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Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients
Abstract
Objective:
There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.
Methods:
Participants were recruited by a press report in local newspapers.
Inclusion criteria:
adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.
Results:
In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.
Conclusion:
Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.
Practice implications:
More explicit attention should be given to empathy during medical education in general and during vocational GP-training.
... Research has shown that healthcare practitioners who interact with their patients in an empathic manner, can contribute to an increase their patients' comfort, are able to build trusting relationships with them and encourage clients to adhere to their treatment programmes [11][12][13][14][15] . Healthcare practitioners refer to individuals who support health and well-being in people through the implementation and administration of the principles and procedures of evidencebased practice 16 . ...
... However, high caseloads, stressors and pressure to perform and be successful in treating clients often have a negative influence on empathy levels 17 . Clients, or patients, who are dissatisfied with practitioners due to a lack of empathy, lead to feelings of distress and this may cause them to lose faith in the healthcare system, whereas the presence of empathy results in feelings of satisfaction, relief and trust 13 . Furthermore, it has been noted that in addition to empathy declining during the course of studying in a healthcarerelated field, countless students fail to recognise the value of this important skill concerning their future profession 18 . ...
... Furthermore, the absence of empathy in healthcare negatively impacts the therapeutic relationship 8,13,25 . It has been suggested in the literature that occupational therapy students' style of clinical practice is influenced by their empathy levels, whereas lower levels of empathy ultimately make them more vulnerable to work-related stress and consequent burnout 38 . ...
INTRODUCTION: Empathy, often described as the comprehension of another person's state of mind, enables one to appreciate social environments and anticipate others' behaviour. In occupational therapy, the therapeutic use of self, which is grounded in empathy, is commonly considered essential, as it enables therapists to manage a therapeutic relationship with clients. However, high caseloads, stressors and pressure to perform often impact empathy levels. This study aimed to determine the empathy levels of undergraduate occupational therapy students, as well as factors affecting empathy levels METHOD: A quantitative approach was used, with an observational, cross-sectional study methodology, employing an electronic survey consisting of the Interpersonal Reactivity Index (IRI) and a questionnaire developed by the researchers RESULTS: In total, 112 (response rate 70.4%) students participated in the study. Overall, the students had a satisfactory level of empathy. Of concern, however, was the impact of the Covid-19 pandemic and the lack of clinical fieldwork experience, which possibly contributed to the lower empathy levels observed among second-and third-year students CONCLUSION: From the findings, it is suggested that more attention should be given to empathy, as it plays an integral role in practice with clients, as well as in the training of occupational therapy students Implications for practice The findings suggest the opportunity for interventions and support systems that can help students manage high caseloads, stressors, and performance pressures, while also fostering and maintaining empathy. Implementing strategies such as stress management programs, mindfulness training, and self-care initiatives can help mitigate the negative impact on empathy levels and promote the development of empathetic skills in future occupational therapists. The research study's results have implications for the professional practice of occupational therapy. It emphasizes the need for ongoing education and training programs that focus on empathy development and maintenance throughout a therapist's career. By providing therapists with the tools, resources, and support to sustain their empathy levels in challenging work environments, the study suggests that the quality of care provided to clients can be enhanced, leading to better therapeutic outcomes and overall client satisfaction. Organizational changes within healthcare settings may be necessary to address workload issues and create a supportive environment that nurtures empathy among occupational therapy professionals.
... Frequent attenders do not consider only the medical aspects of consultations; rather, they place equal or greater emphasis on their interaction with healthcare professionals. Patients consider empathy essential for a good relationship with healthcare professionals (Derksen et al., 2017) and expect healthcare professionals to listen and take interest in them (Derksen, Olde Hartman, Bensing, & Lagro-Janssen, 2018). Healthcare professionals tend to avoid discussing emotional issues when patients express concerns; instead, they focus on medical aspects (Mjaaland, Finset, Jensen, & Gulbrandsen, 2011) or emphasize efficiency in making a diagnosis (Roh & Park, 2016). ...
... Healthcare professionals tend to avoid discussing emotional issues when patients express concerns; instead, they focus on medical aspects (Mjaaland, Finset, Jensen, & Gulbrandsen, 2011) or emphasize efficiency in making a diagnosis (Roh & Park, 2016). Such a lack of empathy may lead to a lack of understanding and make it more difficult to solve the patient's problems (Derksen et al., 2017). Accordingly, frequent attenders felt that healthcare professionals did not fully understand them or their needs. ...
... Some frequent attenders also felt that they did not deserve care, indicating that a lack of empathy may cause some to avoid consultations (Derksen et al., 2017). Previous negative experiences of consultations can also affect frequent attenders' expectations of future healthcare encounters and may adversely affect their efforts to create trustful relationships with healthcare professionals. ...
Rather than measure demographic factors such as socioeconomics, the aim of this study was to examine the lived experience of frequent attenders by synthesizing findings on their encounters with healthcare personnel. The Scopus, CINAHL, PsycARTICLES, and PubMed (Medline) databases were searched in May 2020 in order to screen studies by title and abstract (n = 1794) and full‐text (n = 20). Findings from the included studies (n = 6) were then pooled using meta‐aggregation, yielding the following results: difficulties in resolving frequent attenders' situations may create “service circles,” frustrating patients with their situation; frequent attenders' own expertise regarding their condition should be recognized and valued alongside that of healthcare professionals when performing collaborative care; a lack of empathy and disparagement may make frequent attenders feel misunderstood and unappreciated; frequent attenders should be recognized as individuals by taking their circumstances into account and providing support accordingly. Frequent attenders' experiences demonstrate the importance of shared decision‐making, continuity of care, and acknowledging these patients' individual circumstances. Identifying the variety of frequent attenders' service needs by synthesizing their experiences is a practical way of organizing patient‐centered healthcare services.
... 12 13 15 This could be addressed via the implementation of the ASP pathway as in this study, where parents/ caregivers are engaged to complete the developmental surveillance programme during opportunistic GP visits with opportunities for ongoing monitoring. In NSW, a similar project, the WMG-E, has been implemented to engage parents/caregivers using opportunistic contacts to complete developmental checks digitally and thereafter sends automated reminders for parents to retake the developmental checks at the next recommended ages and stages (6,12,18,24,36,48 and 60 months), thereby providing opportunity for ongoing developmental monitoring. 16 17 The Victorian Maternal and Child Health service provides universal access to all Victorian children for 10 'key age and stage' assessments (after-birth home visit; visits of 2, 4 and 8 weeks; visits of 4, 8, 12 and 18 months; and visits of 2 and 3.5 years). ...
... Such gaps between expectations and actual experiences have been reported in other studies which have linked negative patient experience/ well-being to poor communication or connectedness between patients and doctors, inability to trust and time pressure. [47][48][49] It would appear that, by providing a framework for parents to raise concerns and for GPs to provide appropriate assessments and referrals for children's developmental needs as done in the ASP pathway will help address this issue. ...
Objectives
Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting.
Design
This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, ‘General Practice Surveillance for Autism’, a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically.
Participants
Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed.
Settings
All interviews were completed over the phone.
Results
There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient–doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers.
Conclusion
The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting.
Trial registration number
ANZCTR (ACTRN12619001200178).
... The second variable that influenced PCCC was empathy; thus, supporting previous studies that show that empathy is not only a key factor for PCCC, but also that the two are highly correlated [10,39,40]. Derksen et al. [40] also found that empathy could be used to build supportive relationships while enhancing patient comfort. ...
... The second variable that influenced PCCC was empathy; thus, supporting previous studies that show that empathy is not only a key factor for PCCC, but also that the two are highly correlated [10,39,40]. Derksen et al. [40] also found that empathy could be used to build supportive relationships while enhancing patient comfort. As nurses must play key roles in determining the needs of patients through individualized approaches rather than solely focusing on acute treatments, this requires continual practical revisions of the nursing curriculum to ensure that empathy is highlighted and properly developed. ...
Recent health care developments have emphasized person-centered care, which highlights individualized treatments rather than focusing solely on the nature of a given disease. Thus, we aim to identify the factors and construct a structural equation model for developing person-centered care competency among senior nursing students based on the social cognitive career theory and a subsequent literature review. We use a hypothetical model to examine the factors influencing person-centered care competency, and using a structured questionnaire, and we collect data on self-awareness, the clinical learning environment, clinical practicum adaptation, nursing professionalism, empathy, and person-centered care competency. The participants include 383 third- and fourth-year senior nursing students who had undergone at least one semester of clinical practice in South Korea. SPSS/WIN 26.0 is used to analyze all obtained data, while AMOS 25.0 is used for structural equation modeling. The final model is confirmed to be suitable for explaining and predicting person-centered care competency among participants. Nursing professionalism, empathy, clinical practicum adaptation, self-awareness, and the clinical learning environment explained 38.8% of the total variance among participants. Strategies and interventions designed to enhance person-centered care competency for senior nursing students should particularly focus on nursing professionalism, empathy, clinical practicum adaptation, self-awareness, and the clinical learning environment.
... Patients state that an empathic communication with their GP facilitates a more personal relationship with them. They also experience that an absence of empathy in the meeting with their GP leads to frustration (Derksen et al., 2017). Another reason for empathy as a relevant measure in the current study is that when a person is being cared for via telephone it entails a form of care that risks depersonalizing the caller. ...
... It has been shown that training among students can increase self-efficacy and empathy (Li et al., 2019), and several studies have revealed that it is possible to increase the level of empathy among nurses (Brunero et al., 2010;Cunico et al., 2012;Ward, 2016). Training TNs' empathic ability could also be beneficial to patients, as it has been found that they experience empathic meetings with GPs as more personal (Derksen et al., 2017). Furthermore, empathy training could be useful considering that the use of technology, including the telephone, entails a higher risk of objectifying the person calling than in a physical meeting (Nagel & Penner, 2015). ...
Aim
To examine telephone nurses' perceived stress, self-efficacy and empathy in their work with answering calls from frequent callers.
Design
The study is a quantitative questionnaire survey study with a comparative design.
Methods
Telephone nurses (N = 199) answered a survey containing three instruments: Perceived Stress Scale, General Self-Efficacy Scale and Jefferson's Scale of Empathy. Correlation analysis, multiple regression analysis and analysis of variance were performed to test the research questions.
Results
Significant negative correlations were found between stress involving calls from FCs and self-efficacy (r = −.238), and significant negative correlations between stress involving calls from frequent callers and empathy (r = −.185). It was further revealed that telephone nurses who had worked less than 30 years scored higher on Jefferson's Scale of empathy than those who had worked more than 30 years, F(1, 183) = 4.98, η² = 0.027.
... Empathy-focused education is becoming increasingly popular in health professions education [7,18]. The term "integrated curriculum" has gained popularity in medical education over the past two decades, with many South Asian medical schools transitioning to problem-based learning curricula [19]. However, research on the impact of these curricula on professional skills like empathy and communication remains limited, despite most studies focusing on curriculum implementation. ...
Background: Empathy is a defining trait for healthcare professionals as it fosters trust and understanding between providers and patients. In medical and dental education, empathy is required for enhancing protective health outcomes. Empathy levels vary among medical students throughout their medical schooling and are impacted by factors such as curriculum structure, clinical exposure, and personal characteristics. Objectives: This study aimed to compare empathy scores corresponding to different levels of curricular integration as defined by Harden in order to identify any potential differences in empathy levels between two groups. Methodology: Two study samples, one consisting of medical students and the other of dental students, completed the Kiersma-Chen Empathy Scale-Revised (KCES-R). Empathy scores were assessed across two levels of curriculum integration based on Harden’s integration ladder. Results: The results indicated that students instructed at a higher level of curricular integration reported higher empathy scores compared to those instructed at a lower integration level. Conclusion: In conclusion, the findings of this study suggest a positive relationship between curricular integration and empathy scores in medical and dental students.
