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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] [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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Heo R, Shin J, Kim BS, Kim HJ, Park KY, Park HK, Kim YM, Hwang SY, Mercer SW. Quantitative measurement of empathy and analysis of its correlation to clinical factors in korean patients with chronic diseases. Clin Hypertens 2023; 29:19. [PMID: 37452366 PMCID: PMC10349477 DOI: 10.1186/s40885-023-00246-5] [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: 12/31/2022] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Empathy is the core of the physician-patient relationship. The Consultation and Relational Empathy (CARE) measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in chronic disease patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with chronic disease. METHODS Data were collected from patients with chronic diseases. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors. RESULTS A total of 162 patients with chronic diseases were included. About 60% of patients were male. The mean age was 62 years. They had an average number of 2.6 diseases. More than half of patients experienced overt cardiovascular disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6 ± 7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. Regarding marital status, the CARE score was significantly lower for the small number of patients (n = 4, 2.5%) who refused to provide their marital status than for other groups. Except for four patients, there was no significant difference in the CARE score among married, unmarried, or divorced groups. This trend was maintained in hypertensive patients. CONCLUSIONS The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.
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Affiliation(s)
- Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yu Mi Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | | | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Scotland
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Natali F, Corradini L, Sconza C, Taylor P, Furlan R, Mercer SW, Gatti R. Development of the Italian version of the Consultation and Relational Empathy (CARE) measure: translation, internal reliability, and construct validity in patients undergoing rehabilitation after total hip and knee arthroplasty. Disabil Rehabil 2023; 45:703-708. [PMID: 35191359 DOI: 10.1080/09638288.2022.2037742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. MATERIALS AND METHODS The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. RESULTS Face validity was high. Patients answered all questions and the "does not apply" option was never selected. Internal reliability (Cronbach's α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. CONCLUSIONS The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA.IMPLICATIONS FOR REHABILITATIONInternal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure.The Italian CARE measure can be used to assess patient's perceived therapist's empathy in patients undergoing physical therapy after THA and TKA.Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts.
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Affiliation(s)
- Fabrizio Natali
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Laura Corradini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristiano Sconza
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Patricia Taylor
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaello Furlan
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Stewart W Mercer
- Usher Institute Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Wang Y, Wang P, Wu Q, Wang Y, Lin B, Long J, Qing X, Wang P. Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19. J Gen Intern Med 2023; 38:428-433. [PMID: 36253633 PMCID: PMC9575631 DOI: 10.1007/s11606-022-07784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor-patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic. OBJECTIVE To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19. MAIN MEASURES Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients. RESULTS A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication. CONCLUSIONS During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor-patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs.
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Affiliation(s)
- Yanjiao Wang
- Faculty of Education, East China Normal University, Shanghai, China
- School of Teacher Education, Honghe University, Mengzi, China
| | - Peijuan Wang
- School of Foreign Languages, Tongji University, Shanghai, China
| | - Qing Wu
- College of Education, Lanzhou City University, Lanzhou, China
| | - Yao Wang
- Faculty of Education, East China Normal University, Shanghai, China
| | - BingJun Lin
- Psychological Counseling Center, Fujian Vocational College of Art, Fuzhou, China
| | - Jia Long
- Faculty of Education, East China Normal University, Shanghai, China
| | - Xiong Qing
- The Fourth People's Hospital of Huaihua, Huaihua, China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai, China.
- School of Teacher Education, Honghe University, Mengzi, China.
