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Neeley M, Acosta LMY, Davidson M, Dewey C. An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11414. [PMID: 39006204 PMCID: PMC11239799 DOI: 10.15766/mep_2374-8265.11414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 07/16/2024]
Abstract
Introduction Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors. Methods We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group). Results Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts (p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience (p < .05). Discussion Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy.
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Affiliation(s)
- Maya Neeley
- Associate Professor, Department of Pediatrics, Vanderbilt University Medical Center
| | - Lealani Mae Y Acosta
- Associate Professor, Department of Neurology, Vanderbilt University Medical Center
- Co-second author
| | - Mario Davidson
- Associate Professor, Department of Biostatistics, Vanderbilt University Medical Center
- Co-second author
| | - Charlene Dewey
- Professor, Department of Medicine, and Director, Educator Development Program, Vanderbilt University Medical Center
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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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Pusa S, Baxter R, Andersson S, Fromme EK, Paladino J, Sandgren A. Core Competencies for Serious Illness Conversations: An Integrative Systematic Review. J Palliat Care 2024:8258597241245022. [PMID: 38557369 DOI: 10.1177/08258597241245022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: The Serious Illness Care Program was developed to support goals and values discussions between seriously ill patients and their clinicians. The core competencies, that is, the essential clinical conversation skills that are described as requisite for effective serious illness conversations (SICs) in practice, have not yet been explicated. This integrative systematic review aimed to identify core competencies for SICs in the context of the Serious Illness Care Program. Methods: Articles published between January 2014 and March 2023 were identified in MEDLINE, PsycINFO, CINAHL, and PubMed databases. In total, 313 records underwent title and abstract screening, and 96 full-text articles were assessed for eligibility. The articles were critically appraised using the Joanna Briggs Institute Critical Appraisal Guidelines, and data were analyzed using thematic synthesis. Results: In total, 53 articles were included. Clinicians' core competencies for SICs were described in 3 themes: conversation resources, intrapersonal capabilities, and interpersonal capabilities. Conversation resources included using the conversation guide as a tool, together with applying appropriate communication skills to support better communication. Intrapersonal capabilities included calibrating one's own attitudes and mindset as well as confidence and self-assurance to engage in SICs. Interpersonal capabilities focused on the clinician's ability to interact with patients and family members to foster a mutually trusting relationship, including empathetic communication with attention and adherence to patient and family members views, goals, needs, and preferences. Conclusions: Clinicians need to efficiently combine conversation resources with intrapersonal and interpersonal skills to successfully conduct and interact in SICs.
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Affiliation(s)
- Susanna Pusa
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Rebecca Baxter
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Sofia Andersson
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Erik K Fromme
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanna Paladino
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Hall JA, Duong F, Schwartz R. On the proliferation of the empathy concept in healthcare and medical education research. PATIENT EDUCATION AND COUNSELING 2024; 119:108041. [PMID: 37945425 DOI: 10.1016/j.pec.2023.108041] [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: 05/09/2023] [Revised: 07/07/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To offer a critique of empathy concept usage in healthcare and medical education research. METHODS Analysis of current usage and suggestions for authors and researchers. RESULTS Empathy is often undefined or inconsistently defined, and "empathy" as represented in research covers an unmanageably wide and varied range of intentions, attitudes, emotions, and behaviors. The ubiquitous use of "empathy" as a vague and often undefined umbrella term hinders comprehension and, therefore, scientific progress. Patients are rarely asked directly about empathy; instead, measures of so-called perceived empathy contain descriptive items that could as well be called quality of care, patient-centeredness, or patient satisfaction. CONCLUSIONS Although "empathy" in medical care is widely valued by researchers, educators, and practitioners, the empathy concept as used in the published literature is overused and unclear, and potentially damaging to scholarship, medical education, and ultimately healthcare. The vague term empathy should be replaced as much as possible with concrete descriptions of what is actually measured, experimentally manipulated, or taught. PRACTICE IMPLICATIONS Identifying patients' own empathy definitions will improve medical education and medical care through clarifying what clinical behaviors will best fulfill patients' needs and desires. This approach allows for greater specificity and personalized care delivery.
