The Perception of Physician Empathy by Patients with Inflammatory Bowel Disease

Using Virtual Patients to Support Empathy Training in Health Care Education: An Exploratory Study

INTRODUCTION

Empathy is essential for effective patient care. Yet, research shows suboptimal empathy in patient-practitioner interactions. Intelligent virtual patient simulations may offer an effective educational tool for empathy training. This observational study explored the quality of speech pathology of students' empathy responses in virtual patient simulations.

METHODS

Using the 7-point Empathic Communication Coding System (ECCS), we examined 72 students' empathic communication during a 12-week virtual patient interview series as part of their standard curriculum across 4 cohorts (a total of 388 empathic responses). The ECCS data were tallied and graphically displayed. We compared year groups (cohorts from 2015 to 2018), changes over semester, and differences between virtual patients.

RESULTS

Median ECCS scores were 4 of a maximum of 6 (interquartile range, 3) across all interviews. Most students (89%) scored between a level 2 (implicit recognition) and level 5 (confirmation) with only a few responses scoring at the lowest 2 levels of empathy (0: denial, 0.5%; 1: automatic recognition, 2%) or the highest level of empathy (6: shared feeling or experience, 9%). Students consistently acknowledged patients' feelings and often offered an action, solution, or reassurance. However, shared feelings or experiences were infrequent.

CONCLUSIONS

Although virtual patient simulations do not replace experiential learning such as simulation, standardized patients, and clinical practicum, they offer a safe environment to practice skills. This article provides support for designing larger controlled clinical trials and provides insights for educators on how to design virtual patient empathic opportunities of varying complexity for students.

May ChatGPT be a tool producing medical information for common inflammatory bowel disease patients' questions? An evidence-controlled analysis

Artificial intelligence is increasingly entering everyday healthcare. Large language model (LLM) systems such as Chat Generative Pre-trained Transformer (ChatGPT) have become potentially accessible to everyone, including patients with inflammatory bowel diseases (IBD). However, significant ethical issues and pitfalls exist in innovative LLM tools. The hype generated by such systems may lead to unweighted patient trust in these systems. Therefore, it is necessary to understand whether LLMs (trendy ones, such as ChatGPT) can produce plausible medical information (MI) for patients. This review examined ChatGPT's potential to provide MI regarding questions commonly addressed by patients with IBD to their gastroenterologists. From the review of the outputs provided by ChatGPT, this tool showed some attractive potential while having significant limitations in updating and detailing information and providing inaccurate information in some cases. Further studies and refinement of the ChatGPT, possibly aligning the outputs with the leading medical evidence provided by reliable databases, are needed.

Is the gender or age of the physician key to a good physician–patient with inflammatory bowel disease relationship?

BACKGROUND AND AIMS

A good patient-physician relationship in inflammatory bowel disease (IBD) is very important and physician empathy is its cornerstone. There is no evidence about if age and/or sex of physicians and patients could influence on perceived empathy by patients. The aim of the study was to assess the level of empathy of IBD specialist physicians perceived by their patients and if it varies according to the age and gender of the patient and the physician.

METHODS

We performed a national cross-sectional study based on voluntary online survey to IBD patients that included the Consultation and Relational Empathy (CARE) scale.

RESULTS

Five hundred sixty one responses to the survey were received. After applying exclusion criteria, 536 patients were included in the analysis. Total median score of CARE scale was 44.5 (maximum possible score: 50 points). Most of the patients (99.1%) considered the contents of the questionnaire to be an important issue. There were no significant differences in CARE scale scores in function of patient/physician age range or gender [physician gender: males vs. females: median 46 vs. 44, p=0.139; physician age: <40 years, 40-60 years, >60 years: 45.5 vs. 44 vs. 44, p=0.328].

CONCLUSION

Spanish inflammatory bowel disease patients have a great physician empathy perception, which is the key to a good patient-physician relationship, and this fact is not influenced by age or gender of patients or inflammatory bowel disease specialist.

Evaluation of Physicians' Electronic Health Records Experience Using Actual and Perceived Measures

BACKGROUND

Inadequate electronic health record (EHR) interface design hinders the physician-EHR experience, which may lead to increase physician frustration and fatigue levels.

OBJECTIVES

The objective of this study was to examine the physician EHR experience by evaluating the congruency between actual and perceived measures among physicians with different EHR expertise and utilization levels.

METHODS

We conducted a cross-sectional EHR usability study of intensive care unit (ICU) physicians at a major Southeastern medical center. We used eye-tracking glasses to measure provider EHR-related fatigue and three surveys to measure the perceived EHR experience.