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Takahashi N, Matsuhisa T, Takahashi K, Aomatsu M, Mercer SW, Ban N. A 2-item version of the Japanese Consultation and Relational Empathy measure: a pilot study using secondary analysis of a cross-sectional survey in primary care. Fam Pract 2022; 39:1169-1175. [PMID: 35471659 PMCID: PMC9680666 DOI: 10.1093/fampra/cmac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Consultation and Relational Empathy (CARE) measure is a patient-reported measure of physician empathy which is widely used internationally. The Japanese version of the CARE measure has very high internal reliability, suggesting that a shorter version may have adequate validity and reliability. OBJECTIVE To investigate a valid shorter version of the Japanese CARE measure. METHODS We conducted a pilot study using secondary analysis of previous data obtained from 9 general practitioners and 252 patients and used to develop the Japanese CARE measure. All 1,023 possible combinations of the Japanese CARE items (n = 1-10) were candidates for the short measure. The internal consistency (Cronbach's alpha) and the correlations between candidate short questionnaires and the original questionnaire were calculated. After selecting the most valid short questionnaire, inter-rater reliability was determined using generalizability theory, and construct validity (Spearman's rho) was determined using patient satisfaction. RESULTS Two items were selected for a pilot shorter version: item 6 "Showing care and compassion" and item 9 "Helping you to take control." These showed high internal consistency and correlations with the 10-item measure (Cronbach's alpha = 0.920, correlation = 0.979). Forty-five questionnaires per doctor allowed us to reliably differentiate between practitioners. The construct validity for the pilot short measure was high (Spearman's rho 0.706, P < 0.001). CONCLUSION We generated a pilot 2-item version of the Japanese CARE measure. This pilot 2-item version provides a basis for future validation studies of short CARE measures in other languages.
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Affiliation(s)
- Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Takaharu Matsuhisa
- Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nobutaro Ban
- Medical Education Center, Aichi Medical University School of Medicine, Nagakute, Japan.,Nakatsugawa Community Healthcare Center, Nakatsugawa, Japan
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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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Décary S, Toupin-April K, Légaré F, Barton JL. Five Golden Rings to Measure Patient-Centered Care in Rheumatology. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:686-702. [PMID: 33091246 DOI: 10.1002/acr.24244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Simon Décary
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Jennifer L Barton
- Oregon Health & Science University and US Department of Veteran Affairs Portland Health Care System, Portland, Oregon
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Gehenne L, Lelorain S, Anota A, Brédart A, Dolbeault S, Sultan S, Piessen G, Grynberg D, Baudry A, Christophe V. Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure. Eur J Cancer Care (Engl) 2020; 29:e13306. [DOI: 10.1111/ecc.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/12/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Lucie Gehenne
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Sophie Lelorain
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (IMSER UMR 1098) University of Besançon Besançon France
| | - Anne Brédart
- Psycho‐oncology and Social Service Institut Curie Paris France
- Psychopathology and Health Process Laboratory (LPPS UR 4057) Psychology Institute University Paris Descartes France
| | - Sylvie Dolbeault
- Psycho‐oncology and Social Service Institut Curie Paris France
- University Paris SudUniversity PSL Paris France
| | - Serge Sultan
- Sainte Justine University Health Center Montréal QC Canada
- Departments of Pediatrics and Psychology University of Montreal Montréal QC Canada
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery Claude Huriez University Hospital University of Lille Lille France
- Jean‐Pierre Aubert Research Center – Neurosciences and Cancer University of Lille (IMR‐S 1172‐JPArc) Lille France
| | - Delphine Grynberg
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Institut Universitaire de France Paris France
| | - Anne‐Sophie Baudry
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Oncology and Medical Specialties Department Valenciennes Hospital Valenciennes France
| | - Véronique Christophe
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
