Measurement of Perceived Physician Empathy in Orthopedic Patients.
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ABSTRACT: Background
Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment.Objective
To assess the advantages and disadvantages of the validated Jefferson Scale of Patient's Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools.Methods
Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson's correlation and exploratory factor analysis, we measured the underlying construct. Flooring and ceiling effects were measured. Multivariable models were created to assess factors associated with both measures.Results
The high interquestionnaire correlation (rho = 0.70) and factor loading (0.77) confirm that the JSPPPE and CARE measure the same construct. The CARE (55%) had a higher ceiling effect than JSPPPE (18%). Both JSPPPE (partial R 2 = 0.53, 95% confidence interval [CI]: 0.38-0.64) and CARE (partial R 2 = 0.60, 95% CI: 0.46-0.69) accounted for similar amounts of variation in satisfaction with the orthopedic surgeon.Conclusion
Perceived empathy accounts for a substantial amount of the variation in satisfaction. The JSPPPE measures the same construct as CARE with a lower ceiling effect. Because both questionnaires have considerable ceiling effects, a new questionnaire might help to study factors associated with a more empathetic experience.
SUBMITTER: Keulen MHF
PROVIDER: S-EPMC7534139 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Measurement of Perceived Physician Empathy in Orthopedic Patients.
Keulen Mark Hendrik Franciscus MHF Teunis Teun T Kortlever Joost Teunis Pieter JTP Vagner Gregg Alan GA Ring David D Reichel Lee Matthew LM
Journal of patient experience 20190912 4
<h4>Background</h4>Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment.<h4>Objective</h4>To assess the advantages and disadvantages of the validated Jefferson Scale of Patient's Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools.<h4>Methods</h4>Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson's cor ...[more]
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Project description:Background and aimsThis study focused on the difference between perceived and desired physician empathy (pPE and dPE) in the eye of patients with inflammatory bowel disease (IBD). It was investigated if a discrepancy (ΔPE) correlates with trust and satisfaction of patients. At the same time the aim was to gain detailed information about the subjective burden of disease and the resources of IBD patients, in order to better understand them.MethodsA modified version of the German Version of the Consultation and Relational Empathy (CARE) measure was completed as a paper-and-pencil questionnaire by IBD patients attending our facility (n = 32) and as an online survey by IBD patients at other locations throughout Germany (n = 89). Patients were in average 36.3±12 years old.ResultsThe mean (SD) rating of pPE was 3.93 (0.96) on a scale of 1 to 5 ("poor" to "excellent"); however, the mean (SD) dPE was 4.38 (0.48) on the same scale. ΔPE correlated with perceived empathy and with patients' satisfaction with treatment and trust in their health care providers. Patients reported quite a high subjective burden (mean [SD]: 2.93 [.63]) and named family, friends, and support groups as resources.ConclusionsRather than assessing patient satisfaction with treatment and trust in their physician only with perceived PE, we suggest ΔPE as a useful additional parameter.
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Project description:ImportanceEmpathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain.ObjectiveTo measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain.Design, setting, and participantsThis cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up.ExposurePhysician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups.Main outcomes and measuresMain outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates.ResultsAmong the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery.Conclusions and relevanceIn this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.
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Project description:Aims:This study aims to (i) translate, culturally adapt, and validate the Jefferson Scale of Patient Perception of Physician Empathy questionnaire for the Greek population (Gr-JSPPPE) and (ii) estimate physicians' self-assessed empathy and patients' perceptions of physicians' empathy, investigate their relationship, and assess their predictors. Methods:A total of 189 patients and 17 physicians from an internal medicine clinic took part in the study. A composite questionnaire was administered to the patients, consisting of (1) sociodemographic items, (2) hospitalization-related questions, (3) the Zung Self-Rating Anxiety Scale, (4) the Patient Health Questionnaire (PHQ-9), (5) the EQ-5D-5L Questionnaire, (6) the Gr-JSPPPE, and (7) the Visual Analog Scale for pain. The physicians' composite questionnaire comprised (1) sociodemographic items, (2) the EQ-5D-5L questionnaire, and (3) the Toronto Composite Empathy Scale (TCES). Exploratory and confirmatory factor analyses were conducted to assess the psychometric properties of the Gr-JS PPPE. Univariate comparisons were performed between (a) empathy measures and (b) sociodemographic and health-related measures of both groups; multivariate regression analysis for the Gr-JSPPPE adjusting for baseline confounders was executed. Results:Statistically significant negative correlations were found between the Gr-JSPPPE mean score and the TCES personal/cognitive, professional/cognitive, and professional/emotional subscales. Female sex, being married, duration of employment in current post, and physicians' EQ-5D index score emerged as important predictors of increased physician empathy. Patients' EQ-VAS "thermometer" scale was significantly associated with the Gr-JSPPPE total score at the multivariate level. Conclusion:The Gr-JSPPPE is a psychometrically sound tool to assess patient perceptions of physician empathy. Physician empathy assessed by the self-reported scale is inversely associated with patient perceptions.
