Associations of Physician Empathy with Patient Anxiety and Ratings of Communication in Hospital Admission Encounters

Latent profile analysis of empathy ability and its relationship with professional quality of life among hospice nurses in China

BACKGROUND

Empathy is important in hospice nursing clinics and may influence nurses' professional quality of life (ProQOL). However, present studies ignoring each empathic dimension, and few researches have explored the correlation between empathy and ProQOL in hospice nurses in Asia. To better understand hospice nurses' empathy abilities in China and its relationship with ProQOL, the aim of this study was to identify the latent profiles and its influencing factors of hospice nurses' empathy ability, as well as differences in ProQOL across each latent profile.

METHODS

A cross-sectional study was conducted from October 2021 to September 2022, and a total of 725 hospice nurses were recruited from different geographic regions in China. Participants completed the Empathy Ability Scale for Hospice Nurses and the Brief Professional Quality of Life Scale. Latent profile analysis (LPA) was employed to identify latent profiles of empathy ability among hospice nurses in China. The predictors of hospice nurses' empathy ability in different latent profiles were assessed using multinomial logistic regression analysis. One-way ANOVA test and the Kruskal-Wallis test were used to compare the ProQOL scores in each latent profile of nurses' empathy ability.

RESULTS

This study identified three latent profiles of hospice nurses' empathy ability, and those profiles labelled "poor empathy ability-high surface empathy expression" (n = 216, 29.8%), "moderate empathy ability" (n = 359, 49.5%) and "high empathy ability-high deep empathy expression" (n = 150, 20.7%). Multinomial logistic regression analysis suggested that age, hospital level, whether income meets expectations, interests in hospice care work, hospice work experience, and receiving psychological counselling were predictors of hospice nurses' profile membership of empathy ability. The scores of compassion satisfaction (CS) and burnout (BO) in ProQOL were significantly different across each profile (P < 0.001), while scores of secondary traumatic stress (STS) in ProQOL were not different across each profile (P = 0.294).

CONCLUSIONS

Hospice nurses' empathy ability was divided into three latent profiles, and enhancing empathy ability may be conducive to improving hospice nurses' CS, while reducing BO, thus fostering their overall quality of life. Nursing managers should identify hospice nurses at higher risk of BO and implement targeted interventions focused on enhancing nurse's empathy abilities.

Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature

BACKGROUND

Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions.

OBJECTIVE

We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles.

METHODS

The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2.

RESULTS

Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50% (13/21, 62%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions.

CONCLUSIONS

Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients.

Physician Empathy in Doctor-Patient Communication: A Systematic Review

Physician empathy is at the heart of doctor-patient communication and significantly influences patient outcomes. However, the research on how physicians express their empathy and how physician empathy affects patient outcomes and doctor-patient communication has not been well summarized in the latest literature. Thus, we conducted a systematic review to synthesize existing studies on physician empathy and its value to patient outcomes and doctor-patient communication. The systematic review consisted of studies published in English peer-reviewed journals between January 2017 and October 2021. Following the PRISMA procedure, a total of 3055 articles were retrieved, and 11 articles were retained. The thematic analysis revealed three emergent themes: physicians' empathic expressions; patient outcomes (patient functional status, patient safety, and patient satisfaction); and empathy enhancing doctor-patient communication. This study highlighted the different ways empathy may be expressed by physicians and its positive effects on patient outcomes and doctor- patient communication. This study also suggested the under-researched areas that can be expanded in the future.

Compassionomics: The Science and Practice of Caring

PURPOSE

To summarize the scientific evidence that compassion can measurably improve patient outcomes, health care quality and safety, and the well-being of health care providers, and to consider specific strategies for cultivating compassion and better communicating it to patients.

DESIGN

Perspective.

METHODS

We selectively reviewed the literature on compassion in health care, including obstacles to its expression and the demonstrated effects of provider compassion on patient outcomes, health care quality and cost, and provider well-being. We also review evidence regarding the trainability of compassion, discuss proven methods for cultivating individual compassion, and recommend strategies for incorporating it into routine medical practice.

