Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

Visualizing Empathy in Patient-Practitioner Interactions Using Eye-Tracking Technology: Proof-of-Concept Study

Background

Communication between medical practitioners and patients in health care settings is essential for positive patient health outcomes. Nonetheless, researchers have paid scant attention to the significance of clinical empathy in these interactions as a practical skill.

Objective

This study aims to understand clinical empathy during practitioner-patient encounters by examining practitioners' and patients' verbal and nonverbal behaviors. Using eye-tracking techniques, we focused on the relationship between traditionally assessed clinical empathy and practitioners' actual gaze behavior.

Methods

We used mixed methods to understand clinical encounters by comparing 3 quantitative measures: eye-tracking data, scores from the Korean version of the Jefferson Scale of Empathy-Health Professional, and Consultation and Relational Empathy survey scores. We also conducted qualitative interviews with patients regarding their encounters.

Results

One practitioner and 6 patients were involved in the experiment. Perceived empathy on the part of the practitioner was notably higher when the practitioner focused on a patient's mouth area during the consultation, as indicated by gaze patterns that focused on a patient's face. Furthermore, an analysis of areas of interest revealed different patterns in interactions with new as opposed to returning patients. Postconsultation interviews suggested that task-oriented and socially oriented empathy are critical in aligning with patients' expectations of empathetic communication.

Conclusions

This proof-of-concept study advocates a multidimensional approach to clinical empathy, revealing that a combination of verbal and nonverbal behaviors significantly reinforces perceived empathy from health care workers. This evolved paradigm of empathy underscores the profound consequences for medical education and the quality of health care delivery.

Evaluation of regional variation in racial and ethnic differences in patient experience among Veterans Health Administration primary care users

OBJECTIVE

To evaluate racial and ethnic differences in patient experience among VA primary care users at the Veterans Integrated Service Network (VISN) level.

DATA SOURCE AND STUDY SETTING

We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients-Patient Centered Medical Home for fiscal years 2016-2019.

STUDY DESIGN

We compared 28 patient experience measures (six each in the domains of access and care coordination, 16 in the domain of person-centered care) between minoritized racial and ethnic groups (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic, Multi-Race, Native Hawaiian or Other Pacific Islander [NHOPI]) and White Veterans. We used weighted logistic regression to test differences between minoritized and White Veterans, controlling for age and gender.

DATA COLLECTION/EXTRACTION METHODS

We defined meaningful difference as both statistically significant at two-tailed p < 0.05 with a relative difference ≥10% or ≤-10%. Within VISNs, we included tests of group differences with adequate power to detect meaningful relative differences from a minimum of five comparisons (domain agnostic) per VISN, and separately for a minimum of two for access and care coordination and four for person-centered care domains. We report differences as disparities/large disparities (relative difference ≥10%/≥ 25%), advantages (experience worse or better, respectively, than White patients), or equivalence.

PRINCIPAL FINDINGS

Our analytic sample included 1,038,212 Veterans (0.6% AIAN, 1.4% Asian, 16.9% Black, 7.4% Hispanic, 0.8% Multi-Race, 0.8% NHOPI, 67.7% White). Across VISNs, the greatest proportion of comparisons indicated disparities for three of seven eligible VISNs for AIAN, 6/10 for Asian, 3/4 for Multi-Race, and 2/6 for NHOPI Veterans. The plurality of comparisons indicated advantages or equivalence for 17/18 eligible VISNs for Black and 12/14 for Hispanic Veterans. AIAN, Asian, Multi-Race, and NHOPI groups had more comparisons indicating disparities by VISN in the access domain than person-centered care and care coordination.

CONCLUSIONS

We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation.

What makes a good general practice consultation? An exploratory pilot study with people from a low socioeconomic background

BACKGROUND

While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations.

AIM

To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences.

DESIGN & SETTING

This exploratory pilot study was performed in GP clinics in Melbourne, Australia.

METHOD

We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers.

RESULTS

The following four categories were developed: 1) the doctor's demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor's therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP.

CONCLUSION

For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area.