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Wu H, Zhang Y, Li S, Liu Q, Yang N. Care Is the Doctor's Best Prescription: The Impact of Doctor-Patient Empathy on the Physical and Mental Health of Asthmatic Patients in China. Psychol Res Behav Manag 2020; 13:141-150. [PMID: 32104114 PMCID: PMC7023901 DOI: 10.2147/prbm.s226706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background To explore the impact of empathy between Chinese doctors and patients on anxiety, self-efficacy, sleep and IL-6 levels in hospitalized asthmatic patients. Methods This study included 195 asthmatic patients and 30 respirologists in China. The Jefferson Empathy Scale (JSE) was used to measure the empathy level of doctors, and the consultation and relational empathy (CARE) scale was used to measure patients' perception of empathy between themselves and their doctors. Doctors were divided into three groups, according to JSE scores. Data about anxiety, self-efficacy, sleep and IL-6 were collected and compared between patients in different JSE groups at admission (T1) and 3 months later (T2). The correlation between JSE scores and CARE scores was analyzed. Pearson correlation analysis along with a structural equation model was applied to explore the relevance among anxiety, self-efficacy, sleep, inflammatory factors (IL-6) and patients' perception of empathy shown by their doctors. Results There was no statistical difference between the indices of patients in three groups at admission. For all patients, the changes of indicators were statistically different from T1 to T2. Three months later, patients in high empathy scoring group showed lower anxiety and IL-6, and higher self-efficacy and sleep quality. There was a positive correlation between JSE and CARE scores. Patients' perception of doctor-patient empathy was negatively correlated to anxiety levels and IL-6, and positively correlated to self-efficacy and sleep quality. Anxiety, self-efficacy and sleep quality were mediators in the relationship between patients' perception of empathy and IL-6. Conclusion In the Chinese sample, anxiety, self-efficacy, sleep, empathy between doctors and patients and IL-6 are closely correlated. Anxiety, self-efficacy and sleep may play additional roles in the influence of patients' perception of empathy between doctors and patients on IL-6 in asthmatic patients.
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Affiliation(s)
- Huiduo Wu
- Education and Rehabilitation Department, Faculty of Education, East China Normal University, Shanghai, People's Republic of China
| | - Yan Zhang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, Heilongjiang, People's Republic of China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Qiaoyun Liu
- Education and Rehabilitation Department, Faculty of Education, East China Normal University, Shanghai, People's Republic of China
| | - Ningxi Yang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, Heilongjiang, People's Republic of China
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Yang WY, Low YE, Ng WJ, Ong SH, Jamil JA. Investigation of empathy amongst dietetic interns at selected primary and tertiary health-care facilities. Nutr Diet 2019; 77:231-239. [PMID: 31199060 DOI: 10.1111/1747-0080.12562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Abstract
AIM Empathy is an essential aspect in the delivery of quality nutrition care and promoting better outcomes in patients. With an increased emphasis of patient-centred care in dietetic practice, empathy should underpin the construct of the curriculum in dietetic education. The present study investigated the empathy level of dietetic interns through self-reporting measures and patients' perception. METHODS This cross-sectional study was conducted on a total of 57 dietetic interns and 99 patients from primary and tertiary health care settings. The dietetic interns completed the Toronto Empathy Questionnaire (TEQ) while the Consultation and Relational Empathy (CARE) measure was self-administered by patients. Socio-demographic information of participants was collected. RESULTS The dietetic interns' mean (standard deviation [SD]) TEQ scores were 46.90 ± 5.28 and 47.78 ± 5.34 in primary and tertiary care, respectively. CARE measure scores rated by patients in the primary care were 38.61 ± 8.38 and for tertiary setting, the scores were slightly higher (39.47 ± 7.65). The settings, gender, ethnicity and period of internship did not affect dietetic interns' empathy level. In primary care, CARE scores were significantly different between patients' age grouping (P = 0.007). CONCLUSIONS Findings from the present study showed that patients' age significantly affected their perception of dietetic interns' empathy in primary health care. These preliminary findings could facilitate an understanding of the level of empathy amongst interns for consideration in the future design of dietetic training.