... Az egyik fő tényező az egészségügyi rendszer kapuőr szerepe, amely hatással lehet arra, hogyan lépnek kapcsolatba a betegek az egészségügyi szolgáltatókkal. Például az orvosok kommunikációja különböző európai országokban eltérhet a helyi orvosi gyakorlatok, a társadalmigazdasági hatások és a betegek elvárásai alapján [46]. Az orvos-beteg kommunikációban az országok közötti különbségek megmutatkoznak az affektív és instrumentális viselkedésben; biomedikális és pszichoszociális beszédben; az orvosok beteg felé irányuló tekintetében; a konzultáció hosszában. ...
The study aimed to explore and compare preferences for doctor-patient communication and communication within healthcare teams in the Visegrad countries (Poland, the Czech Republic, Slovakia, and Hungary) through a general literature review. While each of these countries has independent studies on these topics, a comparative analysis using a single validated questionnaire was conducted by Bányai et al. (2021). Their research showed that factors like gender, age, education, and poor health status influence how patients perceive the quality of communication with doctors in all four countries. The study also found that communication within healthcare teams faces challenges due to personal, referral, and system-related barriers. Improving communication skills is crucial in preventing burnout and depersonalization among healthcare workers, and a well-designed communication training process can foster positive attitudes, particularly among specialist nurses. Independent researches from the four countries shows that patients value clear, accurate information about their illness, treatment options, and the effectiveness of care. Patient satisfaction was higher when they received good treatment along with straightforward information about their condition and clear explanations for their relatives. However, the communication skills of healthcare staff were seen as a weakness, and such skills were often not part of their training. To create a more patient-centered healthcare system, effective human resources programs need to be developed, and further research in health communication is necessary. The study suggests using the PPOS (Patient-Practitioner Orientation Scale) questionnaire to assess and compare healthcare professionals' attitudes towards communication across different levels of healthcare in these countries.
... Dehumanization is a complex phenomenon influenced by various factors, including personality traits, empathy, and working conditions [20,41,42]. Developing patient-centered approaches that consider both physical and psychological needs is vital for improving the quality of care provided. ...
Background:
Dehumanization refers to the tendency of individuals or groups to attribute fewer human characteristics to other individuals or groups (referred to as hetero-dehumanization) or to themselves (referred to as self-dehumanization). This phenomenon currently seems to predominate in the medical and nursing professions. Indeed, healthcare environments facilitate latent forms of dehumanization due to their structure, organization, and inherent professional demands. This study aimed to investigate the association between hetero- or self-dehumanization and personality traits of healthcare professionals, as well as the possible key mediating role of empathy in this relationship.
Methods:
A total of 1150 healthcare employees were recruited for the current study with a mean age of 45.13 years. Data were collected through a questionnaire completed by health professionals.
Results:
Statistically significant relationships were found between self- and hetero-dehumanization and most personality traits (extraversion, agreeableness, conscientiousness). A mediation analysis revealed that empathy mediates the effects of personality traits on hetero- and self-dehumanization.
Conclusions:
The present study addresses the vital role of personality traits of healthcare professionals on dehumanizing oneself or patients, offering insights into improving therapeutic relationships through the cultivation of empathy.
... Participants frequently highlighted communication as a facilitator and a barrier to adequate healthcare. For those who felt heard and understood by their GPs, there was a notable increase in satisfaction and perceived quality of care, consistent with healthcare research reported internationally [47,48]. Conversely, instances where medical jargon was used without adequate explanation or where consultations felt rushed and impersonal led to feelings of frustration and disengagement. ...
Objective: To explain older rural women's participation in clinical decision-making with GPs and explore factors associated with their pre-visit planning and involvement in treatment processes.
Methods: A sequential, theory-driven mixed-method study was conducted. Women aged 65 years or above who had visited a GP three months prior were recruited from five rural towns in South Australia through the local Rotary Club. Data collection utilised an 18-item scale and a semi-structured interview guide. Quantitative data were analysed using chi-square tests and multinomial logit models, whereas qualitative data were coded into themes. As applied in the discussion, the candidacy theory provided a framework for further adding meaning to the results.
Results: Seventy-one older rural women completed surveys. Across the domains, including health knowledge, GP visit preparation, participation in discussion, and attitudes towards shared decision-making, most items indicated a moderate level of women's health knowledge and involvement in GP treatments. Multivariate analysis revealed having less than a basic education, not speaking English at home, and being in the youngest-old age group (65-74 years) were positively associated with low levels of pre-visit planning and involvement in GP treatments. Analysis of interviews with 21 women identified three themes: capacity for health planning and preparedness, communication styles and preferences, and accessibility and continuity of care.
Conclusion: The findings of this study underscore the urgent need for redesigning GP services. By considering the intersection between behavioural and clinical aspects of older rural women's pre-visit planning and involvement in GP treatment processes in rural South Australia, we can inspire positive change in healthcare delivery.
Practice Implications: Practice Implications: our study provides actionable insights on how and where to intervene to enhance older rural women's capacity to engage in pre-visit planning for successful GP consultations. This knowledge can empower healthcare professionals and policymakers to implement effective strategies.
... Conversely, when patients are treated without empathy, they get frustrated and reluctant to return to the facility. 3 Furthermore, Women have been revealed to have better indicators in neurological tests that relate to empathy, according to studies done on the general public. 4 Total empathy is associated with better well-being and higher volunteer rates 5 and culture also appear to play a role in the empathic reaction to patients, according to studies with nursing students in Peru in 2020. ...
Introduction: Empathy is a quality that is more cognitive than affective or emotional. It involves the cognitive ability to understand the patient’s perspective, amount of suffering, and ability to communicate this understanding and a desire to assist in the patient’s treatment. Hence, the study was conducted to assess the empathy in patient care among undergraduate nursing students of selected nursing colleges of Pokhara. Methods: A cross-sectional study was undertaken using the paper-based version of the Jefferson Scale of Empathy. A purposive sampling technique was used for selecting colleges. Seventy-nine students participated in the research study. Statistical Package for the Social Sciences was used to generate descriptive statistics, t-test and one-way analysis of variance (ANOVA) tests were used to assess differences in empathy mean scores according to Demographic and previous work-related variables. Results: A total of 79 students participated in this study. Overall, respondents reported a good empathy score (i.e. mean±SD 111.076±13.29) as measured by the JSE-HPS The difference in empathy mean scores according to demographic and previous work-related variables i.e. age group (P= 0.373), academic year of study (P= 0.37), relationship status (P= 0.059), religion (P= 0.241), ethnicity (P= 0.486) and years of experience (P= 0.691) were not statistically significant. Conclusion: The undergraduate nursing students’ level of empathy tends to be satisfactory. The study also concludes that none of the demographic and previous work-related variables tends to influence the empathy among undergraduate nursing students.
... To explore the positive evolution of doctor-patient trust, we need to fully consider interactions within medical contexts Li & Wang, 2018). According to the interactive elements of the generation of doctor-patient trust, numerous studies have indicated that individual interaction needs (such as medical information, decision-making preferences, and emotional states) are bene cial to improve trust levels and promote cooperation between individuals De Silva et al., 2018;Derksen et al., 2017). In addition, based on symbolic interaction theory (Cheng, 2017), interaction modes, like information sharing and positive feedback (Lee & Lin, 2010;Lehmann et al., 2020;Medendorp et al., 2017), are also key in uencing factors in enhancing trust. ...
Background: Effective doctor-patient interaction plays a crucial role in fostering trust between doctors and patients. This study aimed to construct an interactive positive evolution model of doctor-patient trust by incorporating key influencing factors (interaction needs and interaction modes) in the doctor-patient interaction context, drawing from the interpersonal trust model. This new model includes three trust stages: the bounded rational trust stage, the knowledge-based trust stage, and the identification-based trust stage.
Methods: To validate the efficacy of the new model, interactive empirical experiments were conducted using functional near-infrared spectroscopy (fNIRS).
Results: The behavior and fNIRS results revealed that the knowledge-based trust stage, characterized by mutual understanding, exhibited higher levels of doctor-patient trust, accompanied by increased inter-brain synchronization in the left inferior frontal gyrus, compared to the bounded rational trust stage. Furthermore, the identification-based trust stage, characterized by mutual positive feedback, demonstrated the highest levels of doctor-patient trust, with increased inter-brain synchronization observed in the bilateral temporoparietal junction and the right inferior frontal gyrus. Especially, the inter-brain synchronization results in the left temporoparietal junction region were positively correlated with the doctor’s trust.
Conclusions: Therefore, we confirmed the effectiveness of the interactive, positive evolution model of doctor-patient trust and provided neural evidence that predicts the development of doctor-patient trust. This trust model offers valuable guidance for both medical student education and patient education, illuminating the path toward more effective and empathetic healthcare practices.
... In this study the GP's interpersonal demeanour encompassed affective behaviours that demonstrated care, including empathy and friendliness. These findings are reflected in the literature, (38,39) with a systematic review identifying the degree of physician interpersonal care as the main determinant of patient satisfaction. (19) Specifically within the primary care literature, low SES patients identified empathetic concern as contributing to consultation quality, (15) with the degree of physician empathy, in areas of deprivation, being associated with patient enablement postconsultation. ...
Background
Whilst patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report less positive consultation experiences with general practitioners (GP). To our knowledge, existing research does not provide an in-depth understanding of GP conducts 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 qualitative research was performed in Melbourne GP clinics.
Method
We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients with low SES backgrounds who reported positive consultation experiences, undertook a semi-structured qualitative interview whilst 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
Four categories were developed relating to: (1) the doctor’s demeanour and the patient’s feelings, (2) the therapeutic relationship, (3) the doctor’s therapeutic skill set and (4) 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 with low SES backgrounds in primary care and the existing health inequities within this.
... A focus group study conducted showed that empathy makes patients more relaxed, motivated and willing to cooperate. The patients in the study also revealed that a lack of empathy in health providers leaves them 3 frustrated and unwilling to return to the healthcare facility. ...
Context: Observing patient's behavior in healthcare services plays a vital role in improving and regulating the relationship between nurses and patients and is essential in the management of healthcare systems. One of the crucial factors in bedside behavior is the empathy that has been shown to improve patient satisfaction. In health care settings, empathy is the central aspect of nurse patient relationship. Nursing students are expected to show empathy to patients and family members while delivering compassionate care. Developing an effective building module related to empathy and communication learning for nursing students might enhance their communication skills and improve their professional identity. To compare the level of empathy before and after the empathy b Aims: uilding module in I year B.Sc. Nursing students. P.D. Hinduja Hospital & MRC, College of Nursing, One-group Settings and Design: pretestposttest design. A structured questionnaire was created through Google form consisting of 2 sections. Section A was the Jefferson Scale of Empathy & Section B was Scenario based empathy assessment. Pre-test was conducted on Day 1 to know the level of empathy in subjects followed by Empathy building. A set of four empathy modules namely Self -Awareness and awareness of others, Regulation of Behavior, Affective Responding, Integration of analytical and empathetic communication and 1 session on empathy games were developed to foster empathy skills in students. Empathy building module was delivered over a period of 1 week (7days) for 8hours held in the classroom setting as a preparation for rst clinical experience as a novice nurse. Post-test was taken after 7 days of completion of empathy building module post-test was taken to know the effectiveness of the empathy building programme. The result showed a signicant difference in the post inter Results: ventional level and pre interventional level of empathy (t28=2.947, p= 0.006) in Jefferson Scale of Empathy. With regard to Pre & Post-intervention Level of Empathy based on Scenario based questionnaire, (t28=3.380, p= 0.002), hence it can be inferred that the empathy building module was effective in improving the empathy level of I year B.Sc. Nursing Students. In this study the Student Nurses level of empathy has increased after the administration of Empathy Building Module. Our study leads to further research pathways regarding the empathy level follow-up maintained in other years
... Physician empathy is important for developing patientdoctor relationships in person-centered medicine (Bayne et al. 2013;Derksen et al. 2017). This includes understanding patients' perspectives, objectively understanding them, and communicating with them clearly and accurately (Hemmerdinger et al. 2007;Hojat et al. 2011). ...