Experiences of physical healthcare services in Māori and non-Māori with mental health and substance use conditions

OBJECTIVES

Inequities in physical health outcomes exist for people with mental health and substance use conditions and for Indigenous populations (Māori in Aotearoa New Zealand). These inequities may be partly explained by poorer quality of physical healthcare services, including discrimination at systemic and individual levels. This study investigated the experiences of people with mental health and substance use conditions accessing physical healthcare and differences in service quality for non-Māori relative to Māori.

METHODS

A cross-sectional online survey of people with mental health and substance use conditions in New Zealand asked about four aspects of service quality in four healthcare settings: general practice, emergency department, hospital and pharmacy. The quality domains were: treated with respect; listened to; treated unfairly due to mental health and substance use conditions; mental health and substance use condition diagnoses distracting clinicians from physical healthcare (diagnostic and treatment overshadowing).

RESULTS

Across the four health services, pharmacy was rated highest for all quality measures and emergency department lowest. Participants rated general practice services highly for being treated with respect and listened to but reported relatively high levels of overshadowing in general practice, emergency department and hospital services. Experiences of unfair treatment were more common in emergency department and hospital than general practice and pharmacy. Compared to Māori, non-Māori reported higher levels of being treated with respect and listened to in most services and were more likely to report 'never' experiencing unfair treatment and overshadowing for all health services.

CONCLUSION

Interventions to address discrimination and poor-quality health services to people with mental health and substance use conditions should be tailored to the physical healthcare setting. More needs to be done to address institutional racism in systems that privilege non-Māori.

Quantitative Analysis of Challenges Encountered by UK Widening Participation Medical Students in Comparison With Their Non-Widening Participation Peers

OBJECTIVES

Few studies have captured the experiences of widening participation (WP) medical students, and none have compared their experiences to their non-WP peers. This study aims to identify which challenges WP students are more likely to face.

METHODS

A 22-item questionnaire was distributed to medical students across all UK medical schools. Students were asked yes or no questions on whether they faced challenges in finances, socializing, physical and mental health, academic attainment, and COVID19-related teaching changes.

RESULTS

One-hundred seventy-six medical students from all year groups across the UK responded, with 97 students from a WP background. WP students were significantly more likely to have their personal background impacting their mental health (OR = 2.65, WP  =  0.002), more than twice as likely to feel that their job impacted their studies (OR = 2.53, P ≤.05), more likely to feel limited by their financial situation (OR = 2.29, P≤.05) and to receive support from student finance (OR = 2.08, P < .05).

CONCLUSION

WP students were more likely to face challenges in mental health and finances in medical school compared to their peers. These findings, further informed by qualitative insights can aid in advancing equity in medical training.

Psychometric evaluation of the 'Jefferson Scale of Empathy' in a sample of nursing students in the United Kingdom

AIM

To examine the psychometric properties of the 'Jefferson Scale of Empathy'.

DESIGN

A methodological study was conducted.

METHODS

A sample of 230 nursing students was used to analyse the psychometric properties of the 'Jefferson Scale of Empathy'. Exploratory and confirmatory factor analysis was used to test construct validity. Cronbach's alpha and item-total correlations were carried out to test internal consistency reliability.

RESULTS

The mean score of the empathy SUM was 112.0 (SD: 12.6). A three-factor model was explored. This factor structure does not replicate the original 'Jefferson Scale of Empathy' when it was validated with medical students, but it is in line with later research with nursing students. The Cronbach's alpha coefficient was 0.80 for the SUM and 0.80-0.84 for individual items. Item-total correlation coefficients were 0.01-0.63.

NO PATIENT OR PUBLIC CONTRIBUTION

Because this study focused on nursing students. No patients or the public were involved.

Creation and Validation of the Select Medical Patient Reported Experience Measure for Physical and Occupational Therapy Outpatient Clinics

OBJECTIVE

This study describes the creation and examination of the internal consistency, content validity, construct/structural validity, and criterion/concurrent validity of the Select Medical Patient Reported Experience Measure (SM-PREM).

DESIGN

Observational study design.

SETTING

1054 Outpatient physical and occupational therapy locations in North America.

PARTICIPANTS

The study included 89,205 patients with various musculoskeletal disorders (N=89,205).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Content validity was described, and internal consistency, construct/structural validity (factor analysis), and criterion/concurrent validity were analyzed, with concurrent validity compared against patient reported outcomes (PROM), the Net Promoter Scale, and the Orebro Musculoskeletal Screening Questionnaire-12.

