, medical specialty and the nature of the appointment (initial versus subsequent) influenced the CARE measure. CONCLUSIONS The lack of correlation between self-assessed empathy levels and patients' perceptions suggests patients be included in the process of empathy evaluation. PRACTICE IMPLICATIONS Training strategies aiming the development of empathy should include patients' evaluations and perspectives.
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Affiliation(s)
- Monica Oliveira Bernardo
- Radiology Department–Faculty of Medicine—Catholic University of São Paulo–Sorocaba–São Paulo—Brazil
| | - Dario Cecílio-Fernandes
- Center for Educational Development Innovation and Research–University Medical Center–University of Groningen–Groningen–The Netherlands
| | - Patrício Costa
- Life and Health Sciences Research Institute—School of Health Sciences—University of Minho–Braga–Portugal
| | - Thelma A. Quince
- Department of Public Health and Primary Care–University of Cambridge–Cambridge—United Kingdom
| | - Manuel João Costa
- Life and Health Sciences Research Institute—School of Health Sciences—University of Minho–Braga–Portugal
| | - Marco Antonio Carvalho-Filho
- Emergency Department–School of Medical Sciences–University of Campinas–Campinas–São Paulo–Brazil
- Center for Educational Development Innovation and Research–University Medical Center–University of Groningen–Groningen–The Netherlands
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Klein J, von dem Knesebeck O. [Social disparities in outpatient and inpatient care: An overview of current findings in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:238-44. [PMID: 26631009 DOI: 10.1007/s00103-015-2283-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.
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Affiliation(s)
- Jens Klein
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland.
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland
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Schrooten I, de Jong MDT. If You Could Read My Mind: The Role of Healthcare Providers' Empathic and Communicative Competencies in Clients' Satisfaction with Consultations. HEALTH COMMUNICATION 2017; 32:111-118. [PMID: 27177385 DOI: 10.1080/10410236.2015.1110002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article investigates the relationship between healthcare providers' empathic and communicative competencies and clients' overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients' perspective) and empathic skills (ability to estimate clients' evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients' scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients' overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers' empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients' overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.
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Affiliation(s)
- Iete Schrooten
- a Department of Communication Science , University of Twente
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Chiapponi C, Witt M, Dlugosch GE, Gülberg V, Siebeck M. The Perception of Physician Empathy by Patients with Inflammatory Bowel Disease. PLoS One 2016; 11:e0167113. [PMID: 27875561 PMCID: PMC5119824 DOI: 10.1371/journal.pone.0167113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background and Aims This study focused on the difference between perceived and desired physician empathy (pPE and dPE) in the eye of patients with inflammatory bowel disease (IBD). It was investigated if a discrepancy (ΔPE) correlates with trust and satisfaction of patients. At the same time the aim was to gain detailed information about the subjective burden of disease and the resources of IBD patients, in order to better understand them. Methods A modified version of the German Version of the Consultation and Relational Empathy (CARE) measure was completed as a paper-and-pencil questionnaire by IBD patients attending our facility (n = 32) and as an online survey by IBD patients at other locations throughout Germany (n = 89). Patients were in average 36.3±12 years old. Results The mean (SD) rating of pPE was 3.93 (0.96) on a scale of 1 to 5 (“poor” to “excellent”); however, the mean (SD) dPE was 4.38 (0.48) on the same scale. ΔPE correlated with perceived empathy and with patients’ satisfaction with treatment and trust in their health care providers. Patients reported quite a high subjective burden (mean [SD]: 2.93 [.63]) and named family, friends, and support groups as resources. Conclusions Rather than assessing patient satisfaction with treatment and trust in their physician only with perceived PE, we suggest ΔPE as a useful additional parameter.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Maxie Witt
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Gabriele E. Dlugosch
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Veit Gülberg
- Medizinische Klinik IV, Division of Gastroenterology, Hospital of the University of Munich (LMU), Munich, Germany
| | - Matthias Siebeck
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
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Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs. Br J Gen Pract 2016; 66:e887-e895. [PMID: 27884917 DOI: 10.3399/bjgp16x687565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication. AIM To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed. DESIGN AND SETTING Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed. METHOD The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed. RESULTS According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed. CONCLUSION In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal.