Purpose:
Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees.
Methods:
We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE).
Results:
Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy.
Conclusion:
This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy.
... Thus, psychological reactance, a motivational state oriented toward reestablishing one's freedom when threatened [8], may play a key role in responding to vaccine communication. Displaying empathy in health communication, that is, showing the recognition of the receivers' experience, may make them feel supported [41]. Specifically, by taking the receiver's perspective, health communication becomes less pushy and perceived as more internal, which may lead to a higher perceived autonomy of the receiver [42]. ...
Background:
Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context.
Objective:
To investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy-support by COVID-19 vaccine chatbots.
Methods:
An experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used 2 (empathy/autonomy-support expression: present vs. absent) × 2 (chatbot expertise cues: expert endorser vs. layperson endorser) between-subject design. Chatbot conversation quality was assessed through the actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from -5 to 5 (VIS).
Results:
There occurred a negative interaction effect of chatbot empathy/autonomy-support expression and conversation fallback (the percentage of chatbot answers "I do not understand" in a conversation) on PUA (PROCESS, Model 1, B = -3.358, SE = 1.235, t(186) = 2.718, P = .007). Specifically, empathy/autonomy-support expression had a more negative effect on PUA when the conversation fallback was higher (conditional effect of empathy/autonomy-support expression at the conversation fallback (CF) level of +1SD: B = -.405, SE = .158, t(186) = 2.564, P = .011; conditional effects non-significant for the mean level (B = -.103, SE = .113, t(186) = .914, P = .36) and the -1SD level (B = .031, SE = .123, t(186) = .252, P = .80)). Moreover, an indirect effect of empathy/autonomy-support expression on CPI via PUA was more negative when CF was higher (PROCESS, Model 7, 5000 bootstrap samples, moderated mediation index = -3.676, BootSE = 1.614; 95%CI[-6.697, -.102]; the conditional indirect effect at the CF level of +1SD: B = -.443, BootSE = .202; 95%CI[-.809, -.005]; conditional indirect effects non-significant for the mean level (B = -.113, BootSE = .124; 95%CI[-.346, .137]) and the -1SD level (B = .034, BootSE = .132; 95%CI[-.224, .305]). Indirect effects of empathy/autonomy-support expression on VIS via PUA were marginally more negative when the CF was higher. No effects of chatbot expertise cues were found.
Conclusions:
The findings suggest that expressing empathy/autonomy-support by a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users' questions. The paper adds to the literature on vaccine chatbots by exploring the conditional effects of chatbot empathy/autonomy-support expression. The results guide policymakers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy.
... "Empathy improves compassion and a non-judgmental attitude, as well as reduces dishonest behavior, increases satisfaction, and builds trust between nurses and patients" (Hojat, 2016). However, a lack of empathy causes feelings of frustration and disappointment (Derksen et al., 2017) and anxiety. ...
Introduction: Empathy is an essential ingredient of the nurse-patient relationship. The current
... "Empathy improves compassion and a non-judgmental attitude, as well as reduces dishonest behavior, increases satisfaction, and builds trust between nurses and patients" (Hojat, 2016). However, a lack of empathy causes feelings of frustration and disappointment (Derksen et al., 2017) and anxiety. ...
Introduction: Empathy is an essential ingredient of the nurse-patient relationship. The current study’s goal is to investigate empathy levels and associated demographic variables among the nursing workforce in Kathmandu's selected health institutions. Materials and Methods: cross-sectional study and purposive sampling technique; a total of 89 nursing workforce attained in this study; and online through the Google form was used to collect primary information. TEQ is made up of 16 items that are scored on a 5-point Likert scale as well as sociodemographic data (such as age, qualification, experience, and training). There are a total of 64. A score of >45 shows that the person has a high level of empathy. The data was analyzed using descriptive and multiple regression techniques. Results: The descriptive analysis revealed that mostly 65.2% of the nursing workforce had below-average (<45) empathy scores. In the regression analysis model, beta age had a value of 0.357 and beta education had a value of 0.028. It was discovered that education level and age have a significant impact on empathy. Conclusion: The study found that most of the nursing workforce had below-average empathy scores. However, it is an essential attribute for developing nurse-patient relationships at work. It can be learned and acquired. Key words: Empathy, Nursing Workforce, Toronto Empathy Scale
... Historically, research on doctor-patient communication centers on physicians' communication style and/or patient-centered communication (Clever, Jin, Levinson, & Meltzer, 2008;Derksen et al., 2017;Krasner et al., 2009). Although this offers some explanation on the level of patient participation, patient-specific characteristics, including information-seeking skills and motivations, also influence the effectiveness of these exchanges. ...
Among those with chronic health conditions, the effective use of digital health services may foster more productive physician-patient encounters. This study examined the contribution of e-health literacy to patient communication behaviors and patient satisfaction. A cross-sectional survey was administered to a sample of Indian adults with chronic health conditions. Hierarchical regression analyses indicated that e-health literacy directly predicted increased communication self-efficacy, patient empowerment, and reduced communication apprehension. Subsequent indirect effects tests showed that through these motivating factors, e-health literacy indirectly predicted increased patient communication and patient satisfaction. Overall, the findings indicate that the benefits of e-health literacy extend beyond digital information seeking more favorable medical consultations. Overall, enhancing chronically-ill patients' digital health skills can lead to more productive medical consultations and better long-term health maintenance.
... Clinical empathy has been defined as the ability to "a) to understand the patient's situation, perspective, and feelings (and their attached meanings); b) to communicate that understanding and check its accuracy; and, c) to act on that understanding with the patient in a helpful (therapeutic way)" (1). Low levels of clinical empathy have been shown to cause patients to harbor dissent and disappointment toward physicians and to decrease health-seeking rates and patient satisfaction (2). Ventures to increase empathy as expressed by physicians therefore have the potential to enhance the patient's experience in clinical encounters through better situational comprehension and meaningful communication resulting in impactful shared decision making and higher rates of patient compliance (3). ...
Empathy is a cognitive attribute that forms the cornerstone for good doctor–patient encounters. The formative period for the development of empathy toward patients begins with clinical encounters within medical school. An individual medical student's empathy levels may in part be a product of their resilience and perfectionist attitudes. A cross-sectional study with 320 medical students across all years of study was conducted to determine the correlation of perfectionism and resilience with clinical empathy in medical students. The JSE-S, CD-RISC 10, and APS-R scales were used to assess levels of empathy, resilience, and perfectionism, respectively. The study found that a positive correlation exists between resilience (r = 0.174) and academic year with empathy, and a negative correlation exists between maladaptive perfectionism and empathy (r = −0.138). The resilience score declined progressively as the year of study progressed with a statistically significant. Mean empathy scores were lowest in fifth-year students (96.8 ± 12.5) and highest in third-year students (107.8 ± 13.2). Further longitudinal studies are necessary to better understand the impact of resilience and perfectionism on empathy.
... In terms of life support, spouses and children play a major role as providers of family support [24]. The spouse status and living conditions of the elderly in the community were counted, and the results are shown in Figure 10. ...
In the field of psychological research, researchers have been exploring a relatively stable path that can promote good interpersonal relationships and increase positive emotions. Empathy is a new field in emotion research and has gradually become a hot issue in empathy research at home and abroad. However, there are many problem families in the current society that are difficult to achieve positive emotions and need the help of society. At present, casework research has gradually become an important means to solve social problems, but the current work efficiency is relatively low, and the mobilization of the enthusiasm of all parties is also relatively weak. In order to solve these problems, this paper proposes a casework solution based on social network analysis empathy theory, aiming at solving some difficult social problems through the cooperation of all social parties. The method of this paper is to study the application of social network analysis, analyze the network community, and then propose the moderating effect of empathy traits on casework. These methods allow social workers to fully understand the social structure in social networks and feel the role of empathy theory in promoting their work. This article draws on a general methodology for applying casework through actual casework of caregivers of intellectually disabled youth, children with autism, and the elderly with orphans. The results show that the solution proposed in this paper can effectively improve the client’s nonverbal communication behavior, and the improvement rate reaches 65.1%.
... Previous studies demonstrated that empathic doctors who tend to listen to patients and offer emotional support can increase trust in the system. In addition, patients are likely to feel frustrated and disappointed if they could not perceive empathy from the medical staff (Derksen et al. 2017). According to Hadwich et al. (2010), physicians consider their empathic behaviour as a significant predictor of eHealth service quality. ...
Individuals’ use of eHealth services has increased significantly. However, the recent pandemic of coronavirus disease 2019 (COVID-19) has resulted in a significant reallocation of health resources and support. This study investigated the impact of service quality dimensions on individuals’ continued trust in eHealth during COVID-19. A decision-making trial and evaluation laboratory (DEMATEL) approach was used to identify and analyse the causal relationships between service quality dimensions and individuals’ continued trust in eHealth services. A total of 134 eHealth users (78 males and 56 females; aged 29–61 years) responded to the DEMATEL questionnaire. The results showed a variation in the impact of service quality factors on individuals’ continued trust in eHealth services. This study found three core factors (responsiveness, assurance and tangibility) that influence individuals’ continued trust in eHealth services. Other secondary factors (e.g. content quality, reliability, efficiency and hedonic benefits) were found to be primarily influenced by the core factors. The identified relationships in this study can aid the decision-making process of healthcare providers and increase the efficiency of healthcare delivery.
... Sugere, assim, que há um impacto negativo do estresse na maneira de expressar empatia, o que também é percebido pelo usuário atendido que avalia o profi ssional de forma mais negativa. Destaca-se que a avaliação negativa do usuário com relação ao profi ssional está relacionada a frustração e até mesmo a desistência de continuar o atendimento 46 . ...
Objetivo: Investigar a congruência entre a empatia autorreferida por enfermeiros(as) (IRI) e a empatia percebida do profissional pelo usuário (CARE).
Método: Participaram 36 enfermeiros(as) atuantes na Atenção Primária a Saúde (APS) do município de Porto Alegre (RS) e 166 usuários atendidos por esses profissionais. Utilizou-se testes de correção de Spearman para verificar a congruência entre a IRI e a CARE, assim como testes de Mann- Whitney e Kruskal Wallis para analisar a associação entre a IRI e a CARE com variáveis como o estresse ocupacional e características de atuação dos profissionais.
Resultados: Não foram encontradas associações entre a IRI e a CARE (rho = 0,41, p = 0,596). No entanto, constatou-se que a percepção do usuário da empatia do profissional variou conforme os níveis de estresse (H(3) = 9,149, p = 0,027). Enfermeiros(as) que exercem a função de coordenação na Unidade de Saúde referem menores índices de empatia, o que também é percebido pelos usuários.
Discussão: Reconhecer o impacto do estresse na forma como o profissional expressa empatia possibilita que ações de promoção e prevenção a saúde sejam desenvolvidas no local de trabalho e impactem não somente a saúde do trabalhador, mas também na saúde do usuário atendido.