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Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, MA, USA.
| | - Fred Duong
- Department of Psychology, University of Toronto, Mississauga, ON, Canada
| | - Rachel Schwartz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
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Beckstrom KM, Farrow SL. The effects of empathic communication skills training on nurse practitioner students. J Am Assoc Nurse Pract 2023:01741002-990000000-00185. [PMID: 37972939 DOI: 10.1097/jxx.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
ABSTRACT Evidence regarding the impact of empathic communication training on nurse practitioner (NP) students is lacking. Despite increasing emphasis within practice settings in the United States, formal communication training for NP students has been modestly integrated into curriculum, based on limited data supporting its efficacy. As such, we sought to evaluate the impact of empathic communication training on NP students' self-efficacy with empathic communication. This is a quasi-experimental study of a single group of NP students (n = 49) who participated in empathic communication training with pretraining/posttraining measurements using the Self-Efficacy-12 instrument. There were statistically significant improvements in students' comfort and confidence with nine of the 17 items surveyed. Several other domains also showed improvement approaching statistical significance. Based on our results, empathic communication training increases NP students' self-efficacy with empathic communication.
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Affiliation(s)
- Kimberly M Beckstrom
- Nurse Practitioner Clinical Education Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
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Sharafkhani R, Nukpezah RN, Lathabhavan R, Kallmen H, Fournier A, Hosseini Marznaki Z. Factors that affect levels of alexithymia, empathy and communication skills of nursing students in northern Iran. Nurs Open 2023; 10:3936-3945. [PMID: 36808820 PMCID: PMC10170927 DOI: 10.1002/nop2.1652] [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: 07/26/2022] [Revised: 12/03/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
AIM The inability of nurses to express their own emotions, understand others' emotions and show empathy could result in communication gaps that could affect patient care outcomes. This study investigates the factors associated with the levels of alexithymia, empathy and communication skills among nursing students. DESIGN A survey was conducted among 365 nursing students, and data were collected using an online questionnaire. METHODS Data analyses were done using SPSS software version 22. RESULTS There was a significant positive association between age and empathy and a negative association between the number of times a nurse took the entrance exam. The level of education and interest in nursing correlate with communication skills. All the predictor variables of alexithymia in this current study were not significant. Emphasis should be placed on improving nursing students' empathy and communication skills. Student nurses should be taught how to recognize and express their emotions. To assess their mental health, they must be screened regularly.
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Affiliation(s)
- Rahim Sharafkhani
- Department of Public health, Khoy University of Medical Sciences, Khoy, Iran
| | - Ruth Nimota Nukpezah
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | | | - Hakan Kallmen
- Department of Clinical Neuroscience, STAD, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Mulliri A, Lelorain S, Bouvier V, Bara S, Gardy J, Grynberg D, Morello R, Alves A, Dejardin O. Role of empathy in the outcomes of colorectal cancer: protocol for a population-based study in two areas in France (EMPACOL Project). BMJ Open 2022; 12:e066559. [PMID: 36446452 PMCID: PMC9710360 DOI: 10.1136/bmjopen-2022-066559] [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] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The EMPACOL Project aims to investigate the link between healthcare professionals' (HCPs) empathy and the results of the curative treatment of non-metastatic colorectal cancer (CRC). METHODS AND ANALYSIS EMPACOL will be an observational multicentric prospective longitudinal study. It will cover eight centres comprising patients with non-metastatic CRC, uncomplicated at diagnosis in two French areas covered by a cancer register over a 2-year period. As estimated by the two cancer registries, during the 2-year inclusion period, the number of cases of non-metastatic CRCs was approximately 480. With an estimated participation rate of about 50%, we expect around 250 patients will be included in this study. Based on the curative strategy, patients will be divided into three groups: group 1 (surgery alone), group 2 (surgery and adjuvant chemotherapy) and group 3 (neo-adjuvant therapy, surgery and adjuvant chemotherapy). The relationship between HCPs' empathy at the time of announcement and at the end of the strategy, quality of life (QoL) 1 year after the end of treatment and oncological outcomes after 5 years will be investigated. HCPs' empathy and QoL will be assessed using the patient-reported questionnaires, Consultation and Relational Empathy and European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire, respectively. A relationship between HCPs' empathy and early outcomes, particularly digestive and genitourinary sequelae, will also be studied for each treatment group. Post-treatment complications will be assessed using the Clavien-Dindo classification. Patients' anxiety and depression will also be assessed using the Hospital Anxiety and Depression Scale questionnaire. ETHICS AND DISSEMINATION The Institutional Review Board of the University Hospital of Caen and the Ethics Committee (ID RCB: 2022-A00628-35) have approved the study. Patients will be required to provide oral consent for participation. Results of this study will be disseminated by publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05447611.