RESULTS

Exploratory and confirmatory factor analysis of the SM-PREM yielded 3 dimensions, each with a very strong internal consistency (>.850). The SM-PREM yielded statistically significant results in all areas, with values that reflected minimal to fair association with PROMs.

CONCLUSION

The SM-PREM appears to capture a unique construct compared to PROMs. The 11-item tool has 3 definitive dimensions and exhibits strong internal consistency. The tool may be useful in examining patient experience in patients with musculoskeletal injuries seen by physical and occupational therapists.

Effect of Clinician-Expressed Empathy in Advanced Cancer on Different Ethnic Groups: Results from an Experimental Video-Vignette Study

Background: In advanced cancer, clinician-expressed empathy can improve patients' psychological outcomes. It remains unknown whether all patients benefit equally from empathy. Objective: To explore whether the effect of clinician-expressed empathy on patients' psychological outcomes is moderated by patient ethnicity. Methods: Using an experimental video-vignette design, 160 participants watched a consultation-video with/without added empathy. Using regression analysis, the moderating effect of ethnicity (non-Western- vs. Dutch/Western-immigration background) on the relationship between empathy and psychological outcomes was assessed. Results: The main effect of empathy on satisfaction (p = 0.001), trust (p = 0.002), and self-efficacy (p < 0.001) was moderated by ethnicity (satisfaction, p = 0.050; trust, p = 0.066; self-efficacy, p = 0.075). No main effect of empathy nor moderation by ethnicity was found for anxiety (state anxiety: p = 0.284, p = 0.319; current anxiety: p = 0.357, p = 0.949). No main effects of ethnicity (satisfaction, p = 0.942; trust, p = 0.724; self-efficacy, p = 0.244; state anxiety, p = 0.812; current anxiety p = 0.523) were found. Conclusion: In advanced cancer, non-Western patients might benefit most from empathy. Dutch Trial Registration Number: NTR NL8992.

Quantitative measurement of empathy and analysis of its correlation to clinical factors in korean patients with chronic diseases

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.

Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial

OBJECTIVES

To compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised patients would report more negative experiences than typical exit interviews affected by social desirability bias.

SETTING

Cross-sectional surveys in 16 government-operated HIV primary care clinics in Lusaka, Zambia providing antiretroviral therapy (ART).

PARTICIPANTS

3526 participants aged ≥18 years receiving ART participated in the exit surveys between August 2019 and November 2021.

INTERVENTION

Systematic sample (every nth file) of patients in clinic waiting area willing to be trained received pre-visit training and post-visit interviews. Providers were unaware of trained patients.

OUTCOME MEASURES

We compared patient experience among patients who received brief training prior to their care visit (explaining each patient experience construct in the exit survey, being anonymous, without manipulating behaviour) with those who did not undergo training on the survey prior to their visit.

RESULTS

Among 3526 participants who participated in exit surveys, 2415 were untrained (56% female, median age 40 (IQR: 32-47)) and 1111 were trained (50% female, median age 37 (IQR: 31-45)). Compared with untrained, trained patients were more likely to report a negative care experience overall (adjusted prevalence ratio (aPR) for aggregate sum score: 1.64 (95% CI: 1.39 to 1.94)), with a greater proportion reporting feeling unwelcome by providers (aPR: 1.71 (95% CI: 1.20 to 2.44)) and witnessing providers behaving rude (aPR: 2.28 (95% CI: 1.63 to 3.19)).

CONCLUSION

Trained patients were more likely to identify suboptimal care. They may have understood the items solicited better or felt empowered to be more critical. We trained existing patients, unlike studies that use 'standardised patients' drawn from outside the patient population. This low-cost strategy could improve patient-centred service delivery elsewhere.

TRIAL REGISTRATION NUMBER

Assessment was nested within a parent study; www.pactr.org registered the parent study (PACTR202101847907585).