... Empathy is a crucial aspect of a functional and effective patient-nurse relationship with nurses' good empathetic capacities being linked to greater well-being and satisfaction (Richardson et al., 2012), greater treatment compliance and better health outcomes in patients (Derksen et al., 2017). In addition, empathy is associated with higher professional satisfaction (Ozcan et al., 2010) and with lower levels of burnout amongst nurses and nursing students (Wilczek-Rużyczka, 2011). ...
The aim of this study was to explore the role of gender, age, and academic year in shaping dispositional mindfulness (DM) and the association between DM facets and empathy dimensions in a sample of undergraduate nursing students. In a multicenter cross-sectional study design, the Five Facet Mindfulness Questionnaire (FFMQ), the Interpersonal Reactivity Index (IRI), and socio-demographic questions were administrated to a convenience sample of Italian nursing students. 622 nursing students (82.2% female) participated in the study (response rate = 86.15%). Females had higher levels of Acting with Awareness ( p < .001, d = .54) and lower levels of Non-reacting ( p < .001, d = .52) facets of DM than males. Older students displayed higher scores on the Observing ( r = .112, p = .005) and on the Non-reacting ( r = .187, p < .001) FFMQ subscales than younger ones. No statistically significant differences in DM levels between the three academic years were found ( p s > .202). After controlling for socio-demographic factors, DM facets were generally positively related to Perspective Taking ( β s from .131 to .208, p s < .007) and Empathic Concern ( β s from −.156 to .189, p s < .001), whereas negatively related to Personal Distress ( β s from −.141 to −.261, p s < .001). Nursing students with higher levels of DM were more able to consider others’ cognitive perspective and to feel compassion, and were less emotionally distressed when facing tense interpersonal situations. Tailored mindfulness interventions might be useful to foster functional empathy within nursing undergraduate programs.
... It is well documented that empathy is associated with improved enablement, increased participation and education, higher compliance, reduced emotional distress, and improved patient's quality of life [5][6][7]. On the other hand, lack of empathy can frustrate and disappoint patients who tend to avoid visiting healthcare providers [8]. In dental literature, empathy is known to reduce dental fear, improve the provider-patient relationship, enhance patient cooperation and compliance, and bring positive clinical outcomes and high patient satisfaction [9,10]. ...
Objective:
To evaluate empathy and its related factors among undergraduate dental students and interns enrolled in a public dental college in Dammam, Saudi Arabia.
Materials and methods:
This cross-sectional study used the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version to determine empathy in 362 dental students and interns in Dammam, Saudi Arabia. The JSE-HPS is a 20-item 7-point Likert scale questionnaire, and its score ranges from 20 to 140 with high values indicating increased empathy. Influences of age, gender, class year, previous year's grade point average (GPA), educational attainment of parents, and monthly family income on empathy were evaluated.
Results:
Of 501 enrolled students and interns, 362 returned completed questionnaires, and the response rate of the study was 72%. The sample's empathy score (JSPE-HPS scale) ranged from 70 to 129 with a mean of 96.75 (±13.76). Most participants believed that empathy is important for effective communication with patients (96.1%) and can improve the provider-patient relationship (95.6%). Females demonstrated a significantly higher mean empathy score (99.98 ± 14.01) than males (92.72 ± 12.35) (P < 0.001). Similarly, the participants with high GPA (98.06 ± 13.69) had significantly greater mean empathy scores than those with low GPA (94.84 ± 13.68) (P=0.029). The mean empathy score increased significantly from junior students (3rd and 4th year students) to senior students (5th and 6th year students) and interns (P=0.008). Multiple linear regression analysis showed that class year (B = 2.03, P=0.006) and GPA (B = 8.67, P=0.003) were significant factors associated with empathy.
Conclusions:
Empathy is important for effective patient communication and improved provider-patient relationship. Female gender, high GPA, and class years were associated with empathy. Empathy should be integrated into dental curricula for effective student learning and positive patient care outcomes.
... Research corroborates the notion that attentiveness and empathy play an important role in the patient-physician communication; it has been emphasized as an essential element of the physician-patient relations that has a considerable value for the patients [8,9]. Empathetic attitude gives a feeling of being heard and supported to the patient, which results in a sense of trust, relief and consequently satisfaction [10]. Empathy is defined as a "predominantly cognitive (rather than an affective or emotional) attribute that involves an understanding (rather than feeling) of experiences, concerns and perspectives of the patient, combined with a capacity to communicate this understanding, and an intention to help" [11]. ...
Objectives
The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider.
Methods
The Patient-Practitioner Orientation Scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed.
Results
Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Religious respondents had significantly lower Sharing, while healthcare workers had significantly higher Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries.
Conclusions
Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries.
Practice Implications
These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.
... Patients have a clear preference for general practitioners (GPs) who listen with attention, with whom they can build a therapeutic relationship [9,10]. When GPs are clearly pressed for time or when they pay more attention to the computer screen, patients experience this as obstacles to receiving empathy [11]. GPs consider protocolized care as a potential barrier to delivering empathy [9,10]. ...
Objective
Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees’ experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees’ experiences with clinical empathy during GP training.
Methods
This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years’ training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed.
Results
Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years’ training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum.
Conclusions
GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum.
Practice Implications
More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patienets and supervisors
... However, and importantly, this striking result was found only for the emotional dimension of empathy and not for the "active/positive" one [80]. A very high level of emotional empathy may convey the message that the situation is really bad and may worry patients [81,82]. Therefore, the "active/positive" dimension of empathy, which is easier for most physicians as it is not oriented toward emotions, may be particularly relevant in prognosis, especially with patients who are not sensitive to emotions. ...
Purpose of Review
Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy.
Recent Findings
First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: “establishing rapport with the patient,” which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the “active/positive” dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future.
Summary
Although communication tips are helpful, empathy training should be based more on the development of HCPs’ emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
... Neither patients nor providers can take the most from an encounter when they miss these signals the other may have sent. Violating cultural norms of behavior in cross-cultural interactions impact patient expectations during doctor-patient interactions [40] and likely result in incomplete understandings, compromise empathetic accuracy [41] as well as the doctor-patient relationship [40,42]. The more familiar and accurate people become with specific crosscultural emotional and nonverbal communication cues [43], the better physician-patient communications. ...
In this commentary, we argue that the limited experiential exposure of medical students to different cultures makes the instruction devoted to communication skills inadequate. The relationship of these dynamics to honesty in clinical encounters is explored.
Absent significant experiential exposure to differing group cultures to counter the natural tendency to favor one’s own, discrimination prevails. Knowledge or awareness of cultural differences does not necessarily equate to communication proficiency. Critically, interactions based on lived experience offer a deeper knowledge and understanding of culturally meaningful nuances than that imparted through other formats. Medical students’ lack of experiential exposure to different cultures results in communication miscues. When the stakes are high, people detect those miscues diminishing trust in the doctor-patient relationship. Greater experiential cultural exposure will enhance the facility and use of culturally specific communication cues. At its core, the requisite transformation will require medical students to adapt to other cultures and greater representation by marginalized and stigmatized populations not only among the studentry but staff and faculty. The time is now to ensure that the physicians we produce can care for all Americans. What cannot be taught must be identified by the selection process. Competence with half the population is a failure for American medicine.
... Furthermore, sadness was higher for patients in the emo-emp version. This in line with studies demonstrating that empathy is not expected in some contexts and may be perceived as frightening [28,29]. ...
Objective:
The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions.
Results:
The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported.
Conclusion:
Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies.
Practice implications:
Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes.
Background
Although the number of studies on the reflection of compassionate care practices in patient experiences has increased in recent years, the issue is still not sufficiently studied and clearly defined, and no study has been conducted with patients living with a cancer diagnosis in Türkiye.
Objective
This study aimed to examine the perspectives of compassionate care and compassionate care experiences of cancer patients in-depth using qualitative methods.
Methods
Between March and August 2024, 22 phenomenological semistructured interviews were conducted with cancer patients. The data were analyzed using Colaizzi’s 7-step descriptive analysis approach.
Results
Five themes emerged from the analysis: (1) compassionate care behaviors, (2) noncompassionate care behaviors, (3) the value of compassionate care for the patients, (4) perceptions of compassionate care barriers, and (5) suggestions to improve compassionate care.
Conclusions
Compassionate care from cancer patients’ perspectives involves being friendly, respectful, and responsive to needs, whereas noncompassionate care behaviors mainly involve ineffective communication skills. Compassionate care has a positive effect on the outcomes of cancer patients with a long and challenging treatment journey. On the contrary, it may adversely affect communication, leading to an increase in unmet needs and a poor impact on cancer prognosis.
Implications for Practice
Cancer nurses should be trained to gain awareness of compassionate care and practices to ensure compassionate care, and training should be repeated regularly. For institution managers, reducing the patient-nurse ratio, monitoring cancer nurses for compassion fatigue, implementing prevention and coping programs, and creating a corporate culture to provide compassionate care are recommended.
Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.
AIM
The aim of this study was to examine the impact of reverse-role simulation on nursing students’ empathy levels toward ethnoculturally diverse patients.
BACKGROUND
Empathy is an essential component of culturally competent care; however, it is often left out of cultural competence education. Enhancing nursing students’ cultural empathy may benefit students and patients.
METHOD
The study used a quasi-experimental one-group pretest-posttest design in a private nursing school in the Northeast. The sample consisted of 37 undergraduate nursing students.
RESULTS
Pretest and posttest scores were statistically different, indicating a significant increase in the students’ ethnocultural empathy, t (36) = −3.20, p = .003.
CONCLUSION
This study supports using reverse-role simulation as an effective teaching strategy to enhance nursing students’ empathy toward ethnocultural diverse patients. Placing students in the “shoes” of an ethnoculturally diverse patient can increase their empathy levels and enhance cultural competence education.
Background: Empathy is a crucial competence in the doctor-patient relationship that can be trained to enhance health outcomes. The Consultation and Relational Empathy (CARE) measure assists patients in evaluating empathy of health care professionals. While the CARE measure has received extensive validation for application in primary and specialty care in diverse languages, no version has been adapted and validated for use in simulation contexts. This study aimed at adapting and validating a CARE measure for simulated patients (Sp-SIMCARE).
Methods: The contextual adaptation to simulation contexts was completed in four phases by a panel of five experts, in collaboration with five simulated patients to ensure clarity, relevance, and equivalence in language and content: 1) preparation of a preliminary contextual adaptation proposal; 2) first version drafting; 3) pilot evaluation of the first version with simulated patients; and 4) review and refinement of the Sp-SIMCARE final version. The validation of the new measure was conducted on typical primary care scenarios with simulated patients evaluating performance of undergraduate medical students at the International University of Catalunya (Barcelona, Spain). Simulated patients adopted four prototypical primary care patient roles: a) acute; b) chronic; c) with a high functional component; and d) difficult to deal with. The newly developed scale underwent analysis for convergent validity, acceptability and face validity, homogeneity, and internal reliability.
Results: The adaptation process ensured that the content of the Sp-SIMCARE scale was unambiguous, relevant, and presented in a comprehensive manner, with uniform meanings for all users. Validation was performed via 270 interviews involving 95 students (mean age, 23 years; 62.2% females). The final version demonstrated satisfactory convergent validity (Spearman's rho coefficient of 0.730; p < 0.001), high acceptability and face validity (proportion of ‘Does not apply’ responses/missing values at 1.96%), and strong homogeneity (corrected item-total correlations in the range 0.705 to 0.865), and reliability (Cronbach’s alpha of 0.960).
Conclusions: The Sp-SIMCARE measure proved to be psychometrically valid and reliable for simulated patients to evaluate undergraduate medical students. The use of this tool could potentially assist in the design and implementation of interventions aimed at fostering empathy in future doctors throughout their training.
Purpose:
This pilot study aimed to investigate the acceptability and efficacy of a patient storytelling intervention (live and recorded) on empathy levels of medical students.