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Affiliation(s)
| | | | | | | | - Josephine Gardy
- Centre Francois Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | | | - Rémy Morello
- Unité de biostatistique et recherche clinique, CHU Caen, Caen, France
| | | | - Olivier Dejardin
- INSERM U1086 Anticipe, Centre Hospitalier Universitaire de Caen, Caen, France
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Murphy BA, Lilienfeld SO, Algoe SB. Why we Should Reject the Restrictive Isomorphic Matching Definition of Empathy. EMOTION REVIEW 2022. [DOI: 10.1177/17540739221082215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A growing cadre of influential scholars has converged on a circumscribed definition of empathy as restricted only to feeling the same emotion that one perceives another is feeling. We argue that this restrictive isomorphic matching (RIM) definition is deeply problematic because (1) it deviates dramatically from traditional conceptualizations of empathy and unmoors the construct from generations of scientific research and clinical practice; (2) insistence on an isomorphic form undercuts much of the functional value of empathy from multiple perspectives of analysis; and (3) combining the opposing concepts of isomorphic matching and self-other awareness implicitly requires motivational content, causing the RIM definition to implicitly require the kind of non-matching emotional content that it explicitly seeks to exclude.
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Affiliation(s)
- Brett A. Murphy
- Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | | | - Sara B. Algoe
- Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cook JE, Tovin MM, Kenyon LK. Understanding the Lived Experience of Caring for a Child With Severe Cerebral Palsy: A Critical Step Toward Psychologically Informed Family-Centered Care. Phys Ther 2022; 102:6481183. [PMID: 34972870 DOI: 10.1093/ptj/pzab294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/15/2021] [Accepted: 11/30/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the lived experience of parents who care for children with cerebral palsy who function at a Gross Motor Function Classification System Level V, their beliefs about pain and non-pain-related emotional distress, and what it means to provide care and comfort. METHODS A phenomenological research design was used. Eleven participants were involved in this study. Pilot interviews informed the interview guide. Data were collected via participant journals and semi-structured interviews and analyzed using van Manen's framework for understanding experience. Trustworthiness criteria were met through a variety of strategies to ensure a rigorous research process. RESULTS Four themes were revealed in this study: "life is hard, heavy with burden, worry, and love," "remarkable," "identity transformation and empowerment," and "living a life that is planned, forced with structure and without spontaneity." CONCLUSION Caring for a child with lifelong needs is complex and requires a sensitive awareness of the contextual factors that impact daily decisions and routines. Understanding the lived experiences of parents who care for children with cerebral palsy Gross Motor Function Classification System Level V is necessary to provide psychologically informed, family-centered care. Comfort theory is presented as a framework for understanding what factors influence comfort and well-being. Understanding the complex nature of comfort for an individual can lead to greater understanding and empathy-driven care. These results will provide a foundation for future studies that aim to enhance pediatric physical therapist care through provider empathy and understanding. IMPACT Caregiving parent experiences are impactful and play a large role in the life of children with developmental disabilities. Research exploring the lived experience of caregivers may enhance empathy-driven, psychologically informed, family-centered physical therapist care throughout the life course. LAY SUMMARY If you are a parent who cares for a child with severe cerebral palsy, you have unique experiences that impact day-to-day activities and lifelong planning for your family and child.