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Affiliation(s)
- Wai Y Yang
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Yi E Low
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Wan J Ng
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Shu H Ong
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Jamilah A Jamil
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
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11
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Matsuhisa T, Takahashi N, Aomatsu M, Takahashi K, Nishino J, Ban N, Mercer SW. How many patients are required to provide a high level of reliability in the Japanese version of the CARE Measure? A secondary analysis. BMC FAMILY PRACTICE 2018; 19:138. [PMID: 30115032 PMCID: PMC6097289 DOI: 10.1186/s12875-018-0826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/30/2018] [Indexed: 08/23/2023]
Abstract
Background Empathy is widely regarded as being key to effective consultation in general practice. The Consultation and Relational Empathy (CARE) Measure is a widely used and well-validated patient-rated measure in English. A Japanese version of the CARE Measure has undergone preliminary validation, but its ability to differentiate between individual doctors has not been established. The current study sought to investigate the reliability of the Japanese version of the CARE Measure in terms of discrimination between doctors. Methods We conducted secondary analysis of a dataset involving 252 patients assessed by nine attending General Practitioners. The intra-cluster correlation coefficient was evaluated as an index of the reliability of the Japanese version of the CARE Measure for discriminating between doctors. With a criterion of intra-cluster correlation coefficient = 0.8, we conducted a decision (D) study using generalizability theory to determine the required number of patients for reliable CARE Measure estimates. Results The ability of the CARE Measure to discriminate between doctors increased with the number of patients assessed per doctor. A sample size of 38 or more patients provided an average intra-cluster correlation coefficient of 0.8. Conclusions The Japanese CARE Measure appears to reliably discriminate between doctors with a feasible number of patient-ratings per doctor. Further studies involving larger numbers of doctors with a multicenter analysis are required to confirm the results of the current study, which was conducted at a single institution.
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Affiliation(s)
- Takaharu Matsuhisa
- Department of General Medicine/Family & Community Medicine Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | - Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Muneyoshi Aomatsu
- Department of Medical Education, Saku Central Hospital, 197 Usuda, Saku, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Jo Nishino
- Department of Biostatistics Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Nobutaro Ban
- Medical Education Center, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Japan
| | - Stewart W Mercer
- Department of Primary Care Research in General Practice and Primary Care, Institute for Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland
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12
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Differences between GP perception of delivered empathy and patient-perceived empathy: a cross-sectional study in primary care. Br J Gen Pract 2018; 68:e621-e626. [PMID: 30012809 DOI: 10.3399/bjgp18x698381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/16/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy has positive effects on a range of healthcare outcomes. It is therefore an important skill for a GP. However, the correlation between GP perception of delivered empathy and patient perception of GP empathic communication during consultations is still unclear. AIM To investigate the correlation between GP perception of delivered empathy and patient-perceived empathy. DESIGN AND SETTING Cross-sectional study in primary care in the Netherlands, between December 2016 and February 2017. METHOD GPs and their patients were asked to fill in an empathy questionnaire directly after a consultation. Patient perception of received empathy during the consultation was measured through the Dutch version of the Consultation and Relational Empathy (CARE) questionnaire. GP perception of delivered empathy during the consultation was measured with an adapted version of the CARE questionnaire. RESULTS The authors obtained questionnaires from 147 consultations by 34 different GPs in 16 primary care practices. A total of 143 consultations were eligible for inclusion in the analysis. Mean patient-perceived empathy score was significantly higher than mean GPs' empathy score (42.1, range 20.0 to 50.0 and 31.6, range 24.0 to 41.0, respectively, P<0.0001). Furthermore, a low correlation (r = 0.06) was found between GP empathy score and patient-perceived empathy score. CONCLUSION GPs rate the delivered empathy during consultations consistently and significantly lower than their patients experience empathy during consultations. Moreover, GPs' impressions of the empathy delivered during the consultation do not predict the actual amount of empathy perceived by their patients. Patients experience a great deal of empathy during their clinical encounter. GPs' self-reports on empathy delivered gives an inaccurate reflection, and underestimates patient-perceived empathy.