Materials and methods:
Medical students participated in a storytelling intervention that had three components: listening to live or recorded stories from women with abnormal uterine bleeding, reflective writing, and a debriefing session. Empathy scores of students pre- and post-intervention were measured using the Jefferson Scale of Empathy-student version (JSE-S). Students also completed a feedback survey. Descriptive and inferential statistics were used to analyse quantitative data and content analysis was used for text comments.
Results:
Both live and recorded storytelling interventions had positive effects on student's empathy scores post intervention. Overall, students were satisfied with the intervention and reported that it improved their understanding of life experiences of women. Suggestions were made for an in-person storytelling session and interactive discussion after listening to each story.
Conclusion:
A storytelling intervention has the potential to improve medical students' empathy and understanding of lived experience of women with health conditions. This could be valuable when student-patient interactions are limited in healthcare settings, or to enable stories of small numbers of patient volunteers to reach students.
Objective: In oncology, research remains unclear as to whether physician empathy is associated with patient outcomes. Our goal was to answer this question and explore potential moderators of the association. Methods: In this meta-analysis on adult cancer care, we excluded randomised controlled trials, and studies of survivors without active disease or involving analogue patients. Eight databases were searched, in addition to reference lists of relevant articles and grey literature. Two reviewers independently screened citations, extracted data, assessed risk of bias and Accepted Article graded quality of evidence by using the AXIS tool. Effect size correlations (ESr) were chosen and pooled by using a random effect model. Subgroup analyses were performed, and statistically significant variables were introduced in a meta-regression. Several methods were used to explore heterogeneity and publication biases. Results: We included 55 articles, yielding 55 ESr (n = 12976 patients). Physician empathy was associated with favourable patient outcomes: ESr 0.23, 95% confidence interval (CI) [0.18 to 0.27], z = 9.58, p < 0.001. However, heterogeneity was high, as reflected by a large prediction interval, 95% CI [-0.07 to 0.49] and I 2 = 94.5%. The meta-regression explained 53% of variance. Prospective designs and physician empathy assessed by researchers, compared with patient-reported empathy, decreased ESr. Bad-news consultations, compared with all other types of clinical encounters, tended to increase ESr. Conclusion: Patient-reported physician empathy is significantly associated with cancer patient outcomes. However, the high heterogeneity warrants further longitudinal studies to disentangle the conditions under which physician empathy can help patients. Recommendations are proposed for future research.
It is well acknowledged that a high level of empathy among nurses is critical to their nursing care. For successful and efficient nursing care, empathy is a fundamental component of the nurse-patient relationship. Nurses are responsible to deliver patient-centered, safe, and effective nursing care at all levels of the health-care system. Nurses' sympathetic role in the therapeutic setting begins with a thorough assessment of their patients' bodily, psychological, and spiritual needs. Nurses' capacity to listen empathetically to their patients and deliver empathic nursing care successfully leads to proper patient care, which increases patient satisfaction with nursing care. Objective: To determine the association of empathy levels with demographic factors among Nurses working at Public Tertiary care Hospitals Lahore. Methods: A cross sectional analytical study design was used to conduct this study. The Sample size of n=180 nurses were recruited through simple random sampling technique. Jefferson Empathy scale was used for data collection from participants to assess the empathy level among nurses. Filled questionnaires were collected and processed for data analysis through SPSS version 21. Results: The study findings stated that empathy level among nurses was not found in association with educational institute (p-value=.623), marital status (p-value-.771), education level (p-value=.556) and job experience (p-value=.395). It simply means that the mentioned demographic factors have no influence on nurses’ empathy level here in this study. Conclusion: It is concluded that the level of empathy among nurses was not found to be associated with the demographic factors of nurses like their age, experience and institute of graduation.
Objective:
In oncology, research remains unclear as to whether physician empathy is associated with patient outcomes. Our goal was to answer this question and explore potential moderators of the association.
Methods:
In this meta-analysis on adult cancer care, we excluded randomised controlled trials, and studies of survivors without active disease or involving analogue patients. Eight databases were searched, in addition to reference lists of relevant articles and grey literature. Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence by using the AXIS tool. Effect size correlations (ESr) were chosen and pooled by using a random effect model. Subgroup analyses were performed, and statistically significant variables were introduced in a meta-regression. Several methods were used to explore heterogeneity and publication biases.
Results:
We included 55 articles, yielding 55 ESr (n = 12976 patients). Physician empathy was associated with favourable patient outcomes: ESr 0.23, 95% confidence interval (CI) [0.18 to 0.27], z = 9.58, p < 0.001. However, heterogeneity was high, as reflected by a large prediction interval, 95% CI [-0.07 to 0.49] and I2 = 94.5%. The meta-regression explained 53% of variance. Prospective designs and physician empathy assessed by researchers, compared with patient-reported empathy, decreased ESr. Bad-news consultations, compared with all other types of clinical encounters, tended to increase ESr.
Conclusion:
Patient-reported physician empathy is significantly associated with cancer patient outcomes. However, the high heterogeneity warrants further longitudinal studies to disentangle the conditions under which physician empathy can help patients. Recommendations are proposed for future research. This article is protected by copyright. All rights reserved.
Balint training was originally developed as a means for improving the doctor-patient relationship. In recent years Balint groups have become part of medical students' training during their clinical clerkships. The purpose of the study was to explore whether gender and age differences affect medical students' perceptions of Balint training. A total of 72 students in the fourth year at the Hebrew University Medical School completed a questionnaire on their perception of the importance of Balint training. A significant difference by gender was found but not for age. As the percentage of female medical students is expected to increase over the next few years, the inclusion of Balint training in schools that have not yet included it in their curriculum would be appropriate.
Lernziel: Ziel des Workshops ist es, den Austausch zwischen verschiedenen Akteuren im Bereich der digitalen Lehre anzuregen
und Lösungen für die aktuellen Herausforderungen der digitalen Transformation der Lehre zu finden.
Ablauf der Veranstaltung mit Zeitplan inkl. eingesetzter didaktischer Methoden: Im Rahmen des Workshops sollen zwei aktuelle
Fragestellungen der digitalen Transformation der Lehre bearbeitet werden: Welche Herausforderungen müssen bei digitalen
Prüfungen beachtet werden und wie kann die Lehre in den Gesundheitsberufen in Zukunft gestaltet werden („New Normal“)?
Hintergrund: Durch die COVID-19-Pandemie kam es an Hochschulen zu einem sogenannten Digitalisierungs-Schub, in dem sich
in kürzester Zeit eine Vielzahl von neuen und unterschiedlichen digitalen Lehr- und Lernmethoden entwickelt haben [1]. Die
schnelle Umgestaltung der digitalen Lehre führte allerdings vielerorts zu dem was von Hodge mit dem Begriff des „Emergency
Remote Teachings“ prägte [2]. Einige dieser entwickelten Lehr-Lernmethoden bieten allerdings auch das Potential auch in
Zukunft in der „regulären“ Lehre implementiert zu werden [3]. In diesem Zusammenhang können ein institutions- und disziplinenübergreifender Austausch und das Lernen voneinander gewinnbringend für die (Weiter-)Entwicklung künftiger Lehr-Lernformate
sein.
Methode: In zwei kurzen Impuls-Vorträgen von je 10 Minuten werden die aktuellen Entwicklungen in den beiden Themenbereichen vorgestellt.
Anschließend werden die Teilnehmer*innen auf zwei BarCamps-Session aufgeteilt. Ein Barcamp ist eine offene Veranstaltung,
die als Weiterentwicklung der Open Space Methode vor allem Interaktion und Partizipation der Teilnehmer*innen fördert. Inhalte
und Ablauf werden von den Teilnehmer*innen zu Beginn selbst entwickelt und im weiteren Verlauf gestaltet. Barcamps dienen
dem inhaltlichen Austausch auf Augenhöhe, unabhängig von Vorerfahrungen und Expertise und der Diskussion, können aber
auch bereits am Ende der Veranstaltung konkrete Ergebnisse vorweisen. In diesem Fall handelt es sich um eine modifizierte
BarCamp-Variante, in der Impuls-Vorträge zu den zwei genannten Themen den jeweiligen Elevator-Pitches der Teilnehmenden
vorausgehen.
Zeitplan:
• 10 Min. Begrüßung und Vorstellung des Ablaufs
• 20 Min. Impuls-Vorträge
• 100 Min. Arbeit in den BarCamps-Sessions (inkl. Pausen)
• 10 Min. Pitches
• 90 Min. Arbeit in selbstorganisierten Kleingruppen, je nach Interesse
• 30 Min. Vorstellung der Ergebnisse und Abschlussdiskussion
Ergebnisse: Im Rahmen des Workshops sollen die Teilnehmer*innen die Herausforderungen und Lösungen für die dringenden
Themen im Feld der digitalen Transformation der Lehre herausarbeiten.
Zielgruppe & Vorbereitung: Alle an der digitalen Transformation der Lehre interessierte Personen mit Lehrerfahrung.
Teilnehmer*innen sollten mit dem grundsätzlichen Ablauf von BarCamps vertraut sein.
https://www.egms.de/static/de/meetings/gma2022/22gma221.shtml
Purpose/objectives:
Empathetic communication of dentists with their patients is a primary characteristic of their health care. This study aims to evaluate dental students' empathy levels during the transitional period of internship and postgraduate studies of different specialties at one of the oldest dental schools in Saudi Arabia and explore how this empathy was affected by gender, age, and study duration.
Methods:
In this study, the self-reported empathy level among the participants was assessed using the Jefferson scale of empathy-student version (JSE-HPS). This survey includes a 20-question Likert scale formulated to measure clinical empathy in health care professionals. The JSE-HPS was distributed to all registered dental interns and postgraduate students during the academic year 2019-20 in King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia.
Results:
Mean total score of empathy of the participants was (101.07 ± 14.8) with a response rate of 89%. A statistically significant higher empathy score appeared among dental postgraduate students in general (p = 0.04) and specifically among the females (p = 0.04) and those with postgraduate programs for more than four years, (p = 0.02). Dental postgraduate students scored significantly higher in the parameters of standing in patients' shoes (p = 0.02).
Conclusion:
Gender, academic level, and duration of postgraduates' studies influenced empathy more than the age of the dental graduates in KAUFD. Our recommendation is to integrate empathy into the dental curriculum emphasizing interactive communication skills and early patient contact.
Introduction
The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients’ appointment choices in Germany.
Methods
A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis.
Results
The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario.
Conclusion
This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care.
Clinical empathy has been associated with many positive outcomes, including patient trust and satisfaction. Physicians can demonstrate clinical empathy through verbal statements and non-verbal behaviors, such as head nodding. The use of verbal and non-verbal empathy behaviors by healthcare robots may also positively affect patient outcomes. The current study examined whether the use of robot verbal empathy statements and head nodding during a video recorded interaction between a healthcare robot and patient improved participant trust and satisfaction. One hundred participants took part in the experiment, online through Amazon Mechanical Turk. They were randomized to watch an interaction with a Nao robot that (1) either made empathetic or neutral statements and (2) nodded its head when listening to the patient or not. Results showed that the use of empathetic statements by the healthcare robot significantly increased participant perceptions of robot empathy, trust and satisfaction and reduced robot distrust. No significant findings were revealed in relation to robot head nodding. The positive effects of empathy statements support the model of Robot-Patient Communication, which theorizes that robot use of recommended clinical empathy behaviors can improve patient outcomes. The effects of healthcare robot nodding behavior need to be further investigated.