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Tsao P, Yu CH. "There's no billing code for empathy" - Animated comics remind medical students of empathy: a qualitative study. BMC MEDICAL EDUCATION 2016; 16:204. [PMID: 27520824 PMCID: PMC4983096 DOI: 10.1186/s12909-016-0724-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 08/02/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Physician empathy is associated with improved diabetes outcomes. However, empathy declines throughout medical school training. This study seeks to describe how comics on diabetes affect learning processes for empathy in medical students. METHODS All first- or second-year students at a Canadian medical school were invited to provide written reflections on two comics regarding diabetes and participate in a focus group. Responses were analyzed qualitatively for emergent themes. Students completed the Jefferson Scale of Physician Empathy (JSPE) at baseline, after the comic, and after the focus group. Linear mixed model statistical analyses were performed. RESULTS Thirteen first-year and 12 second-year students participated. Qualitative analysis revealed four themes: 1) Empathy decline and its barriers; 2) Impact of the comic and focus group on knowledge, attitudes and skills; 3) Role of the comic in the curriculum as a reminder tool of the importance of empathy; 4) Comics as an effective medium. Baseline mean JSPE scores were 116.4 (SD 10.5) and trended up to 117.2 (SD 12.5) and 119.6 (SD 15.2) after viewing the comics and participating in the focus groups, respectively (p = 0.08). CONCLUSIONS Animated comics on diabetes are novel methods of reminding students about empathy by highlighting the patient perspective.
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Affiliation(s)
- Pamela Tsao
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, 200 Elizabeth Street, EN 12-243, Toronto, ON M5G 2C4 Canada
| | - Catherine H. Yu
- Department of Medicine, Division of Endocrinology & Metabolism, St. Michael’s Hospital, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
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Atinga RA, Bawole JN, Nang-Beifubah A. 'Some patients are more equal than others': Patient-centred care differential in two-tier inpatient ward hospitals in Ghana. PATIENT EDUCATION AND COUNSELING 2016; 99:370-377. [PMID: 26475729 DOI: 10.1016/j.pec.2015.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine differences in patient-centred care among private and public inpatients in public hospitals and whether satisfaction with patient-centred care differ between the patient groups. METHOD Cross-sectional data collected from inpatients in private wards (n=300) and public wards (n=520) in Ghana, using a structured questionnaire modelled on four dimensions of patient-centred care: respect and dignity, emotional support, interpersonal relations and information sharing. RESULTS Patient-centred care differed significantly among private and public patients (p<0.001), with an effect size ranging from medium to large. Private patients rated patient-centred care higher than public patients in all the items of the four dimensions. Satisfaction with patient-centred care discriminated between the patient groups. Satisfaction was significantly high for private patients who are aged 50+ (p<0.001), had high education (p<0.05) and high income (p<0.001) compared to the same category of public patients. CONCLUSION Physicians behaviour is stereotyping and less favourable to public patients, suggesting inequitable access to patient-centred care for inpatients from high and low socioeconomic backgrounds. PRACTICE IMPLICATIONS Hospitals with private and public wards should be compelled to properly coordinate and regulate the activities of physicians to avoid fragmented care for inpatients.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana.
| | - Justice N Bawole
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Sulzer SH, Feinstein NW, Wendland C. Assessing empathy development in medical education: a systematic review. MEDICAL EDUCATION 2016; 50:300-10. [PMID: 26896015 PMCID: PMC4914035 DOI: 10.1111/medu.12806] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/19/2015] [Accepted: 06/08/2015] [Indexed: 05/06/2023]
Abstract
CONTEXT Empathy in doctor-patient relationships is a familiar topic for medical scholars and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study 'empathy' may not measure anything meaningful to clinical practice or patient satisfaction. METHODS We performed a systematic review to learn how empathy is conceptualised in medical education research. We examined how researchers define the central construct of empathy and what they choose to measure, and investigated how well definitions and operationalisations match. RESULTS Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all and only 13% used an operationalisation that was well matched to the definition provided. The majority of studies were characterised by internal inconsistencies and vagueness in both the conceptualisation and operationalisation of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a 'black box', using global construct measurements that are unable to shed light on the underlying processes that produce an empathic response. CONCLUSIONS We suggest that future research should follow the lead of basic scientific research that conceptualises empathy as relational - an engagement between a subject and an object - rather than as a personal quality that may be modified wholesale through appropriate training.
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Affiliation(s)
- Sandra H. Sulzer
- Corresponding Author: Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1100 Deleplaine Ct, Madison, WI, USA 53715 , +1-608-263-4550, +1-608-263-5813
| | - Noah Weeth Feinstein
- Departments of Curriculum and Instruction and Community and Environmental Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Claire Wendland
- Departments of Anthropology, Obstetrics & Gynecology, and Medical History and Bioethics, University of Wisconsin-Madison, Madison, WI, USA
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Derksen F, Bensing J, Kuiper S, van Meerendonk M, Lagro-Janssen A. Empathy: what does it mean for GPs? A qualitative study. Fam Pract 2015; 32:94-100. [PMID: 25448162 DOI: 10.1093/fampra/cmu080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Research has highlighted empathy as an important and effective factor in patient-physician communication. GPs have extensive practical experience with empathy. However, little is known about the personal views of GPs regarding the meaning and application of empathy in daily practice. OBJECTIVES To explore GP's experiences and the application of empathy in daily practice and to investigate the practical use of empathy. Facts such as preconditions, barriers and facilitating possibilities are described. METHODS Qualitative interview study; 30 in-depth interviews were performed between June 2012 and January 2013 with a heterogeneous sample of Dutch GPs. Interviews were recorded and transcribed verbatim; content analysis was performed with the help of ATLAS-ti. RESULTS Empathy was seen as an important quality-increasing element during the patient-GP consultation. The application of non-verbal and verbal techniques was described. Attention to cues and references to previous consults were reported separately. Required preconditions were: being physically and mentally fit, feeling no time pressure and having an efficient practice organization. Not feeling connected to the patient and strict medical guidelines and protocols were identified as obstacles. A key consideration was the positive contribution of empathy to job satisfaction. CONCLUSIONS The opinions of GPs in this research can be considered as supplementing and strengthening the findings of previous researches. The GPs in this study discussed, in particular, ideas important to the facilitation of empathy. These included: longer consultations, smaller practices, efficient telephonic triage by practice assistants, using intervision to help reflect on their work and drawing financiers' attention to the effectiveness of empathy.