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Arigliani M, Castriotta L, Pusiol A, Titolo A, Petoello E, Brun Peressut A, Miorin E, Elkina I, Marzona F, Cucchiaro D, Spanghero E, Pavan M, Arigliani R, Mercer SW, Cogo P. Measuring empathy in pediatrics: validation of the Visual CARE measure. BMC Pediatr 2018; 18:57. [PMID: 29439733 PMCID: PMC5812057 DOI: 10.1186/s12887-018-1050-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). Methods The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. Results Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93). Conclusions The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics.
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Affiliation(s)
- Michele Arigliani
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy.
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, ASUI Udine, Istituto Igiene, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Anna Pusiol
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Annachiara Titolo
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Enrico Petoello
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Alberto Brun Peressut
- Department of Surgery, University Hospital of Udine, ASUI Udine, Clinica Chirurgica, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisabetta Miorin
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Iana Elkina
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Federico Marzona
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Davide Cucchiaro
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisa Spanghero
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Matteo Pavan
- University of Trieste, Facoltà di Medicina e Chirurgia dell'Università degli Studi di Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Raffaele Arigliani
- Pediatric Primary Care, ASL Benevento, Via Giuseppe Piermarini, 12, 82100, Benevento, Italy
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Paola Cogo
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
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Crosta Ahlforn K, Bojner Horwitz E, Osika W. A Swedish version of the Consultation and Relational Empathy (CARE) measure. Scand J Prim Health Care 2017; 35:286-292. [PMID: 28768444 PMCID: PMC5592356 DOI: 10.1080/02813432.2017.1358853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE A validated measure to gather patient feedback on physicians' empathy is not available in Swedish. The objective for this study was to examine the psychometric characteristics of a Swedish version of the Consultation and Relational Empathy (CARE) measure (widely used in English). DESIGN, SETTING AND PATIENTS The CARE measure was translated into Swedish and tested on 554 unselected patients visiting physicians in two primary care clinics in northwestern Stockholm, Sweden. MAIN OUTCOME MEASURES Adequate translation, as well as reliability and validity of the Swedish CARE measure. RESULTS The Swedish CARE measure seemed to demonstrate high acceptability and face validity when consulting a physician. The mean CARE score 41.5 (SD 8.9) over all 10 item was not significantly influenced by seasonality, age or gender. Scores were somewhat negatively distributed, but corrected item-total correlations were high (0.86-0.91) suggesting homogeneity. Internal reliability was very high (Cronbach's alpha 0.975). Factor analysis implied a one-dimensional structure with factor loadings between 0.89 and 0.93. CONCLUSIONS The Swedish CARE measure appears to be psychometrically valid and reliable enough in physicians.
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Affiliation(s)
- K. Crosta Ahlforn
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E. Bojner Horwitz
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - W. Osika
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Clinic Foundation, Stockholm, Sweden
- CONTACT W. Osika Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
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Babar MG, Hasan SS, Yong WM, Mitha S, Al-Waeli HA. Patients’ Perceptions of Dental Students’ Empathic, Person-Centered Care in a Dental School Clinic in Malaysia. J Dent Educ 2017; 81:404-412. [DOI: 10.21815/jde.016.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Muneer Gohar Babar
- School of Dentistry, International Medical University; Kuala Lumpur Malaysia
| | - Syed Shahzad Hasan
- School of Pharmacy, International Medical University; Kuala Lumpur Malaysia
| | - Wong Mei Yong
- International Medical University; Kuala Lumpur Malaysia
| | - Shahid Mitha
- School of Dentistry, International Medical University; Kuala Lumpur Malaysia
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Berrada-Baby Z, Oker A, Courgeon M, Urbach M, Bazin N, Amorim MA, Martin JC, Passerieux C, Roux P, Brunet-Gouet E. Patients with schizophrenia are less prone to interpret virtual others' empathetic questioning as helpful. Psychiatry Res 2016; 242:67-74. [PMID: 27262087 DOI: 10.1016/j.psychres.2016.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/13/2016] [Accepted: 05/17/2016] [Indexed: 12/30/2022]
Abstract
Individuals with schizophrenia are impaired in their neurocognition and present cognitive biases. These impairments may lead to a deficit in recognizing helping intentions of others. To investigate recognition of help, we designed a card-guessing game (Virtual Help Recognition Paradigm) involving two successive virtual agents asking questions to the participant at different moments of the game. These questions were either empathetic (i.e. on the subject's feelings) or non-empathetic (i.e. on technical aspects of the game). We assessed how much the participant felt that the virtual agent had helped him and, her attitude and personality traits. We measured how much the participant trusted the virtual agent with a monetary allocation procedure. Twenty individuals with schizophrenia and twenty healthy controls were recruited. The controls' ratings demonstrated that they interpreted empathetic questioning as helping and rewarded it positively with an increased monetary allocation. Participants with schizophrenia had a reduced perception of the differences between the two agents. Only the rating concerning the "interest/attention" of the agent toward these participants yielded significant differences among conditions. Hypothetically, individuals with schizophrenia take into account the fact they are the object of another's attention, but may fail to infer a helping intention and to behave accordingly.