This chapter is an update that examines the effect of using “deliberation” as a tool for teaching at the college level. The students in this study considered the economic benefits and expenses of a box store. Deliberation provides a unique insight into what might be a better understanding of what students are thinking. The literature review contains various forms of deliberation including the process of deliberation in education; the outcomes of deliberative polling events; deliberation with technology; and whether working has an impact on students who deliberate. The use of pre- and posttest surveys shows that students who engaged in a deliberative dialogue were more likely to increase their civic learning and to change their opinions about the issues discussed. The findings demonstrate that deliberation pedagogy influences students' beliefs at both the individual and aggregate level.
We investigated general practitioners’ (GPs’) responses to patients’ concerns in chronic care consultations. Video recordings of 14 consultations were analyzed with conversation analysis. We found two categories of responses: exiting and exploring the patient’s concerns. Most GPs exited the concern by interrupting the patient, acknowledging the concern but then referring back to the progression of the consultation, or affiliating with the concern without exploring it. Only a few raised concerns were explored, and then most often the somatic rather than the emotional aspects of them. The findings point to the risk of missing patients’ voiced concerns in consultations with a fixed agenda.
Ohne Empathie ist eine Gesundheitsversorgung nur schwer vorstellbar. Sie ist eine wichtige Voraussetzung und zugleich ein zentrales Arbeitsinstrument für den Pflegeberuf, das es ermöglicht, Bedürfnisse und Gefühle anderer Menschen zu erschließen. Seit Florence Nightingale (1820–1910) werden Mitgefühl und Empathie als ein wesentliches und unverzichtbares Element der Pflege-Patienten-Beziehung anerkannt und finden auch Niederschlag in relevanten Pflegetheorien. Die Beschreibung von Empathie in der Pflege orientiert sich an relevanten Bezugswissenschaften wie der Psychologie (z. B. Carl Rogers) und greift beispielsweise mit der Interaktionsarbeit auf ergänzende Konzepte der Soziologie zurück. Spezifisch ist, dass der Pflege über die Körperarbeit zusätzliche Kommunikationsmöglichkeiten zur Verfügung stehen. Unbenommen hat Empathie in der Pflege einen hohen Stellenwert, kann aber auch eine Quelle für berufliche Belastungen sein. Pflegende brauchen daher erlebbare und praxistaugliche Strategien, wie sie psychischen Belastungen der eigenen Person vorbeugen können.
Background
Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent.
Aim
The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice.
Design
Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory.
Setting/participants
Data were collected from 53 advanced cancer inpatients in a large urban hospital.
Results
Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful.
Conclusion
Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.
Purpose:
We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings.
Methods:
Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods.
Results:
Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups.
Conclusions:
Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."
Background:
Research has highlighted empathy as an important and effective factor in patient-physician communication. GPs have extensive practical experience with empathy. However, little is known about the personal views of GPs regarding the meaning and application of empathy in daily practice.
Objectives:
To explore GP's experiences and the application of empathy in daily practice and to investigate the practical use of empathy. Facts such as preconditions, barriers and facilitating possibilities are described.
Methods:
Qualitative interview study; 30 in-depth interviews were performed between June 2012 and January 2013 with a heterogeneous sample of Dutch GPs. Interviews were recorded and transcribed verbatim; content analysis was performed with the help of ATLAS-ti.
Results:
Empathy was seen as an important quality-increasing element during the patient-GP consultation. The application of non-verbal and verbal techniques was described. Attention to cues and references to previous consults were reported separately. Required preconditions were: being physically and mentally fit, feeling no time pressure and having an efficient practice organization. Not feeling connected to the patient and strict medical guidelines and protocols were identified as obstacles. A key consideration was the positive contribution of empathy to job satisfaction.
Conclusions:
The opinions of GPs in this research can be considered as supplementing and strengthening the findings of previous researches. The GPs in this study discussed, in particular, ideas important to the facilitation of empathy. These included: longer consultations, smaller practices, efficient telephonic triage by practice assistants, using intervision to help reflect on their work and drawing financiers' attention to the effectiveness of empathy.
The current review aims to unify existing views of altruism through an examination of the biological bases of a fundamental form of giving: altruistic responding. Altruistic responding is most salient during heroic acts of helping but is also observed any time one perceives another's distress or need, which in turn motivates one to help at a current cost to the self. Such aid is simple, observable across species, and rooted in the instincts and circuits that evolved to maximize inclusive fitness through the care of helpless offspring. By design, the system already biases aid to both kin and nonkin under conditions that are largely adaptive. These inherent benefits are also buttressed in primates and humans by known, later-arriving benefits to helping in group-living animals. Evidence for the proposed homology between altruistic responding and offspring retrieval is presented through 10 key shared factors. Conceptually, both require (a) participation by nonmothers, (b) motor competence and expertise, (c) an adaptive opponency between avoidance and approach, and a facilitating role of (d) neonatal vulnerability, (e) salient distress, and (f) rewarding close contact. Physiologically, they also share neurohormonal support from (g) oxytocin, (h) the domain-general mesolimbocortical system, (i) the cingulate cortex, and (j) the orbitofrontal cortex. The framework intermixes ultimate and proximate levels of analysis and unifies existing views by assuming that even complex human behaviors reflect ancient mammalian neural systems that evolved to solve key problems in adaptive ways, with far-reaching consequences for even our most venerated human traits. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes.
To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice.
Systematic literature search.
Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs' empathy, were included. Qualitative assessment was applied using Giacomini and Cook's criteria.
After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients' anxiety and distress and delivers significantly better clinical outcomes.
Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient-physician communication in general practice is of unquestionable importance.
Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.
A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.
Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.
Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings.
The aim of this study is to generate empirically based 'tips' from lay people on how medical consultations could become more successful from a patient perspective.
258 Lay people in the United Kingdom, Italy, Belgium and the Netherlands, distributed over 32 focus groups, were invited to formulate 'tips' for doctors as well as patients after rating the quality of communication from videotaped consultations and discussing their arguments in focus groups.
Tips were remarkably similar across the four countries. Most tips reflect the professional literature, such as the importance of nonverbal communication, personal attention and empathy, but also addressed issues as how to deal with new technologies and new accessibility arrangements (triage). The tips were targeted to the consultation itself, its preparation and the aftercare. Tips for doctors were mirrored in tips for patients.
Lay people seem to be competent in participating in quality-of-care debates. They are well aware of patients' own responsibilities. Besides, they have clear opinions about novel technology and healthcare arrangements (triage).
Listening to patients, showing empathy and personal attention seem to have a universal value. Doctors should be trained to practice these behaviors, healthcare managers in involving patients in practice reorganisations.
Objective:
to establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people.
Methods:
A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations. In a two-step procedure participants gave their individual quality ratings of the whole consultations and then of a set of four fragments from each consultation. They contained a patient negative emotional expression and the subsequent physician response, according to the VR-CoDES.
Results:
Higher quality ratings were given to physician responses which provided space to the patient to talk and to the explicit expressions of empathy. The explicit responses were favored above non-explicit responses. Participants' global evaluation of the whole consultation affected their quality assessments of the fragments (halo-effect). In a multivariate model, lay people's background characteristics appeared to be relevant: to be female, of lower educational level and living in Belgium or Italy predicted higher ratings.
Conclusions:
Providing space to patients is appreciated by all participants, combined with the need for tailor made communication.
Practice implications:
To teach physicians listening skills and how to show empathy with distressed patients should be a core element in medical education.
A key question in research on empathy is what interpersonal motivations might be activated by empathy. Does empathy promote only a concern with other's outcomes ("altruism"), as well as decreased concern with one's own outcomes ("selflessness"), or an increased concern with equality in outcomes ("egalitarianism")? These interpersonal motivations were assessed with a series of experimental games, and our manipulations of empathy paralleled earlier research on the empathy-altruism model. Participants received a (fictitious) note from another person outlining that he or she is coping with the anticipated loss of his or her father in conditions that emphasized taking the other's perspective or an objective perspective (high and low empathy), whereas another group of participants received no note (no empathy). Consistent with our hypotheses, results revealed that a concern with another's well-being (altruism) was greater in the two empathy conditions than in the no-empathy condition. Further, the authors observed no effect of empathy on selfishness or egalitarianism, two motivations that were substantially present independent of empathy. Thus, the findings suggest that empathy adds altruistic motivation to already existing selfish and egalitarian motivation.
Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline.
The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline.
The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline.
General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities.
"Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.
Patient priorities and patient evaluations indicate that accessibility should receive more attention to increase quality in general practice. The definition of family medicine emphasizes the patient-centred approach, communication skills, continuity, and clinical skills. We aimed to explore the associations between the 23 items in the Europep questionnaire measuring patient evaluation of general practice and the patients' recommendation of their general practitioner (GP) to friends and to study the relationship of these items with the core competences of family medicine.
Cross-sectional study where patients aged 18 years and over attending the practice were included. Patients completed the Danish version of the 23 item Europep questionnaire and an additional item about the degree to which they could recommend their GP to friends.
Danish general practice (the DanPEP study).
A total of 50 191 patients and 690 GPs were included in the analyses.
For each item, associations were calculated between a positive answer and the degree to which the patient could recommend the GP. Analyses were made at patient and GP levels.
We found 12 items that covered the 10 most strongly associated items from both analyses: four of six items from the "doctor-patient relationship", two of five items from "medical care", and all items from "information and support" and "organization of services". No items from "accessibility" were among the 12 items.
Recommending the GP to others was most strongly associated with the "emphatic", "patient-oriented", "informative and coordinating", and "competent/skilled" GP and to a lesser degree with accessibility to general practice.
The authors developed and empirically tested a model reflecting a system of interrelations among patient loyalty, trust, and satisfaction as they are related to patients' intentions to stay with a primary care physician (PCP) and recommend the doctor to other people. They used a structural equation modeling approach. The fit statistics indicate a well-fitting model: root mean square error of approximation = .022, goodness-of-fit index = .99, adjusted goodness-of-fit index = .96, and comparative fit index = 1.00. The authors found that patient trust and good interpersonal relationships with the PCP are major predictors of patient satisfaction and loyalty to the physician. Patients need to trust the PCP to be satisfied and loyal to the physician. The authors also found that patient trust, satisfaction, and loyalty are strong and significant predictors of patients' intentions to stay with the doctor and to recommend the PCP to others.
Empathy is a key aspect of the clinical encounter but there is a lack of patient-assessed measures suitable for general clinical settings.
Our aim was to develop a consultation process measure based on a broad definition of empathy, which is meaningful to patients irrespective of their socio-economic background.
Qualitative and quantitative approaches were used to develop and validate the new measure, which we have called the consultation and relational empathy (CARE) measure. Concurrent validity was assessed by correlational analysis against other validated measures in a series of three pilot studies in general practice (in areas of high or low socio-economic deprivation). Face and content validity was investigated by 43 interviews with patients from both types of areas, and by feedback from GPs and expert researchers in the field.
The initial version of the new measure (pilot 1; high deprivation practice) correlated strongly (r = 0.85) with the Reynolds empathy measure (RES) and the Barrett-Lennard empathy subscale (BLESS) (r = 0.63), but had a highly skewed distribution (skew -1.879, kurtosis 3.563). Statistical analysis, and feedback from the 20 patients interviewed, the GPs and the expert researchers, led to a number of modifications. The revised, second version of the CARE measure, tested in an area of low deprivation (pilot 2) also correlated strongly with the established empathy measures (r = 0.84 versus RES and r = 0.77 versus BLESS) but had a less skewed distribution (skew -0.634, kurtosis -0.067). Internal reliability of the revised version was high (Cronbach's alpha 0.92). Patient feedback at interview (n = 13) led to only minor modification. The final version of the CARE measure, tested in pilot 3 (high deprivation practice) confirmed the validation with the other empathy measures (r = 0.85 versus RES and r = 0.84 versus BLESS) and the face validity (feedback from 10 patients).