RESULTS

Compassion is the emotional response to another's pain or suffering, accompanied by a desire to alleviate it. Review of the literature shows that compassionate health care measurably improves physical and psychological patient outcomes, increases patient adherence, improves health care quality and safety, increases financial margins, and prevents physician burnout. Psychophysiological research shows that empathy and compassion can be actively cultivated through intentional practice. Validated models of compassion-based interactions can facilitate the consistent expression of compassion in daily medical practice.

CONCLUSIONS

Given its many proven benefits to patients, health care organizations, and providers, compassion should be cultivated by health care providers and systems and considered an essential component of optimal medical care.

A scoping review of empathy recognition in text using natural language processing

OBJECTIVE

To provide a scoping review of studies on empathy recognition in text using natural language processing (NLP) that can inform an approach to identifying physician empathic communication over patient portal messages.

MATERIALS AND METHODS

We searched 6 databases to identify relevant studies published through May 1, 2023. The study selection was conducted through a title screening, an abstract review, and a full-text review. Our process followed the PRISMA-ScR guidelines.

RESULTS

Of the 2446 publications identified from our searches, 39 studies were selected for the final review, which summarized: (1) definitions and context of empathy, (2) data sources and tested models, and (3) model performance. Definitions of empathy varied in their specificity to the context and setting of the study. The most common settings in which empathy was studied were reactions to news stories, health-related social media forums, and counseling sessions. We also observed an expected shift in methods used that coincided with the introduction of transformer-based models.

DISCUSSION

Aspects of the current approaches taken across various domains may be translatable to communication over a patient portal. However, the specific barriers to identifying empathic communication in this context are unclear. While modern NLP methods appear to be able to handle empathy-related tasks, challenges remain in precisely defining and measuring empathy in text.

CONCLUSION

Existing work that has attempted to measure empathy in text using NLP provides a useful basis for future studies of patient-physician asynchronous communication, but consideration for the conceptualization of empathy is needed.

Stress and mental health of COVID-19 survivors and their families after hospital discharge: relationship with perceived healthcare staff empathy

Several studies attest to the long-term consequences of COVID-19 infection on survivors' mental illness, especially in terms of high prevalence of post-traumatic stress disorder (PTSD) 1-3 months after hospitalization. Aims of the present study were (1) to jointly evaluate PTSD and positive mental health among COVID-19 survivors and family members after hospital discharge, and (2) to investigate the relationship between perceived healthcare staff's relational empathy during hospitalization and survivors' post-traumatic stress levels. In this cross-sectional study, 60 survivors (M_age = 60.45; 63.3% men) and 40 family members (M_age = 52.33; 60% women) participated in an online survey 3-7 months after hospital discharge. In addition to providing socio-demographic data, they completed PTSD Checklist for DSM-5 and Mental Health Continuum Short Form. Survivors also completed the Consultation and Relational Empathy measure. Percentages of participants meeting a provisional PTSD and mental health diagnosis (flourishing, moderate, languishing) were calculated. A hierarchical regression analysis was performed on survivors' data, with perceived staff's empathy as predictor and post-traumatic stress symptoms (PTSS) as outcome. One-fifth of the participants received a provisional PTSD diagnosis, about half were diagnosed with flourishing or moderate mental health, and only 5% were languishing, with no significant between-group differences. Among survivors, a negative association was detected between perceived healthcare staff's empathy and PTSS, explaining 10.5% of the model variance over and above demographic and clinical variables. Findings highlighted the coexistence of PTSD and positive mental health among survivors and family members, suggesting the usefulness of assessing both negative and positive dimensions of mental health, in order to promote psycho-social adaptation once returning to everyday life. In addition, the role of compassionate care in clinical practice emerged as a potential means to mitigate severe traumatic reactions among survivors.

