Providing support to patients in emotional encounters: A new perspective on missed empathic opportunities
ABSTRACT Studies have repeatedly found that providers miss 70-90% of opportunities to express empathy. Our study sought to characterize provider responses to patients' emotions, with the overall goal of better understanding reasons for lack of empathic response.
We analyzed 47 visits between patients and their providers. We defined empathic opportunities as instances where patients expressed a strong negative emotion. We then developed thematic categories to describe provider response.
We found a total of 29 empathic opportunities within 21 visits. Provider responses were categorized as ignore, dismiss, elicit information, problem-solve, or empathize. An empathic statement occurred at some point in the response sequence in 13/29 opportunities (45%). When problem-solving was the initial response, empathic statements rarely occurred in subsequent dialogue. Among the 16 instances with no empathic statements, providers engaged in problem-solving in 8 (50%).
Similar to other studies, we found providers missed most opportunities to respond empathically to patient emotion. Yet contrary to common understanding, providers often addressed the problem underlying the emotion, especially when the problem involved logistical or biomedical issues, as opposed to grief.
With enhanced awareness, providers may better recognize situations where they can offer empathy in addition to problem-solving.
SourceAvailable from: Stewart C Chang Alexander[Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: Seriously ill hospitalized patients and their loved ones are frequently faced with complex treatment decisions laden with expressions of emotional distress during palliative care (PC) consultations. Little is known about these emotional expressions or the compassionate responses providers make and how common these are in PC decision-making conversations. Objectives: To describe the types and frequency of emotional distress that patients and loved ones express and how providers respond to these emotions during PC decision-making consultations with seriously ill hospitalized patients. Methods: We used a quantitative descriptive approach to analyze 71 audio-recorded inpatient PC decision-making consultations for emotional distress and clinicians' responses to those emotions using reliable and established methods. Results: A total of 69% of conversations contained at least one expression of emotional distress. The per-conversation frequency of expressions of emotional distress ranged from 1 to 10. Anxiety/fear were the most frequently encountered emotions (48.4%) followed by sadness (35.5%) and anger/frustration (16.1%). More than half of the emotions related to the patient's feelings (53.6%) and 41.9% were related to the loved ones' own emotions. The majority of emotions were moderate in intensity (65.8%) followed by strong (20.7%) and mild (13.5%). Clinicians responded to a majority of emotions with a compassionate response (75.7%) followed by those with medical content (21.9%) and very few were ignored (1.3%). Conclusions: Expressions of emotional distress are common during PC consultations and are usually met with compassionate responses by the clinician.Journal of palliative medicine 03/2014; 17(5). DOI:10.1089/jpm.2013.0551 · 1.84 Impact Factor
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ABSTRACT: Objectives To investigate general practitioners’ (GPs’) and psychiatrists’ responses to emotional disclosures in consultations with patients with depression. Methods Thirteen patient consultations with GPs and 17 with psychiatrists were video-recorded and then analysed using conversation analysis (CA). Results Psychiatrists responded to patients’ emotional disclosures by attempting to clarify symptoms, by rational argumentation, or by offering an interpretation of the emotions from their own perspectives. GPs responded by claiming to understand the emotions or by formulating the patients’ statements, but without further exploring the emotions. Conclusion GPs displayed a greater engagement with patients’ emotions than psychiatrists. Their approach could be described as empathic, corresponding to a mentalizing stance. The different approaches taken by psychiatrists could represent conceptual differences and might affect fruitful interdisciplinary work. Psychiatric nurses’ responses to patients’ emotions must also be studied to complete our knowledge from psychiatry. Practice implications Experiences from training in mentalization could be used to develop physicians’ empathic or mentalizing approach. As most patients with depression are treated in primary care, developing GPs’ mentalizing capacity instead of offering didactic training could have a substantial effect in the population.Patient Education and Counseling 04/2014; DOI:10.1016/j.pec.2013.12.018 · 2.60 Impact Factor
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ABSTRACT: Objective: To examine the relationship between professional expression of empathy and agreement about decisions made in the consultation. Methods: Consultations between 86 individuals with diabetes and four dieticians were audio-recorded. Immediately following consultations patients and dieticians independently reported decisions made in a booklet. Audio-recordings were coded directly for empathy using an amended version of the empathic communication coding system (ECCS). Results: Empathy correlated significantly with patient and professional agreement about decisions made in the consultation (tau = .283, p = .0005). Multiple regression analysis indicates that for each dietician the greater the empathy the higher the level of agreement about decisions (p < .0005). Professional empathic response to patients statements of challenge was a significant factor in increasing agreement about decisions (p = .008). Conclusion: Results support the hypothesis that greater professional empathy will result in greater agreement about decisions made in consultations. Practice implications: Findings have implications for empathy training and provide guidance on the communication skills needed to support expression of empathy. Patient and professional agreement about decisions made provides a simple marker of effectiveness and highlights the importance of empathy as a seminal component of professional communication skills during a patient consultation.Patient Education and Counseling 05/2014; 96(2). DOI:10.1016/j.pec.2014.04.019 · 2.60 Impact Factor