Methodological innovations to strengthen evidence-based serious illness communication

BACKGROUND/OBJECTIVE

A growing population of those affected by serious illness, prognostic uncertainty, patient diversity, and healthcare digitalization pose challenges for the future of serious illness communication. Yet, there is paucity of evidence to support serious illness communication behaviors among clinicians. Herein, we propose three methodological innovations to advance the basic science of serious illness communication.

RESULTS

First, advanced computation techniques - e.g. machine-learning techniques and natural language processing - offer the possibility to measure the characteristics and complex patterns of audible serious illness communication in large datasets. Second, immersive technologies - e.g., virtual- and augmented reality - allow for experimentally manipulating and testing the effects of specific communication strategies, and interactional and environmental aspects of serious illness communication. Third, digital-health technologies - e.g., shared notes and videoconferences - can be used to unobtrusively observe and manipulate communication, and compare in-person to digitally-mediated communication elements and effects. Immersive and digital health technologies allow integration of physiological measurement (e.g. synchrony or gaze) that may advance our understanding of patient experience.

CONCLUSION/PRACTICE IMPLICATIONS

New technologies and measurement approaches, while imperfect, will help advance our understanding of the epidemiology and quality of serious illness communication in an evolving healthcare environment.

The Role of Compassionate Care in Medicine: Toward Improving Patients' Quality of Care and Satisfaction

INTRODUCTION

Despite its description as a cornerstone of a healthcare provider's professional identity, the impact of compassionate care on various aspects of medicine has been poorly defined. In this review, we aimed to elucidate the role of compassionate care in various aspects of medicine and healthcare delivery.

METHODS

Four databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for a literature review regarding compassionate care and its intersection with medical education, patient-provider communication, patient care, and clinical outcomes, patient and provider characteristics, telemedicine and artificial intelligence, caregiver compassion fatigue, and cost of care.

RESULTS

Twenty-two articles met the inclusion criteria. Analysis revealed that clinical outcomes are correlated with the degree of patients' perception of empathy and compassion from their providers. Along with enhanced patient outcomes, compassionate care was shown to reduce the costs of care, compassion fatigue and burnout, and the number of malpractice claims. However, compassion can be perceived differently among patients of various cultural and ethnic backgrounds. Compassion training sessions can be implemented among residents in surgical and nonsurgical medical specialties to improve perceived compassion. Furthermore, the use of telehealth modalities may positively or negatively impact compassionate care, requiring further exploration.

CONCLUSIONS

Compassionate care plays a crucial role in improving patient care and clinical outcomes while reducing caregiver burnout and the risk of malpractice litigation. However, a lack of compassion training and caregiver compassion fatigue may detract from the delivery of effective compassionate care.

PATIENT-CENTERED CARE AND SELF-MANAGEMENT: OPINION OF MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE

OBJECTIVE

The aim: Тo determin attitude of military personnel with coronary artery disease to implementation of the principles of patient- centered care and self-assessment of adherence to treatment.

PATIENTS AND METHODS

Materials and methods: 72 military personnel (male aged 30-58 years) with coronary artery disease, who visited the general practitioners at the Outpatient Care Clinic of the National Military Medical Clinical «Main Military Clinical Hospital» were interviewed anonymously, using the specially designed questionnaire. The patients were divided into two groups: the 1st group with individuals of 49 years old and younger (39 military personnel, mean age 42,8«5,0) and the 2nd group who is 50 years and older (33 military personnel, mean age 53,2«2,4 years).

RESULTS

Results: The results of a sociological survey showed that the majority of military personnel with coronary artery disease believe that doctors do not always provide them with enough information about their health (61,1%) and they do not always provide emotional support to solve their health problems (66,7 %). It has been indicated a mismatch between patients' willingness to participate in shared decision-making regarding a treatment (84,7 % of them) and adher¬ence to treatment - 55,6% of surveyed patients rated adherence to treatment by three points or less on a five-point scale. There is no statistically significant difference between military personnel of the 1st and 2nd groups.

CONCLUSION

Conclusions: The results of the study showed the interest and readiness of surveyed military personnel with coronary artery disease to implementation of the principles of patient-centered medical care.