What Matters Most? The Power of Kafka's Metamorphosis to Advance Understandings of HIV Stigma and Inform Empathy in Medical Health Education

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka's Metamorphosis advance understandings of HIV stigma in medical health education? Metamorphosis amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. Metamorphosis may ultimately promote medical health humanities' social mission-allowing literature to unfold such revelations towards greater equity in health.

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Design of a communication skills course in dentistry: Applying active-learning strategies to improve educational outcomes

PURPOSE/OBJECTIVE

Effective communication, between patient and dentist, is a core clinical skill that commands dedicated pedagogy similar to that of developing scientific knowledge and psychomotor skills. This study aimed to describe active-learning strategies in a dental communication skills course, which sits within a broader foundation dental course and evaluate students' educational outcomes.

METHODS

This is a two-phase retrospective, mono-centred study, completed in 2019 at an Australian dental school. Phase I, a case report, describes the Communication Skills for Oral Health (CSOH) course design and its active-learning strategies. Phase II analysed data from the course using Kirkpatrick's evaluation model to objectively measure the impact of the course and provide feedback to education designer. Students' perception (Level 1) was evaluated with an institutional, validated online survey. Descriptive and statistical analysis, included paired tests and Spearman's correlation analyses, used to investigate learning effect (Level 2) and student behaviour change (Level 3). To assess the impact of the CSOH course design (Level 4) the student grades from the course were analysed.

RESULTS

The CSOH course encompasses three major topics: Essentials of Communication Skills, Professional-Patient Relationship and Managing Difficult Situations. Each topic included didactic content complimented with a variety of active-learning strategies to teach and assess students. Positive outcomes were recorded across all Kirkpatrick levels.

CONCLUSIONS

This study suggests an efficient communication skills course design, which may assist in the development of communication skills courses in other dental education institutions.

Essential Elements of Communication

Relationship-centered communication (RCC) is an effective approach to patient-provider communication. This article describes RCC components known as the essential elements of communication. The article also describes current standard conceptual models for applying RCC to the patient encounter, including a structure for relationship building. The authors also explore the challenges to using RCC.

Anxiety and depression in patients with breast cancer undergoing radiotherapy: the role of intelligence, life history, and social support-preliminary results from a monocentric analysis

Purpose

It is known that the diagnosis of breast cancer often causes anxiety and depression. Radiotherapy of the breast as an obligatory part of a breast-conserving treatment concept can markedly increase these psychological symptoms in many, but not all patients. In this clinical observational study, we aimed at identifying cognitive, health-related and social factors that may either enhance or reduce the emergence of anxiety and depression.

Methods

Using a longitudinal study design with 25 women (mean age: 52.9 years; SD = 10.6; age range 29–70 years) with a first diagnosis of nonmetastatic breast cancer, measures of anxiety, depression, situational emotional states, intelligence, and aspects of social frameworks were assessed before, during, and after radiotherapy of the breast. At 4 time-points, standard and self-constructed questionnaires were used to assess the course of anxiety and depressive symptoms across the radiotherapy intervention.

Results

We found that anxiety is highest immediately before the start of radiation therapy, while the anxiety level was lowest on the day that therapy was completed. Anxiety and depression were enhanced in women with a lifetime history of chronic diseases at all time points of measurement. Moreover, women with high intelligence and low social support had stronger symptoms of depression than women with low intelligence and a stable family background at some time points of measurement. The degree of anxiety was neither related to intelligence nor to social support.

Conclusion

For the first time, we demonstrate empirical pilot data on cognitive and social modulators of anxiety and depression in women with breast cancer over the course of radiotherapy. Our results may help to optimize clinical procedures and thereby reduce symptoms of anxiety and depression in these patients.

Supplementary Information

The online version of this article (10.1007/s00066-022-01904-7) contains supplementary material, which is available to authorized users.

A Telecommunication Model to Teach Facilitator to Deliver Acceptance and Commitment Training

Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioral skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across four participants. Quantitative data on fidelity and confidence were collected at baseline, posttraining, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioral skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-021-00628-x.