These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.
More than 20 years have passed since the American-Israeli medical sociologist Aaron Antonovsky introduced his salutogenic theory 'sense of coherence' as a global orientation to view the world, claiming that the way people view their life has a positive influence on their health. Sense of coherence explains why people in stressful situations stay well and even are able to improve their health. The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy. Sixty years after the Holocaust this paper aim to shed light on the salutogenic theory in the context of public health and health promotion. In addition, other approaches with salutogenic elements for the explanation of health are considered. A potential direction for public health of the early 21st century is proposed. The historical paradox is to honour the victims of the Holocaust and see the birth of post-modern public health and the salutogenic framework through the experience of its survivors in the ashes of Modernity.
The vast majority of patients with psychological problems are seen solely by their GP, but little is known about patients' perspectives regarding the variety of consultation skills that may be used in routine GP consultations with these patients.
To identify which aspects of GP consultations patients presenting with psychological problems experience as helpful or unhelpful.
Qualitative study.
Nine general practices in north central London.
Twenty patients, who had discussed psychological problems as a significant part of their index GP consultation, were asked in detail using the tape-assisted recall (TAR) method, about aspects of the consultation they had experienced as helpful or unhelpful.
All patients described how the relationship with the GP helped or hindered them in discussing their problems; this was central to their experience of the consultation. An underlying attitude of genuine interest and empathy, within a continuing relationship, was highly valued. Patients also described how the GP helped them make sense of, or resolve their problems, and supported their efforts to change.
These patient accounts suggest that routine GP consultations for psychological problems can have a powerful impact, at least short-term. The GP role in providing a safe place where patients feel they are listened to and understood should not be underestimated, particularly in the mental health context. Further research is required to investigate the longer-term impact of different GP behaviours on patient health outcomes. The TAR method has potential applications in primary care research and in the training of GPs and other health professionals.
Aim:
The aim of this paper is to identify the broad epistemological debates which underpin conflicting statements on 'rigour' and 'good practice' in qualitative research; to relate divergences in statements of 'good practice' in focus group design made by the pre-eminent commentators on focus group methodology to these broader epistemological debates; and to stimulate further reflection on the range of possible uses for focus groups in health services research. Considerations of the analysis of focus group data are beyond the scope of this paper.
Discussion:
Focus groups are a popular form of qualitative data collection, and may be defined as a particular form of group interview intended to exploit group dynamics. While qualitative research may be broadly characterized as concerned with exploring people's lived experiences and perspectives in context, it is a heterogeneous field incorporating many theoretical traditions. Consequently, qualitative researchers may be informed by a wide range of assumptions about the nature of knowledge (epistemology). These assumptions, whether implicit or explicit, have important consequences for claims about rigour and 'good practice' in data collection. Thus, while there is broad agreement over the general form of focus groups, statements of 'good practice' in terms of its application are varied. A close reading of texts by the two pre-eminent commentators on the practical application of focus groups identifies differences in 'best practice' focus group design related to their respective epistemological assumptions, and differences principally related to sampling techniques, composition of groups, the perceived role of group interaction and the nature of inference.
Conclusion:
Explicit consideration of the epistemological basis of divergent statements of 'best practice' in focus group design forces health services researchers to balance the demands of theory with the practicalities of conducting focus group research within complex host organisations; and encourages readers to apply appraisal criteria appropriate to the stated intentions of researchers.
Inequality in health and health care services is an important policy issue internationally as well as in the UK, and is closely linked to socio-economic deprivation, which in Scotland is concentrated in and around Glasgow. Patients views on primary care in deprived areas are not well documented. In the present study we explore the views of patients living in a high deprivation area on the quality of consultations in general practice.
Qualitative focus group study set in an area of high socio-economic deprivation in a large peripheral housing estate in Glasgow, Scotland. 11 focus groups were conducted; 8 with local community groups and 3 with other local residents. In total 72 patients took part. Grounded theory was used to analyse the data.
Patients' perceptions of the quality of the consultation with GPs consisted of two broad, inter-relating themes; (1) the GPs' competence, and (2) the GPs empathy or ' caring'. Competence was often assumed but many factors coloured this assumption, in particular whether patients had experienced (directly or indirectly with a close family member) 'successful' outcomes with that doctor previously or not. 'Caring' related to patients feeling (a) listened to by the doctor and being able to talk; (b) valued as an individual by the doctor (c) that the doctor understood 'the bigger picture', and (d) the doctors' explanations were clear and understandable. Relational continuity of care (being able to see the same GP and having a good relationship), and having sufficient time in the consultation were closely linked with perceptions of consultation quality.
Patients from deprived areas want holistic GPs who understand the realities of life in such areas and whom they can trust as both competent and genuinely caring. Without this, they may judge doctors as socially distant and emotionally detached. Relational continuity, empathy and sufficient time in consultations are key factors in achieving this.
Empathy is frequently cited as an important attribute in physicians and some groups have expressed a desire to measure empathy either at selection for medical school or during medical (or postgraduate) training. In order to do this, a reliable and valid test of empathy is required. The purpose of this systematic review is to determine the reliability and validity of existing tests for the assessment of medical empathy.
A systematic review of research papers relating to the reliability and validity of tests of empathy in medical students and doctors. Journal databases (Medline, EMBASE, and PsycINFO) were searched for English-language articles relating to the assessment of empathy and related constructs in applicants to medical school, medical students, and doctors.
From 1147 citations, we identified 50 relevant papers describing 36 different instruments of empathy measurement. As some papers assessed more than one instrument, there were 59 instrument assessments. 20 of these involved only medical students, 30 involved only practising clinicians, and three involved only medical school applicants. Four assessments involved both medical students and practising clinicians, and two studies involved both medical school applicants and students. Eight instruments demonstrated evidence of reliability, internal consistency, and validity. Of these, six were self-rated measures, one was a patient-rated measure, and one was an observer-rated measure.
A number of empathy measures available have been psychometrically assessed for research use among medical students and practising medical doctors. No empathy measures were found with sufficient evidence of predictive validity for use as selection measures for medical school. However, measures with a sufficient evidential base to support their use as tools for investigating the role of empathy in medical training and clinical care are available.
We wanted to review and synthesize published criteria for good qualitative research and develop a cogent set of evaluative criteria.
We identified published journal articles discussing criteria for rigorous research using standard search strategies then examined reference sections of relevant journal articles to identify books and book chapters on this topic. A cross-publication content analysis allowed us to identify criteria and understand the beliefs that shape them.
Seven criteria for good qualitative research emerged: (1) carrying out ethical research; (2) importance of the research; (3) clarity and coherence of the research report; (4) use of appropriate and rigorous methods; (5) importance of reflexivity or attending to researcher bias; (6) importance of establishing validity or credibility; and (7) importance of verification or reliability. General agreement was observed across publications on the first 4 quality dimensions. On the last 3, important divergent perspectives were observed in how these criteria should be applied to qualitative research, with differences based on the paradigm embraced by the authors.
Qualitative research is not a unified field. Most manuscript and grant reviewers are not qualitative experts and are likely to embrace a generic set of criteria rather than those relevant to the particular qualitative approach proposed or reported. Reviewers and researchers need to be aware of this tendency and educate health care researchers about the criteria appropriate for evaluating qualitative research from within the theoretical and methodological framework from which it emerges.
Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained.
Primary care clinicians were purposefully selected as exemplar healers. Patients were selected by these clinicians as having experienced healing relationships. In-depth interviews, designed to elicit stories of healing relationships, were conducted with patients and clinicians separately. A multidisciplinary team analyzed the interviews using an iterative process, leading to the development of case studies for each clinician-patient dyad. A comparative analysis across dyads was conducted to identify common components of healing relationships
Three key processes emerged as fostering healing relationships: (1) valuing/creating a nonjudgmental emotional bond; (2) appreciating power/consciously managing clinician power in ways that would most benefit the patient; and (3) abiding/displaying a commitment to caring for patients over time. Three relational outcomes result from these processes: trust, hope, and a sense of being known. Clinician competencies that facilitate these processes are self-confidence, emotional self-management, mindfulness, and knowledge.
Healing relationships have an underlying structure and lead to important patient-centered outcomes. This conceptual model of clinician-patient healing relationships may be generalizable to other kinds of healing relationships.
The current chapter summarizes research on empathy in terms of its benefits and costs. The majority of research on empathy finds desirable correlates. For example, high empathy is associated with more prosocial behaviors and stronger relationships with others. Yet, excessive empathy can also be problematic in a variety of ways. Taken together, the positives and negatives of empathy can best be understood within an evolutionary framework in which empathy evolved to address issues of survival and reproduction. Empathy seems to facilitate caregiving behavior to close others, at the expense of outgroups and society at larger, and sometimes (but not always), at the expense of the self.
Context:
Empathy and compassion are important catalysts for the healing process, but some research suggests their decline during training and practice. Compassion involves recognition, understanding, emotional resonance and empathic concern for another's concerns, distress, pain and suffering, coupled with their acknowledgement, and motivation and relational action to ameliorate these conditions.
Compassion, altruism and reward:
Neuroscientists have identified neural networks that generate shared representations of directly experienced and observed feelings, sensations and actions. When shared representations evoke empathic concern or compassion for another's painful situation, humans experience altruistic motivation to help. The resulting behaviours are associated with activation of areas in the brain associated with affiliation and reward.
Compassion modulators:
Activation of these neural networks is sensitive to multiple inter- and intrapersonal influences. These include the ability to focus one's attention, the ability to receive and accurately interpret input about distress, the perspective one adopts in order to understand another's experience, self-other boundary awareness, the degree to which one values another's welfare, the ability to recognise and regulate one's own emotions, the ability to attend to one's own wellbeing through self-care and self-compassion, effective communication skills, reflection and meta-cognition.
Conclusions:
Current research suggests that compassion can be modulated through education and training and is associated with positive emotions, a sense of affiliation, reward and prosocial behaviours. A compassion process model and framework with examples of educational goals, interventions and resources for curriculum development are described. However, education must be aligned with changes in clinical practice to sustain compassionate care.
In a previous qualitative study (GULiVer-I), a series of lay-people derived recommendations ('tips') was listed for doctor and patient on 'How to make medical consultation more effective from the patient's perspective'. This work (GULiVer-II) aims to find evidence whether these tips can be generally applied, by using a quantitative approach, which is grounded in the previous qualitative study.
The study design is based on a sequential mixed method approach. 798 patients, representing United Kingdom, Italy, Belgium and the Netherlands, were invited to assess on four point Likert scales the importance of the GULiVer-I tips listed in the 'Patient Consultation Values questionnaire'.
All tips for the doctor and the patient were considered as (very) important by the majority of the participants. Doctors' and patients' contributions to communicate honestly, treatment and time management were considered as equally important (65, 71 and 58% respectively); whereas the contribution of doctors to the course and content of the consultation was seen as more important than that of patients.
The relevance of GULiVer-I tips is confirmed, but tips for doctors were assessed as more important than those for patients.
Doctors and patients should pay attention to these "tips" in order to have an effective medical consultation.
Copyright © 2015. Published by Elsevier Ireland Ltd.