A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis

BACKGROUND/OBJECTIVES

There is limited research on the associated immediate and long-term outcomes of postpartum hemorrhage. Mothers with a pre-existing psychiatric disease prior to delivery may be especially vulnerable to postpartum hemorrhage outcomes but little is known on this topic. Barriers to studying this population exist and add to knowledge gaps. The goal of this study is to determine the clinical characteristics and frequency of complications within 1 year of a postpartum hemorrhage diagnosis and the psychiatric sequelae within 7 days of a postpartum hemorrhage diagnosis in mothers with a pre-existing mental health diagnosis prior to delivery versus those without.

METHODS/DESIGN

This is a multicenter retrospective observational cohort study using TriNetX, a de-identified electronic health record database. The following electronic health record data were collected and evaluated in postpartum females who were billed for either a vaginal or cesarean delivery: age, race, ethnicity, diagnostic codes, medication codes, and number of deaths.

RESULTS

We included 10,649 subjects (6994 (65.7%) no mental health diagnosis and 3655 (34.3%) pre-existing mental health diagnosis). Haloperidol administration (118 (3.2%) versus 129 (1.8%), p < 0.001) was more prevalent in subjects with a pre-existing mental health diagnosis. Adjusting for demographics, pre-existing mental health diagnoses were associated with complications within 1 year after postpartum hemorrhage diagnosis (OR = 1.39, 95% CI: 1.26-1.52, p < 0.001).

CONCLUSION

Having a mental health disorder history is associated with a higher odds of developing subsequent complications within 1 year of postpartum hemorrhage diagnosis. Mothers with a pre-existing mental health disorder have a significantly higher frequency of certain severe postpartum hemorrhage sequelae, including acute respiratory distress syndrome, retained placenta, sickle cell crisis, and need for mechanical ventilation/tracheostomy up to 1 year after delivery. Medications such as haloperidol were ordered more frequently within 7 days of a postpartum hemorrhage diagnosis in these mothers as well. Further research is needed to understand and manage the unique consequences of postpartum hemorrhage in this vulnerable maternal population.

Frequency and Results of Pregnancy Screening in Critically Ill Adolescents in Multiple Health Care Organizations

PURPOSE

Adolescent females may undergo pregnancy screening while receiving critical care services, but the frequency and results are unknown. The objectives of this study are to evaluate patient characteristics, pregnancy screening frequency, and rate of positive pregnancy screens in adolescent females of childbearing age who require critical care services. We hypothesize that when adolescent pregnancy screening is performed in the critical care setting, it occurs in a higher frequency in older subjects.

METHODS

This is a multicenter retrospective observational cohort study utilizing TriNetX, an electronic health record database. The following electronic health record data were collected and evaluated in adolescent females aged 12-18 years and billed for critical care services: age, race, ethnicity, diagnostic codes, selected radiology and surgical procedure codes, number of deaths, pregnancy screening laboratory codes, and pregnancy screening results.

RESULTS

A total of 5,241 subjects (2,242 [42.8%] subjects for whom pregnancy screen was noted and 2,999 [57.2%] subjects for whom it was not noted) were included in this study. Subjects aged 15-18 years (odds ratio = 1.56, 95% confidence interval = 1.38-1.77, p value < .0001) and had Hispanic or Latina ethnicity (odds ratio = 1.46, 95% confidence interval = 1.28-1.66, p value < .0001) had a higher association with pregnancy screening. A positive pregnancy screen was identified in 18 (0.8%) subjects.

DISCUSSION

In our study, positive pregnancy screens were infrequent, not all subjects were screened, and there was an association between pregnancy screening and ethnicity. Because of the potential for screening bias, this study suggests that clinicians should strongly consider routine pregnancy screening for all females of childbearing age and that hospital policies should require this type of screening.