Zusammenhänge zwischen Empathie, therapeutischer Haltung und Wirkeffizienz

Empathisch sein heißt, fühlen und verstehen können, was andere fühlen. Vermuten zu können, was das Gegenüber fühlt, denkt und wünscht, beruht auf der Fähigkeit, eigene Gefühle und Gedanken als getrennt von jenen anderer wahrnehmen und regulieren zu können. Definierte Therapieerfolge mit adäquatem Aufwand erreichen zu können, verlangt ein Fokussieren auf Wesentliches und Wichtiges. Die Empathie ist im Bereich der Psychotherapie jener Faktor, für den für sich genommen die höchste Effektstärke nachgewiesen werden konnte. Empathietraining ermöglicht eine bessere soziale Performance. Im Falle von Defiziten in sozialer Kompetenz ist störungsunabhängig ein besonders hoher Leidensdruck nachweisbar.

Intersections between patient-provider communication and antenatal anxiety in a public healthcare setting in Pakistan

This study explores pregnant women’s and healthcare providers’ perspectives on the role of patient-provider communication in experiences of antenatal anxiety within a low-resource setting. In 2017–18, we consecutively sampled pregnant women (n = 19) with at least mild anxiety and purposively sampled antenatal care providers (n = 10) from a public hospital in Punjab Province, Pakistan. We then conducted in-depth interviews and thematically coded them with a combination of inductive and deductive coding methodologies. We found that patients expressed a desire for warm, empathetic communication from providers who demonstrate respect, attentiveness, and a shared lived experience. Providers revealed an awareness that their heavy caseloads, high stress levels, and discourteous tones adversely influenced communication with pregnant women and may exacerbate their anxieties, but also reported that compassionately addressing women’s concerns, providing financial problem-solving and/or assistance, and moderating conflicting healthcare desires between patients and their families could alleviate anxiety in pregnant women. Patients reported feelings of anxiety stemming from a belief that they received lower quality communication from antenatal providers at public hospitals than patients received from antenatal providers at private hospitals, an experience that they partially attributed to their low socioeconomic status. Meanwhile, some providers disclosed potentially stigmatizing views of women from particular sociocultural backgrounds or low socioeconomic status, including perceptions that appeared to shape communication with these patients in antenatal care encounters. Our findings provide preliminary evidence that communication between pregnant women and antenatal providers that is warm, normalizes patient fears, and integrates patients’ interpersonal and financial considerations can mitigate pregnant women’s experiences of anxiety and reduce barriers to accessing antenatal care in Pakistan’s public healthcare facilities.

Creating a compassion system to achieve efficiency and quality in health care delivery

Purpose

Health care delivery is experiencing a multi-faceted epidemic of suffering among patients and care providers. Compassion is defined as noticing, feeling and responding to suffering. However, compassion is typically seen as an individual rather than a more systemic response to suffering and cannot match the scale of the problem as a result. The authors develop a model of a compassion system and details its antecedents (leader behaviors and a compassionate human resource (HR) bundle), its climate or the extent that the organization values, supports and rewards expression of compassion and the behaviors and practices through which it is enacted (standardization and customization) and its effects on efficiently reducing suffering and delivering high quality care.

Design/methodology/approach

This paper uses a conceptual approach that synthesizes the literature in health services, HR management, organizational behavior and service operations to develop a new conceptual model.

Findings

The paper makes three key contributions. First, the authors theorize the central importance of compassion and a collective commitment to compassion (compassion system) to reducing pervasive patient and care provider suffering in health care. Second, the authors develop a model of an organizational compassion system that details its antecedents of leader behaviors and values as well as a compassionate HR bundle. Third, the authors theorize how compassion climate enhances collective employee well-being and increases standardization and customization behaviors that reduce suffering through more efficient and higher quality care, respectively.