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Affiliation(s)
- Frans Derksen
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, Nijmegen and
| | - Jozien Bensing
- NIVEL (Netherlands Institute for Health Services Research) and Utrecht University, Utrecht, the Netherlands
| | - Sascha Kuiper
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, Nijmegen and
| | - Milou van Meerendonk
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, Nijmegen and
| | - Antoine Lagro-Janssen
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, Nijmegen and
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Steinhausen S, Ommen O, Thüm S, Lefering R, Koehler T, Neugebauer E, Pfaff H. Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients. PATIENT EDUCATION AND COUNSELING 2014; 95:53-60. [PMID: 24411659 DOI: 10.1016/j.pec.2013.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/19/2013] [Accepted: 12/03/2013] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To analyze whether patients' perception of their medical treatment outcome is higher among patients who experienced a higher empathy by trauma surgeons during their stay in hospital. METHODS 127 patients were surveyed six weeks after discharge from the trauma surgical general ward. Subjective evaluation of medical treatment outcome was measured with the corresponding scale from the Cologne Patient Questionnaire. Clinical empathy was assessed by using the CARE measure. The influence of physician empathy and control variables on a dichotomized index of subjective evaluation of medical treatment outcome was identified with a logistic regression. RESULTS 120 patients were included in the logistic regression analysis. Compared to patients with physician empathy ratings of less than 30 points, patients with ratings of 41 points or higher have a 20-fold higher probability to be in the group with a better medical treatment outcome on the CPQ-scale (α-level<.001, R(2) 46.9). CONCLUSION Findings emphasize the importance of a well-functioning relationship between physician and patient even in a surgical setting where the focus is mostly on the bare medical treatment. PRACTICE IMPLICATIONS Communication trainings i.e. in surgical education can be an effective way to improve the ability to show empathy with patients' concerns.
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Affiliation(s)
- Simone Steinhausen
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany.
| | - Oliver Ommen
- Federal Center for Health Education (BZgA), Cologne, Germany
| | - Sonja Thüm
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
| | | | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany
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Jubb J, Bensing JM. The sweetest pill to swallow: How patient neurobiology can be harnessed to maximise placebo effects. Neurosci Biobehav Rev 2013; 37:2709-20. [DOI: 10.1016/j.neubiorev.2013.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022]
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Abstract
Physician payment system (PPS) is a principal incentive system to motivate doctors to provide excellent care for patients. During the past decade, physician remuneration in China has not been in proportional to physician's average work load and massive responsibilities. This paper reviewed the constitution of the PPS in China, and further discussed the problems and issues to be addressed with respect to pay for performance. Our study indicated that the lower basic salary and bonus distribution tied to "profits" was the major contributor to the physician's profit-driven incentive and the potential cause for the speedy growth of health expenditures. We recommend that government funding to hospitals should be increased to fully cover physicians' basic salary, a flexible human resource and talent management mechanism needs to be established that severs personal interest between physicians and hospitals, and modern performance assessment and multiplexed payment systems should be piloted to encourage physicians to get the more legitimate compensation.
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Active student participation may enhance patient centeredness: patients' assessments of the clinical education ward for integrative medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:743832. [PMID: 23573149 PMCID: PMC3615625 DOI: 10.1155/2013/743832] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 02/07/2013] [Accepted: 02/14/2013] [Indexed: 12/30/2022]
Abstract
Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM), where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG). General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.
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Patient compliance, physician empathy and financial incentives within a principal-agent framework. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.socec.2012.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krueger E, Reilly D. The "cash or care" conflict in general practice--a cautionary tale with methodological reflections. PATIENT EDUCATION AND COUNSELING 2011; 82:479-481. [PMID: 21306858 DOI: 10.1016/j.pec.2011.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 05/30/2023]
Affiliation(s)
- Eckard Krueger
- Alexander-von-Humboldt-Klinik, Dr.-Gebhardt-Steuer-Straße 24, 95138 Bad Steben, Germany.
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