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Affiliation(s)
- Zina Berrada-Baby
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France
| | - Ali Oker
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France
| | - Matthieu Courgeon
- LabSTICC, UMR6285, Université Bretagne-Sud, France; LIMSI UPR3251, Université Paris Sud, France
| | - Mathieu Urbach
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France; Schizophrenia Center of Expertise, Fondation FondaMental, Versailles, France
| | - Nadine Bazin
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France
| | | | | | - Christine Passerieux
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France; Schizophrenia Center of Expertise, Fondation FondaMental, Versailles, France
| | - Paul Roux
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France; Schizophrenia Center of Expertise, Fondation FondaMental, Versailles, France
| | - Eric Brunet-Gouet
- HandiResp, EA4047, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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Chung VCH, Yip BHK, Yu ELM, Liu S, Ho RST, Sit RWS, Leung AWN, Wu JCY, Wong SYS. Patient Perceptions of Expression of Empathy From Chinese Medicine Clinicians in a Chinese Population: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3316. [PMID: 27124021 PMCID: PMC4998684 DOI: 10.1097/md.0000000000003316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the level of empathy perceived by patients receiving care from herbalists, acupuncturists and massage therapists and to investigate the factors that influence levels of perceived empathy.Participants who were 18 years or above; able to provide written informed consent; and able to read and write in Chinese without assistance were included. A total of 514 participants sampled from charity and semipublic Chinese medicine (CM) clinics in Hong Kong were recruited to assess levels of empathy perceived during various length of consultations (1-20 minutes) by the Chinese Consultation and Relational Empathy Measure (Chinese CARE). Multiple linear regressions were conducted to evaluate the associations between perceived levels of empathy and the type of CM practitioner consulted and participants' demographic and health characteristics.The average Chinese CARE total score for participants consulting CM practitioners was 34.3 of a maximum of 50. After adjusting for participants' health and demographic characteristics, acupuncturists received the highest ratings (P < 0.001), whereas massage therapists (P < 0.001) scored the lowest of the 3 modalities. Participants receiving social benefits (P = 0.013), those with longer waiting times (P = 0.002), and those with shorter consultation durations (P = 0.020) scored significantly lower on the Chinese CARE.The level of empathy perceived by participants using CM was similar to results found for those in conventional care, in contrast to findings in other geographical settings, where a high level of perceived empathy was a major motivator for participants to choose complementary medicine.