Originality/value

This paper develops a novel model of how health care organizations can simultaneously achieve efficiency and quality through a compassion system. Specific leader behaviors and practices that enable compassion climate and the processes through which it achieves efficiency and quality are detailed. Future directions for how other service organizations can replicate a compassion system are discussed.

The burden of laryngomalacia and its effects on caregivers: A support group survey evaluation

OBJECTIVE

To evaluate which factors may affect anxiety and child's health perception of parents with children that have laryngomalacia.

STUDY DESIGN

Survey Study.

SETTING

"Coping with Laryngomalacia" - largest online laryngomalacia support group for parents with children who have laryngomalacia.

SUBJECTS

and Methods: A survey was sent to support group member that gathered information regarding the patient's diagnosis and associated course of treatment and evaluated for parental anxiety and perceived health of their child. Analysis was performed to evaluate which variables are associated with increased parental anxiety and worsened perceived child's health.

RESULTS

Data was gathered on 434 patients. All caregivers reported some level of anxiety due to the diagnosis and 64% felt completely anxious. Parents who saw an increased number of physicians prior to a pediatric ENT rated their child with poorer health (p < .05). Those that felt their concerns were brushed off initially reported increased anxiety (p < .05). If the child was admitted to the hospital, ICU, required intubation, had feeding troubles, required a feeding tube, or underwent pH monitoring, the patient was rated to have poorer health per the parents (p < .05).

CONCLUSION

Laryngomalacia causes a significant burden on patients and their families due to the eating problems, feeding problems, hospital stay, and other various conditions associated with the disease. Caregivers should take a more modern and compassionate approach to management and diagnosis.

A Survey of Patient Perspectives on Approach to Health Care: Focus on Physician Competency and Compassion

We conducted a cross-sectional, survey study of 764 volunteers to gain insight into patients’ perceptions of physician qualities of compassion and competence. Among 651 (85% response rate) survey participants, mean age was 52.4 (SD 21.4) years, 70.8% (n = 458) were female, and 84% (n = 539) identified as white. Predictors of compassion over competence included female gender (adjusted odds ratio [aOR] = 1.4, 95% CI: 1.04-1.89) and whether the respondent had a personal connection to the vignette (aOR = 1.24, 95% CI: 1.0-1.53). Thematic analysis demonstrated that preferences were influenced by: (a) explicit beliefs regarding the value of physician compassion and physician competence; (b) impact of emotional and mental health on medical experiences; (c) the type and frequency of health care exposure; and (d) perceived role of the physician in various clinical vignettes. Patients had wide-ranging, complex opinions on the qualities they valued in their physicians. These findings suggest that patients are engaged and can provide critical thoughtful feedback on the practice and delivery of health care.

A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance

BACKGROUND

Although ensuring high-quality care requires assessment of individual hospitalist performance, current assessment approaches lack consistency and coherence. The Institute of Medicine's STEEEP framework for quality healthcare conceptualizes quality through domains of "Safe," "Timely," "Effective," "Efficient," "Equitable," and "Patient Centered." This framework may be applicable to assessing individual hospitalists.

OBJECTIVE

This scoping review sought to identify studies that describe variation in individual hospitalist performance and to code this data to the domains of the STEEEP framework.

METHODS

Via a systematic search of peer-reviewed literature that assessed the performance of individual hospitalists in the Medline database, we identified studies that described measurement of individual hospitalist performance. Forty-two studies were included in the final review and coded into one or more domains of the STEEEP framework.

RESULTS

Studies in the Safe domain focused on transitions of care, both at discharge and within the hospital. Many studies were coded to more than one domain, especially Timely, Effective, and Efficient. Examples include adherence to evidence-based guidelines or Choosing Wisely recommendations. The Patient Centered domain was most frequently coded, but approaches were heterogeneous. No included studies addressed the domain Equitable.

CONCLUSIONS

Applying the STEEEP framework to the published literature on assessment of individual hospitalist performance revealed strengths and weaknesses. Areas of strength were assessments of transitions of care and application of consensus guidelines. Other areas, such as equity and some components of safe practice, need development. All domains would benefit from more practical approaches. These findings should stimulate future work on feasibility of multidimensional assessment approaches.