Empathic Communication in Specialty Palliative Care Encounters: An Analysis of Opportunities and Responses

Background: Although empathic responding is considered a core competency in specialty palliative care (PC), patterns of empathic communication in PC encounters are not well understood. Objectives: In this secondary analysis, we delineate types and frequency of empathic communication and examine relationships between patient empathic opportunities and clinician responses. Design: We used the Empathic Communication Coding System to analyze empathic opportunities across three types: emotion (i.e., negative affective state), progress (i.e., stated recent positive life event or development), and challenge (i.e., stated problem or recent, negative life-changing event) and clinician responses. Setting/Subjects: Transcripts from a pilot randomized trial of communication coaching in specialty PC encounters (N = 71) audio-recorded by 22 PC clinicians at two sites in the United States: an academic health system and a community-based hospice and PC organization. Results: Empathic opportunities were frequent across encounters; clinicians often responded empathically to those opportunities (e.g., confirming or acknowledging patients' emotions or experiences). Even though challenge empathic opportunities occurred most frequently, clinicians responded empathically more often to progress opportunities (i.e., 93% of the time) than challenge opportunities (i.e., 75% of the time). One in 12 opportunities was impeded by the patient or a family member changing the topic before the clinician could respond. Conclusions: PC patients frequently express emotions, share progress, or divulge challenges as empathic opportunities. Clinicians often convey empathy in response and can differentiate their empathic responses based on the type of empathic opportunity. PC communication research and training should explore which empathic responses promote desired patient outcomes.

Spotlight on noncognitive skills: Views from nursing students and educators

BACKGROUND

Noncognitive skills have a considerable role in influencing nursing students' performance in clinical and educational settings. Understanding how nursing students and educators perceive noncognitive skills is important given the broad classifications of noncognitive competencies.

OBJECTIVE

This study sought to examine nursing students' and educators' perception of noncognitive skills.

DESIGN

This study adopted a descriptive qualitative approach.

SETTING

This study was conducted virtually via Zoom in one university in Singapore.

PARTICIPANTS

Purposive sampling through a maximum variation technique was used to select 35 nursing students and 12 educators.

METHODS

Semistructured interviews were conducted through eight virtual face-to-face focus group discussions. Interviews were audio- and videorecorded and transcribed verbatim. Data were analysed through thematic analysis.

RESULTS

The participants stated that individual and interpersonal skills contribute to one's noncognitive skills. Two themes emerged from the participants' narratives: (1) the ability to manage oneself and (2) social interactions with others. The first theme describes the various individual characteristics such as growth mindset, adaptability, resilience, and emotional regulation. The second theme describes the importance of empathy and meaningful relationships as types of non-cognitive skills.

CONCLUSIONS

The findings of this study provide the basis for the development of noncognitive assessment tools by educators. In addition, they pave the foundation for the curation of future programs that promote the noncognitive skills of nursing students. Hospital-based educators may use these findings to curate suitable programs for improving the noncognitive abilities of nurses.

Possible alleviation of symptoms and side effects through clinicians' nocebo information and empathy in an experimental video vignette study

To alleviate anti-cancer treatment burden in advanced breast cancer, patient-clinician communication strategies based on nocebo-effect mechanisms are promising. We assessed distinct/combined effects on psychological outcomes (e.g. anxiety; main outcome) and side-effect expectations of (1) nocebo information about the (non)pharmacological origin of side effects, and (2) clinician-expressed empathy through reassurance of continuing support. Furthermore, we explored whether information and empathy effects on side-effect expectations were mediated by decreased anxiety. In a two-by-two experimental video-vignette design, 160 cancer patients/survivors and healthy women watched one of four videos differing in level of nocebo information (±) and empathy (±). Regression and mediation analysis were used to determine effects of information/empathy and explore anxiety's mediating role. Anxiety was not influenced by empathy or information (Stai-state: p = 0.295; p = 0.390, VAS p = 0.399; p = 0.823). Information improved (specific) side-effect coping expectations (p < 0.01). Empathy improved side-effect intensity expectations (p < 0.01 = specific; p < 0.05 = non-specific/partial) and specific side-effect probability expectations (p < 0.01), and increased satisfaction, trust, and self-efficacy (p < 0.001). No mediating effects were found of anxiety on expectations. Mainly empathy, but also nocebo information improved psychological outcomes and-mainly specific-side-effect expectations. Exploring the power of these communication elements in clinical practice is essential to diminish the anti-cancer treatment burden in advanced breast cancer.

Quality of Care for Youth Hospitalized for Suicidal Ideation and Self-Harm

OBJECTIVE

To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization.

METHODS

Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions.

RESULTS

Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07-2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24-0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28-0.83).

CONCLUSIONS

This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.