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Affiliation(s)
- Vincent C H Chung
- From the Jockey Club School of Public Health and Primary Care (VCHC, BHKY, ELMY, SL, RSTH, RWSS, SYSW), Hong Kong Institute of Integrative Medicine (VCHC, RWSS, JCYW, SYSW), and School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China (AWNL)
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Chin WY, Wan EYF, Choi EPH, Chan KTY, Lam CLK. The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients. Ann Fam Med 2016; 14:47-53. [PMID: 26755783 PMCID: PMC4709155 DOI: 10.1370/afm.1854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Evidence regarding the onset of depressive symptoms in primary care is rarely available but can help inform policy development, service planning, and clinical decision making. The objective of this study was to estimate the 12-month cumulative incidence and predictors of a positive screen for depressive symptoms on the 9-item Patient Health Questionnare-9 (PHQ-9) among primary care patients with no history of physician-diagnosed depression. METHODS We monitored a cohort of 2,929 adult primary care patients with no past history of physician-diagnosed depression and with baseline PHQ-9 scores of 9 or lower by telephone interview at 3, 6, and 12 months. A generalized linear mixed effects Poisson Model was used to explore factors associated with the incidence of PHQ-positive symptoms. RESULTS The cumulative incidence of positive screening on the PHQ-9 over 12 months was 5.23% (95% CI, 3.83%-6.64%). Positive predictors included being female, coming from a lower-income household, being a smoker, having at least 2 comorbidities, having a family history of depression, and having consulted a physician at least twice in the past 4 weeks. Consulting a physician with qualifications in both family medicine and psychological medicine was a negative predictor. CONCLUSIONS The cumulative incidence of PHQ-9-screened depressive symptoms in this study population was higher than those reported for depressive disorders in earlier systematic reviews. Groups who may warrant greater treatment attention include women, patients with multimorbidity, smokers, patients with recent high rates of medical consultations, and those who are from lower-income households or who have a family history of depression. Greater physician training may have a protective effect.
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Affiliation(s)
- Weng-Yee Chin
- Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, China Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, China Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, China
| | | | - Kit Tsui Yan Chan
- Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, China Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, China Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, China
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Yu FSK, Yip BHK, Kung K, Fung CSC, Wong CKM, Lam AT, Mercer SW, Wong SYS. The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong. PLoS One 2015; 10:e0144492. [PMID: 26658427 PMCID: PMC4678047 DOI: 10.1371/journal.pone.0144492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown. OBJECTIVE This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings. METHODS This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors. RESULTS Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting. CONCLUSION Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors' training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors' empathy and enablement for chronic illness patients.
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Affiliation(s)
- Frances S. K. Yu
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong SAR, The People's Republic of China
| | - Benjamin H. K. Yip
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Kenny Kung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Colman S. C. Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Carmen K. M. Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Augustine T. Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong SAR, The People's Republic of China
| | - Stewart W. Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Samuel Y. S. Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
- * E-mail:
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Chen JY, Chin WY, Fung CSC, Wong CKH, Tsang JPY. Assessing medical student empathy in a family medicine clinical test: validity of the CARE measure. MEDICAL EDUCATION ONLINE 2015; 20:27346. [PMID: 26154863 PMCID: PMC4495620 DOI: 10.3402/meo.v20.27346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The Consultation and Relational Empathy (CARE) measure developed and validated in primary care settings and used for general practitioner appraisal is a 10-item instrument used by patients to assess doctors' empathy. The aim of this study is to investigate the validity of the CARE measure in assessing medical students' empathy during a formative family medicine clinical test. METHOD All 158 final-year medical students were assessed by trained simulated patients (SPs) - who completed the CARE measure, the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating score to assess students' empathy and history-taking ability. RESULTS Exploratory and confirmatory factor analysis identified a unidimensional structure. The CARE measure strongly correlated with both convergent measures: global rating (ρ=0.79 and <0.001) and JSPPPE (ρ=0.77 and <0.001) and weakly correlated with the divergent measure: history-taking score (ρ=0.28 and <0.001). Internal consistency was excellent (Cronbach's α=0.94). CONCLUSION The CARE measure had strong construct and internal reliability in a formative, undergraduate family medicine examination. Its role in higher stakes examinations and other educational settings should be explored.