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Affiliation(s)
- Jason E Cook
- Department of Physical Therapy, Baylor University, Waco, Texas, USA
| | - Melissa M Tovin
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Lisa K Kenyon
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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Schwartz R, Dubey M, Blanch-Hartigan D, Sanders JJ, Hall JA. Physician empathy according to physicians: A multi-specialty qualitative analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:2425-2431. [PMID: 34330597 DOI: 10.1016/j.pec.2021.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore how physicians in neurology, family medicine, internal medicine, and emergency medicine characterize clinical empathy. METHODS Physicians (N = 94) were asked to describe up to 10 examples of empathic physician behavior. Data were analyzed using template analysis. RESULTS Physicians' descriptions of clinical empathy patterned into three themes: Clinical Performance and Professionalism, Interpersonal Communication, and Clinician Orientation. Clinical Performance and Professionalism subthemes included physician competency and accessibility; intersection with institutional resources; and spending/making/taking time with patients. Interpersonal Communication subthemes involved information sharing; verbal and nonverbal approaches; interpersonal sensitivity; physician self-disclosure; and attention to emotion. Clinician Orientation encompassed general physician demeanor and internal thoughts and feelings that might be unobservable by patients. Physicians varied widely in the themes they mentioned in their definition of empathy. CONCLUSION Physicians hold diverse notions of clinical empathy. These extend beyond traditional affective and cognitive empathy definitions to include structural elements like team-based care and accessibility after hours. Communication behaviors were perceived as important for demonstrating empathy. Some physician descriptions of empathy may not be perceptible to patients. PRACTICE IMPLICATIONS Training physicians to engage in behaviors that both they and patients perceive as empathic may lead to higher patient and physician satisfaction.
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Affiliation(s)
| | - Manisha Dubey
- University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA.
| | | | - Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Ariadne Labs, Boston, MA, USA.
| | - Judith A Hall
- Department of Psychology, Northeastern University, Boston, MA, USA.
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Cameron CD, Conway P, Scheffer JA. Empathy regulation, prosociality, and moral judgment. Curr Opin Psychol 2021; 44:188-195. [PMID: 34695643 DOI: 10.1016/j.copsyc.2021.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/10/2023]
Abstract
In this review, we examine relationships between empathy, prosocial behavior, and moral judgment. We focus on recent evidence for these relationships, with a focus on motivated empathy regulation as an important process that shapes empathic and moral outcomes. In particular, we highlight tradeoffs in contexts that involve competing victims with different needs, such as in large-scale suffering situations and sacrificial moral dilemmas, as well as on effects on punishment and recursive effects of morality on empathy. Our aim is to integrate motivation frameworks in empathy regulation and social cognition with prosocial and moral judgments.
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Sanders JJ, Dubey M, Hall JA, Catzen HZ, Blanch-Hartigan D, Schwartz R. What is empathy? Oncology patient perspectives on empathic clinician behaviors. Cancer 2021; 127:4258-4265. [PMID: 34351620 DOI: 10.1002/cncr.33834] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Oncology patients and physicians value empathy because of its association with improved health outcomes. Common measures of empathy lack consistency and were developed without direct input from patients. Because of their intense engagement with health care systems, oncology patients may have unique perspectives on what behaviors signal empathy in a clinical setting. METHODS As part of a cross-sectional study of patient perspectives on clinician empathy at an academic cancer center in the northeastern United States, the authors solicited up to 10 free-text responses to an open-ended question about what clinician behaviors define empathy. RESULTS The authors categorized open-ended responses from 89 oncology patients into 5 categories representing 14 themes. These categories were relationship sensitivity, focus on the whole person, communication, clinician attributes, and institutional resources and care processes. Frequently represented themes, including listening, understanding, and attention to emotions and what matters most, aligned with existing measures of empathy; behaviors that were not well represented among existing measures included qualities of information sharing and other communication elements. Patients also associated clinician demeanor, accessibility, and competence with empathy. CONCLUSIONS Oncology patients' perspectives on empathy highlight clinician behaviors and attributes that may help to refine patient experience measures and may be adopted by clinicians and cancer centers to enhance patient care and outcomes. High-quality communication skills training can promote active listening and paying attention to the whole person. A system-level focus on delivering empathic care may improve patients' experiences and outcomes. LAY SUMMARY Oncology patients' responses to an open-ended question about empathic clinician behavior have revealed insights into a variety of behaviors that are perceived as demonstrative of empathy. These include behaviors that imply sensitivity to the clinician-patient relationship, such as listening and understanding and attention to the whole person. Participants valued caring communication and demeanor and clinician accessibility. Perspective taking was not common among answers. Many existing measures of clinical care quality do not include the behaviors cited by patients as empathic. These results can inform efforts to refine quality measures of empathy-associated behaviors in clinical practice. Cancer centers can use skills training to improve elements of communication.
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Affiliation(s)
- Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Manisha Dubey
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Hall
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Hannah Z Catzen
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | - Rachel Schwartz
- WellMD and WellPhD Center, Stanford University School of Medicine, Palo Alto, California
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