Hospice Patient Care Goals and Medical Students' Perceptions: Evidence of a Generation Gap?

BACKGROUND

The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians.

OBJECTIVE

The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals.

DESIGN

Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index.

SETTINGS/PARTICIPANTS

Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school.

RESULTS

Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year.

CONCLUSIONS

Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.

Trust in the referring physician reduces anxiety in an integrated community-to-hospital care system

Background

Continuity of care between the community and hospital is considered of prime importance for quality of care and patient satisfaction, and for trust in the medical system. In a unique model of continuity of care, cardiologists at our hospital serve as primary, community-based cardiologists one day a week. They refer patients from the community to our hospital for interventional procedures such as coronary angiography and angioplasty. We examined the hypotheses that patient anxiety during hospital-based coronary angiography is lower when a patient trusts the referring cardiologist and when the performing cardiologist also treated him/her in the community.

Methods

We administered questionnaires to 64 patients in our cardiology department within 90 min of completion of coronary angiography. The questions assessed anxiety, trust in the medical system and trust in the referring physician. Data were also collected regarding patients’ demographic variables, the number of visits to the referring physician, and whether the physician who performed the coronary angiography was the physician who referred the patient to the hospital.

Results

Mean levels (on 7-point Likert scales) were 2.1, 5.6 and 6.7 for patient anxiety, trust in the medical system and trust in the referring physician, respectively. Multivariate regression analysis showed that trust in the referring physician was significantly and negatively correlated with anxiety level. The number of visits to referring physicians, patients’ demographic characteristics and whether the physician who performed the angiography was the same physician who referred the patient from the community were not found to be associated with patient anxiety.

Conclusion

In this study, trusting the referring physician was associated with lower anxiety among patients who underwent coronary angiography. This trust seemed to have more positive impact than did previous contact with the physician who performed the procedure.

Effects of Patients' Perceptions of Physician-Patient Relational Empathy on an Inflammation Marker in Patients with Crohn's Disease: The Intermediary Roles of Anxiety, Self-Efficacy, and Sleep Quality

Background

Physician-patient empathy is inextricably linked with outcomes of patients. The purpose of this study was to test whether anxiety, self-efficacy, and sleep quality played intermediary roles in relationships between patients' perceptions of physician-patient relational empathy and an inflammation marker in Crohn's disease patients.

Methods

The study included 187 patients. At admission (T1) and 3 months after admission (T2), anxiety, self-efficacy, sleep, and the inflammatory marker IL6 of patients were tested and compared. Patients' perceptions of physician-patient relational empathy (CARE scale) was measured at T2. Correlations among patients' anxiety, self-efficacy, sleep quality, IL6, and CARE scores were explored by Pearson's correlation analysis and a structural equation model.

Results

Compared with T1, patients showed higher self-efficacy and sleep quality and lower anxiety and IL6 at T2. Patients' perceptions of physician-patient relational empathy were negatively related to anxiety and IL6 and connected to self-efficacy and sleep quality positively. Patients' anxiety, self-efficacy, and sleep quality played intermediary roles incorrelations between empathy and IL6.

Conclusion

In correlations of patients' perceptions of physician-patient relational empathy and IL6 in patients with Crohn's disease, patients' anxiety, self-efficacy, and sleep quality acted as intermediary effects. Therefore, medical staff should empathize with patients.

The Impact of a Communication Skills Workshop on Doctors' Behavior Over Time

PURPOSE

Communication skills education is still relatively new in some non-Western countries. Further, most evaluation research on communication skills education examines only short-term results. In our communication skills program in Qatar, we aimed to: 1) assess the impact of the communication skills course on participant skills application; 2) assess the length of time since course completion associated with participant skills application; and 3) assess participant gender or clinical position associated with participant skills application.