Empathy is a process essential for mitigation of human suffering and for the creation and long-term stability of social bonds. Although it has recently become the focus of intensive study after decades of neglect, models of empathy emerging from cognitive neuroscience, affective neuroscience, and functional imaging studies show considerable confusion about defining empathy and widespread differences of opinion about the cognitive vs. affective dimensions to empathy. Human empathy probably reflects variable admixtures of more primitive affective resonance mechanisms, melded with developmentally later-arriving theory of mind and perspective taking. This integration of primitive with more cognitive mechanisms occurs under the “supervision” of a motivated valuing of another sentient creature, a supervision that underlines intrinsic ties between empathy and attachment processes. We know little, however, about how more primitive resonance-induction mechanisms centrally involved in attachment connect developmentally to more later arriving cognitive theory of mind components. From these considerations, a basic model of affective empathy is generated as a gated resonance induction of the internal distress of another creature, with an intrinsic motivation to relieve the distress. It is “gated” in that at least four classes of poorly mapped variables determine the intensity of an empathic response to the suffering of another. Potential classes of variables affecting empathic inductions are: (1) genotypic and (2) phenotypic effects; (3) state-dependent influences (on the affective state of the empathizer); and finally (4) the perceived qualities of the suffering party. Most current models have failed to conceptualize this critical “gating” process, subsequently losing any naturalistic predictive efficacy in modeling real-world social phenomena. Contagion has been generally neglected in affective neuroscience, but it may point to poorly understood receptive processing capabilities, embedded in the distributed paralimbic and subcortical architectures for primary emotion. Thus, contagion may be a developmentally primitive emotion-induction mechanism that cognitive development largely (but not totally) supplants. Detailed differential predictions of this model are proposed.
Although most health care professionals im- or explicitly will assume that they tend to use patient-centered communication strategies, there are reasons to believe that this might not always be a valid assumption. In everyday practice, professionals' own value system is often the dominant steering guide. This Special Issue aims to bring together ongoing research and reflections about the quality of health care communication from the patients' own perspective. In short: what do patients want?
This introduction presents a comprehensive overview of the papers in the special issue of Patient Education and Counseling within a framework that describes the collected papers according to the six functions of medical consultations, taking account of the studies' applied methodologies: quantitative versus qualitative.
Two functions of the medical consultation are strongly represented in the collected papers on the quality of communication from the patients' perspective: 'fostering the relationship' and 'information giving'. There is a remarkable difference between the qualiative and quantitative studies, showing that if patients are not limited to prestructured questionnaires but completely free to express themselves, they tend to focus on 'fostering the relationship' with an emphasis on personal attention, warmth and empathy.
Patients' needs and preferences for personalized and humane medical care cannot be overestimated. For the rest, patient diversity is striking, showing the limited usefulness of general communication guidelines for the other five functions of the medical consultation. Researchers should be aware that patients' views might be different dependent on the applied methodologies.
Doctor-patient communication has been influenced over time by factors such as the rise of evidence-based medicine and a growing emphasis on patient-centred care. Despite disputes in the literature on the tension between evidence-based medicine and patient-centered medicine, patients' views on what constitutes high quality of doctor-patient communication are seldom an explicit topic for research. The aim of this study is to examine whether analogue patients (lay people judging videotaped consultations) perceive shifts in the quality of doctor-patient communication over a twenty-year period.
Analogue patients (N = 108) assessed 189 videotaped general practice consultations from two periods (1982-1984 and 2000-2001). They provided ratings on three dimensions (scale 1-10) and gave written feedback. With a mixed-methods research design, we examined these assessments quantitatively (in relation to observed communication coded with RIAS) and qualitatively.
1) The quantitative analyses showed that biomedical communication and rapport building were positively associated with the quality assessments of videotaped consultations from the first period, but not from the second. Psychosocial communication and personal remarks were related to positive quality assessments of both periods; 2) the qualitative analyses showed that in both periods, participants provided the same balance between positive and negative comments. Listening, giving support, and showing respect were considered equally important in both periods. We identified shifts in the participants' observations on how GPs explained things to the patient, the division of roles and responsibilities, and the emphasis on problem-focused communication (first period) versus solution-focused communication (last period).
Analogue patients recognize shifts in the quality of doctor-patient communication from two different periods, including a shift from problem-focused communication to solution-focused communication, and they value an egalitarian doctor-patient relationship. The two research methods were complementary; based on the quantitative analyses we found shifts in communication, which we confirmed and specified in our qualitative analyses.
To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold.
We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, "standard" interaction or an "enhanced" interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 h later.
Patients' perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p=0.04) and duration (perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count (perfect: 49, sub-perfect: 12, p=0.09).
When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change.
This study helps us to understand the importance of the perception of empathy in a therapeutic encounter.
To test the hypothesis that physicians' empathy is associated with positive clinical outcomes for diabetic patients.
A correlational study design was used in a university-affiliated outpatient setting. Participants were 891 diabetic patients, treated between July 2006 and June 2009, by 29 family physicians. Results of the most recent hemoglobin A1c and LDL-C tests were extracted from the patients' electronic records. The results of hemoglobin A1c tests were categorized into good control (<7.0%) and poor control (>9.0%). Similarly, the results of the LDL-C tests were grouped into good control (<100) and poor control (>130). The physicians, who completed the Jefferson Scale of Empathy in 2009, were grouped into high, moderate, and low empathy scorers. Associations between physicians' level of empathy scores and patient outcomes were examined.
Patients of physicians with high empathy scores were significantly more likely to have good control of hemoglobin A1c (56%) than were patients of physicians with low empathy scores (40%, P < .001). Similarly, the proportion of patients with good LDL-C control was significantly higher for physicians with high empathy scores (59%) than physicians with low scores (44%, P < .001). Logistic regression analyses indicated that physicians' empathy had a unique contribution to the prediction of optimal clinical outcomes after controlling for physicians' and patients' gender and age, and patients' health insurance.
The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes.
Includes bibliographical references, index
The concepts of patient-centeredness and patient empowerment offer opportunities for patients to increase their autonomy and involvement in their care and treatment. However, these concepts appear to be understood in different ways by professional groups involved in healthcare and research. To optimize understanding there is a need to create a common language. To explore and compare the concepts of patient-centeredness and patient empowerment, and clarify a possible relationship between the two from the perspective of the encounter between patients and their healthcare providers.
Concept analysis approach in which the concepts are compared based on literature review.
Patient-centeredness can be the goal of an encounter between patient and caregiver. As a process, it is of great value in the process of patient empowerment. Patient empowerment appears to be broader than patient-centeredness, and may place greater demands on caregivers and the organisation of healthcare.
Patient-centeredness and patient empowerment are complementary concepts which do not oppose one-another. Patient empowerment can be achieved by patient-centeredness, but patients can also empower themselves.
Clarification of patient-centeredness and patient empowerment can facilitate their use by those involved in healthcare, improve the quality of healthcare, and aid future research.
To present a model of the medical consultation as a value chain, and to apply a neurobehavioral perspective to analyze each element in the chain with relevance for emotion regulation.
Current knowledge on four elements in medical consultations and neuroscientific evidence on corresponding basic processes are selectively reviewed.
The four elements of communication behaviours presented as steps in a value chain model are: (1) establishing rapport, (2) patient disclosure of emotional cues and concerns, (3) the doctor's expression of empathy, and (4) positive reappraisal of concerns.
The metaphor of the value chain, with emphasis on goal orientation, helps to understand the impact of each communicative element on the outcome of the consultation. Added value at each step is proposed in terms of effects on outcome indicators; in this case patients affect regulation. Neurobehavioral mechanisms are suggested to explain the association between communication behaviour and affect regulation outcome.
The value chain metaphor and the emphasis on behaviour-outcome-mechanisms associations may be of interest as conceptualizations for communications skills training.
Objective:
Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a 'patient-centered' caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient's experience of care.
Methods:
Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in 'think aloud' exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5 h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters.
Results:
Thirteen behaviors emerged as focal for describing a doctor's caring attitude but with disagreement as to whether specific examples of these behaviors were 'caring' or 'uncaring.' For example, although the concept of empathic inquiry was considered important by most patients, the physician question, "Is there someone you can call or talk with" (about a cancer diagnosis) was interpreted by one patient as 'very caring' while another was 'impressed with how uncaring' the statement appeared.
Conclusion:
At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is 'in the eye of the beholder.' The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient's perspective and reflecting on the patient's responses.
Practice implications:
Medical education must focus on the underlying abilities of caring.
A selective review of various conceptual positions within a historic framework is used to address four issues: whether an empathic response is an understanding or sharing of affect; whether an empathic response is a response to an object, another’s affect, and/or circumstance; which mechanisms explain empathy, and is self-other differentiation required by various definitions. This discussion is related to an examination of representative, predictive and situational measures. Comments are made regarding the reliability and construct validity of certain measures. The implications of this evidence for the use and the development of measures are advanced. A cognitive theoretical perspective is applied, in which variables that influence empathic learning are discussed with several applications of data, to assist in our understanding of empathy.Copyright © 1975 S. Karger AG, Basel
Reviews of the literature on how to convey bad news to patients with serious diseases have identified a paucity of empirically based information to guide clinicians in undertaking this difficult task. In 1994, consensus guidelines for clinicians that incorporated the views of medical oncologists, general practitioners, surgeons, nurse consultants, social workers, clergy, human-rights representatives, cancer patients, hospital interns, and clinical directors of medical schools were developed in Australia. Since then, the guidelines have been published widely and incorporated into other documents outlining recommendations for the best practices. The most recent version of the guidelines on breaking bad news is reported in this article. Revisions based on feedback from key groups, including medical schools and clinicians, and on comparisons of the views of breast cancer patients with their providers' views on the importance of each recommendation in the guidelines are included, and suggestions for future research are detailed.
The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.
Physicians associate empathy with benevolent emotions and with developing a shared understanding with patients. While there have been many articles on managing "difficult" patients, little attention has been paid to the challenges physicians face during conflicts with patients, especially when both parties are angry and yet empathy is still needed. This topic is especially important in light of recent studies showing that practicing medicine increasingly requires physicians to manage their own feelings of anger and frustration. This article seeks to describe how physicians can learn to empathize with patients even when they are both subject to emotions that lead to interpersonal distancing. Empathy is defined as engaged curiosity about another's particular emotional perspective. Five specific ways for physicians to foster empathy during conflict are described: recognizing one's own emotions, attending to negative emotions over time, attuning to patients' verbal and nonverbal emotional messages, and becoming receptive to negative feedback. Importantly, physicians who learn to empathize with patients during emotionally charged interactions can reduce anger and frustration and also increase their therapeutic impact.
Disease management is being promulgated by many policy makers, legislators, and a burgeoning new disease management industry as the next major hope, together with information technology and consumer-directed health care, to bring cost containment to runaway costs of health care. Many expect quality improvement as well. The concept is being aggressively marketed to employers, health plans, and government in the wake of managed care's failure to contain costs. There is widespread confusion, however, about what disease management is and what impact it will have on patients, physicians, and the health care system itself. In this article I give a current snapshot of disease management by briefly addressing (1) its rationale and growth, (2) its track record concerning costs and quality of care, and (3) its impacts on primary care.
How to assess progress in competency-based postgraduate medical training
- F Tromp
F. Tromp, How to assess progress in competency-based postgraduate medical
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The communication wheel
- G Essers
G. Essers, The communication wheel. Available from: http://www.hovumc.nl/
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Positive and negative interactions with health professionals: a qualitative investigation of the experiences of informal cancer carers
- E Gilbert
- J M Ussher
- J Perz
- K Hobbs
- L Kirsten
E. Gilbert, J.M. Ussher, J. Perz, K. Hobbs, L. Kirsten, Positive and negative interactions with health professionals: a qualitative investigation of the experiences of informal cancer carers, Cancer Nurs. 33 (6) (2010) E1-9.
- F Derksen
- J Bensing
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F. Derksen, J. Bensing, S. Kuiper, M. van Meerendonk, A. Lagro-Janssen,
Empathy: what does it mean for GPs? A qualitative study, Fam. Pract. (2014).