RESULTS

Of the 25 ICU physicians, 11 were residents, nine were fellows, and five were attending physicians. No significant differences were found between actual fatigue levels and their perceived EHR usability (p=0.159), workload (p=0.753), and satisfaction (p=0.773).

CONCLUSION

We found that there was low congruency between physicians' EHR-related fatigue and the perceived ratings for usability, satisfaction, and workload, which suggests using actual and perceived measures for a comprehensive assessment of the user experience. EHR-related fatigue may not be instantly felt by some physicians, hence the similar rating of perceived EHR experience among physicians.

The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review

Background

The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal.

Aims

In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle.

Methods

Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo.

Results

We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle.

Conclusions

The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01850-1.

Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain

OBJECTIVE

While the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism.

METHODS

A community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses.

RESULTS

Results revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates.

CONCLUSION

Chronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction.

PRACTICE IMPLICATIONS

Clinical training and practice should promote empathetic components of health communication within chronic pain treatment.

Inflammatory Bowel Disease Nurse-Practical Messages

Background and Objectives: Patients affected by inflammatory bowel diseases (IBDs) are complex patients with various problems from a clinical and psychological point of view. This complexity must be addressed by a multidisciplinary team, and an inflammatory bowel disease nurse can be the ideal professional figure to create a link between doctor and patient. The objective of this comprehensive review is to describe the figure of inflammatory bowel disease nurses and the various benefits that their introduction into a multidisciplinary team can bring, as well as a focus on how to become an inflammatory bowel disease nurse. Materials and Methods: A search on the PubMed database was performed by associating the terms “IBD” or “inflammatory bowel disease” with the Boolean term AND to the various issues addressed: “life impact”, “communication”, “fistulas”, “ostomy”, “diet”, “incontinence”, “sexuality”, “parenthood”, “fatigue”, “pain management”, and “follow up appointments”. Regarding the analysis of the benefits that the IBD nurse brings, the terms “IBD”, “inflammatory bowel diseases”, “Crohn’s disease”, and “ulcerative colitis” were used, associating them with the terms “benefit”, “costs”, “team”, and “patients”. Finally, regarding the focus on how to become an IBD nurse, an IBD nurse was interviewed. Results: An IBD nurse is a valuable nursing figure within the multidisciplinary team that takes care of patients with IBD because this nurse performs important functions from both a clinical assistance point of view (management of fistulas, ostomies, infusion of biological drugs) and an information and therapeutic education point of view (communication with patients, direct contact with patients by telephone or email). Furthermore, this nurse performs the “filter” function between doctor and patient, saving time for doctors that will be used for more outpatient visits. Conclusions: The introduction of an inflammatory bowel disease nurse is therefore recommended for multidisciplinary organizations dealing with the clinical course of patients suffering from IBD.

Perceptions of IBD within patient and community samples: a systematic review

Objective: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). Design: A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted.Results: The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD.Conclusion: For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.

[Quality of communication with the caregiver of pediatric patient]

INTRODUCTION

The deficiencies in the communication between the doctor and the patient have an impact on the care process and its therapeutic outcome. The objective of this study was to determine the perception of the information provided by treating physicians by parents or primary caregivers and the deficits observed in their relationship during the hospitalization of pediatric patients in high, medium and low complexity units.

MATERIALS AND METHODS

Descriptive study carried out from January to May 2017 at the Foundation Hospital de la Misericordia, Bogotá (Colombia), through an anonymous, self-filled survey during the hospital stay, consisting of a first part of open questions, and the second by a survey Likert type with qualitative variables. The qualitative variables evaluated through the survey were summarized in frequencies; in addition, the Kaiser-Meyer-Olkin test was performed with principal component analysis under a Varimax rotation.

RESULTS

Three hundred and eighty-seven primary caregivers were surveyed, 68.5% belonged to the general stay area, 20.4% to intermediate care and 11.1% to intensive care. Ninety percent of the respondents agreed on the way in which the patient's evolution was explained, expressing satisfaction with the information delivered, the language in which it was expressed and the interest towards their concerns; despite this, 41% indicated uncertainty regarding the medical evolution of their son.

CONCLUSIONS

An adequate warning was received regarding the medical information provided, the language used, the treatment of the patient and teaching the main caregiver about the pathology presented by the patient. The uncertainty regarding the evolution of patients is the factor that contributes the most to dissatisfaction with the quality of the information.