METHODS

Seven hundred and thirty-eight physicians completed a seven-module communication skills course. Participants reflected on what they learned in the course and how the course had impacted their behavior through a nine-item online survey that included a four-item Communication Workshop Impact Scale (CWIS), three open questions, and two demographic questions. To assess the effect of time since workshop on outcomes, we stratified the respondents into five groups based on how long ago they had completed the course.

RESULTS

Three hundred and thirty-two physicians completed the survey. Participants reported agreement with the items on the CWIS: X=4.45 (range 1-5; SD=0.70). When asked which skill(s) they had been able to implement in their clinical practice, 235 gave a specific response, either a specific communication skill (eg, ask open questions), a higher-order category of skills (eg, questioning skills), or the name of one of the seven modules of the course. Only 28 participants listed the name of a skill or module name that they had not been able to implement. There was no evidence of difference in CWIS score based on time since course completion. There was no gender difference; however, residents had significantly lower CWIS scores than fellows (4.70 vs. 4.29, p<0.05).

CONCLUSION

Participants reported agreement with response items about the impact of the course on their skills application. Participant gender did not play a significant role, but residents had lower scores than did fellows. Furthermore, most physicians (92%) were able to name something specific that they had learned from the course and were currently implementing in their practice. Positive outcomes of the course did not seem to diminish over time. Future research should identify whether observable communication behavior matches the self-reported behavior.

Correlation analysis of empathy satisfaction and empathy, mental resilience, and social support in elderly patients with functional dyspepsia

BACKGROUND

The development direction of empathic satisfaction as helping industry is gradually shifting from medical personnel to patients. The level of empathy satisfaction is closely related to the levels of empathy ability, social support, and mental resilience.

AIM

To explore the correlation among empathy satisfaction, empathy ability, mental resilience, and social support in elderly patients with functional dyspepsia (FD).

METHODS

One hundred and thirty elderly patients with FD who were admitted to our hospital from June 2017 to August 2019 were selected as the study subjects. The professional quality of life scale, the Chinese-version Jefferson empathy scale, the comprehension social support scale, and the self-recovery strength scale were used for investigations.

RESULTS

The scores of empathy competence, mental resilience, social support, and empathy satisfaction in elderly FD patients were 106.94 ± 9.36, 35.72 ± 6.87, 67.83 ± 8.34, and 33.94 ± 4.90, respectively, all of which were positively correlated [r = 0.765- (-0.423), P < 0.05]. Regression analysis was conducted with empathy ability as the independent variable, mental resilience as the mediating variable, and empathy satisfaction as the dependent variable. The results showed that both empathy (β = 0.189, P < 0.01) and resilience (β = 0.282, P < 0.01) positively predicted empathy satisfaction, and the predictive effect of empathy on empathy satisfaction was decreasing (β = 0.153, P < 0.01), indicating that psychological resilience has a mediating effect between empathy ability and empathy satisfaction. The moderating effect test program of the mediating variable was used for multiple regression analysis, and equation 1 and equation 2 were established, respectively, with mental resilience and empathy satisfaction as the dependent variables. The results showed that in equation 1, the moderating effect of mental resilience on empathy × social support was not significant (β = -0.031, P > 0.05). In equation 2, empathy satisfaction had a significant moderating effect on psychological resilience × social support (β = 0.179, P < 0.01).

CONCLUSION

The level of empathy in elderly FD patients is low, which may be related to age and course of disease. Empathy ability, psychological resilience, social support, and empathy satisfaction are positively correlated, so we should attach importance to the role of psychological resilience in clinical work and provide a high level of social support, so as to improve the empathy satisfaction of elderly FD patients.

Validation of a 5-item tool to measure patient assessment of clinician compassion in the emergency department

Background

To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED).

Methods

Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach’s alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis.

Results

We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach’s alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction.

Conclusions

The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED.

Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil

OBJECTIVES

This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training.

DESIGN

A multicentric, observational, cross-sectional study.

SETTING

This study was conducted in three public teaching hospitals in Brazil.