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Affiliation(s)
- Julie Y Chen
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
- Institute of Medical and Health Sciences Education, The University of Hong Kong, Pokfulam, Hong Kong;
| | - Weng Y Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
- Institute of Medical and Health Sciences Education, The University of Hong Kong, Pokfulam, Hong Kong
| | - Colman S C Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joyce P Y Tsang
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
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Chin WY, Chan KTY, Lam CLK, Wong SYS, Fong DYT, Lo YYC, Lam TP, Chiu BCF. Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network. BMC FAMILY PRACTICE 2014; 15:30. [PMID: 24521526 PMCID: PMC3937039 DOI: 10.1186/1471-2296-15-30] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
Background This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong. Methods A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management. Results 10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice. In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor. Conclusion About one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.
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Affiliation(s)
- Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
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23
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Aomatsu M, Abe H, Abe K, Yasui H, Suzuki T, Sato J, Ban N, Mercer SW. Validity and reliability of the Japanese version of the CARE measure in a general medicine outpatient setting. Fam Pract 2014; 31:118-26. [PMID: 24115011 DOI: 10.1093/fampra/cmt053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Empathy is an important attribute in medicine, influencing both the process and outcome of consultations. However, there are no validated tools available in Japan to gather patient feedback on physicians' empathy. The Consultation and Relational Empathy (CARE) Measure developed in the UK is widely used internationally. OBJECTIVES To investigate the psychometric properties of a Japanese version of the CARE Measure. METHOD Following two cycles of translation and back translation, the Japanese CARE Measure was completed by 317 patients in a primary medical care clinic in Japan. Tests of internal reliability and validity included Cronbach's alpha, item-total correlations and factor analysis. Predicted associations between CARE Measure score and other variables were assessed by Spearman's rho. RESULTS Low numbers of missing values (8.2-9.8%) and 'not applicable' responses (0-1.3%) suggested high acceptability and face validity of the Japanese CARE Measure. Internal reliability was high (Cronbach's alpha 0.984) and was reduced by the removal of any of 10 items. High corrected item-total correlations (0.897-0.946) suggested homogeneity. Factor analysis showed a single solution with high item loadings (0.917-0.957). Construct validity was supported by a significant relationship (Spearman's rho 0.74, P < 0.001) with overall satisfaction with the consultation. CONCLUSION The Japanese CARE Measure appears to be valid and reliable in a primary medical care setting. Further work is required to determine its ability to discriminate between doctors.
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Affiliation(s)
- Muneyoshi Aomatsu
- Department of Education for Community-Oriented Medicine, Graduate School of Medicine
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24
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Wong CKM, Yip BHK, Mercer S, Griffiths S, Kung K, Wong MCS, Chor J, Wong SYS. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC FAMILY PRACTICE 2013; 14:200. [PMID: 24364989 PMCID: PMC3879648 DOI: 10.1186/1471-2296-14-200] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022]
Abstract
Background There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor’s facemask wearing were explored. Method A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients’ perception of doctors’ empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients’ views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling. Results 1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients’ perception of the doctors’ empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors’ mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03). Conclusion This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient’s perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level. Clinical trial registration This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/en/proj/show.aspx?proj=3486. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012.
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Affiliation(s)
| | - Benjamin Hon Kei Yip
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
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25
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Murphy J, Mercer SW, Duncan EAS. A pilot study to explore the feasibility, validity and reliability of a visual version of the CARE Measure. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.9.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joan Murphy
- of Talking Mats, Stirling University Innovation Park, Stirling, Scotland, UK
| | - Stewart W Mercer
- at the Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Edward AS Duncan
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, UK
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26
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Johnson L, Gorman C, Morse R, Firth M, Rushbrooke S. Does communication skills training make a difference to patients' experiences of consultations in oncology and palliative care services? Eur J Cancer Care (Engl) 2012; 22:202-9. [DOI: 10.1111/ecc.12014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - S. Rushbrooke
- North of England Cancer Network; Newcastle upon Tyne; UK
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