PARTICIPANTS

From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females.

PRIMARY AND SECONDARY OUTCOME MEASURES

Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE).

RESULTS

This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments.

CONCLUSIONS

Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.

Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?

The practice of behavior analysis has become a booming industry with growth to over 30,000 Board Certified Behavior Analysts (BCBAs) who primarily work with children with autism and their families. Most of these BCBAs are relatively novice and have likely been trained in graduate programs that focus primarily on conceptual and technical skills. Successfully working with families of children with autism, however, requires critical interpersonal skills, as well as technical skills. As practitioners strive to respond efficiently and compassionately to distressed families of children with autism, technical skills must be balanced with fluency in relationship-building skills that strengthen the commitment to treatment. The current article provides an outline of important therapeutic relationship skills that should inform the repertoire of any practicing behavior analyst, strategies to cultivate and enhance those skills, and discussion of the potential effects of relationship variables on treatment outcomes.

Association between emergency physician self-reported empathy and patient satisfaction

Background

Higher physician self-reported empathy has been associated with higher overall patient satisfaction. However, more evidence-based research is needed to determine such association in an emergent care setting.

Objective

To evaluate the association between physician self-reported empathy and after-care instant patient-to-provider satisfaction among Emergency Department (ED) healthcare providers with varying years of medical practice experience.

Research design

A prospective observational study conducted in a tertiary care hospital ED.

Methods

Forty-one providers interacted with 1,308 patients across 1,572 encounters from July 1 through October 31, 2016. The Jefferson Scale of Empathy (JSE) was used to assess provider empathy. An after-care instant patient satisfaction survey, with questionnaires regarding patient-to-provider satisfaction specifically, was conducted prior to the patient moving out of the ED. The relation between physician empathy and patient satisfaction was estimated using risk ratios (RR) and their corresponding 95% confidence limits (CL) from log-binomial regression models.

Results

Emergency Medicine (EM) residents had the lowest JSE scores (median 111; interquartile range [IQR]: 107–122) and senior physicians had the highest scores (median 119.5; IQR: 111–129). Similarly, EM residents had the lowest percentage of “very satisfied” responses (65%) and senior physicians had the highest reported percentage of “very satisfied” responses (69%). There was a modest positive association between JSE and satisfaction (RR = 1.04; 95% CL: 1.00, 1.07).

Conclusion

This study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction, though minor heterogeneity occurred between different provider characteristics.

Mediating Effects of Patients' Stigma and Self-Efficacy on Relationships Between Doctors' Empathy Abilities and Patients' Cellular Immunity in Male Breast Cancer Patients

BACKGROUND Doctors' empathy is closely related to patients' health. This study aimed to examine whether patients' stigma and self-efficacy play a mediating role in the relationship between doctors' empathy abilities and patients' cellular immunity in male patients with breast cancer. MATERIAL AND METHODS Doctors' empathy scores and patients' demographic data, disease condition, stigma, and self-efficacy were measured. Patient T cell subset was tested at admission and 3 months after the operation and was compared by paired t test. The multivariate linear regression model was applied to analyze the factors influencing the immune index. Pearson correlation analysis and structural equation modeling were applied to explore the relationships among patients' stigma, self-efficacy, and cellular immunity and doctors' empathy abilities. RESULTS At the 2 time points, only the change in NK subset was statistically significant, while the changes in percentage of CD3+, CD4+, CD8+, and B cells were not statistically significant. The doctors' empathy abilities were negatively correlated with patients' stigma and were positively related to patients' self-efficacy. Patients' stigma was negatively related to NK subset, while self-efficacy was positively associated with NK subset. Patients' stigma and self-efficacy played a mediating role in the relationship between doctors' empathy abilities and patients' NK subset, and stigma had a stronger effect than self-efficacy. CONCLUSIONS Doctors' empathy abilities affected breast cancer patients' NK subset through their stigma and self-efficacy. The mental health of male breast cancer patients need more attention and empathy education needs to be improved.