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Project description:BackgroundA trusting physician-patient relationship is an essential component of high-quality care.ObjectiveTo explore the relationship between the physician-patient relationship, physician empathy, and patient trust.DesignCross-sectional survey.ParticipantsA total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys.Main measurePhysician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed.Key resultsThere were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02).ConclusionsPatients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.
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Project description:BACKGROUND: Physician empathy is both theoretically and empirically critical to patient health, but research indicates that empathy declines throughout medical school and is lower than ideal among physicians. In this paper, we synthesize the published literature regarding interventions that were quantitatively evaluated to detect changes in empathy among medical students, residents, fellows and physicians. METHODS: We systematically searched PubMed, EMBASE, Web of Science and PsychINFO in June of 2014 to identify articles that quantitatively assessed changes in empathy due to interventions among medical students, residents, fellows and physicians. RESULTS: Of the 1,415 articles identified, 64 met inclusion criteria. We qualitatively synthesized the findings of qualified studies by extracting data for ten study metrics: 1) source population, 2) sample size, 3) control group, 4) random assignment, 5) intervention type, 6) intervention duration, 7) assessment strategy, 8) type of outcome measure, 9) outcome assessment time frame, and 10) whether a statistically significant increase in empathy was reported. Overall, the 64 included studies were characterized by relatively poor research designs, insufficient reporting of intervention procedures, low incidence of patient-report empathy assessment measures, and inadequate evaluations of long-term efficacy. 8 of 10 studies with highly rigorous designs, however, found that targeted interventions did increase empathy. CONCLUSIONS: Physician empathy appears to be an important aspect of patient and physician well-being. Although the current empathy intervention literature is limited by a variety of methodological weaknesses, a sample of high-quality study designs provides initial support for the notion that physician empathy can be enhanced through interventions. Future research should strive to increase the sample of high-quality designs through more randomized, controlled studies with valid measures, explicit reporting of intervention strategies and procedures, and long-term efficacy assessments.
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Project description:BackgroundPrevious studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.MethodsIn total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.ResultsOverall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).ConclusionsEven though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.
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Project description:BackgroundHigher physician self-reported empathy has been associated with higher overall patient satisfaction. However, more evidence-based research is needed to determine such association in an emergent care setting.ObjectiveTo evaluate the association between physician self-reported empathy and after-care instant patient-to-provider satisfaction among Emergency Department (ED) healthcare providers with varying years of medical practice experience.Research designA prospective observational study conducted in a tertiary care hospital ED.MethodsForty-one providers interacted with 1,308 patients across 1,572 encounters from July 1 through October 31, 2016. The Jefferson Scale of Empathy (JSE) was used to assess provider empathy. An after-care instant patient satisfaction survey, with questionnaires regarding patient-to-provider satisfaction specifically, was conducted prior to the patient moving out of the ED. The relation between physician empathy and patient satisfaction was estimated using risk ratios (RR) and their corresponding 95% confidence limits (CL) from log-binomial regression models.ResultsEmergency Medicine (EM) residents had the lowest JSE scores (median 111; interquartile range [IQR]: 107-122) and senior physicians had the highest scores (median 119.5; IQR: 111-129). Similarly, EM residents had the lowest percentage of "very satisfied" responses (65%) and senior physicians had the highest reported percentage of "very satisfied" responses (69%). There was a modest positive association between JSE and satisfaction (RR = 1.04; 95% CL: 1.00, 1.07).ConclusionThis study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction, though minor heterogeneity occurred between different provider characteristics.
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Project description:BackgroundVariation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization.ObjectivesThe objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization.MethodsThis cross-sectional study included two parts: 1) a secondary analysis of emergency department (ED) CT imaging utilization data in a large health system from July 2013 to June 2014 and 2) a survey study of the cohort of physicians responsible for this imaging using four psychometric scales: the Jefferson Scale of Empathy (JSE), a risk-taking subset of the Jackson Personality Index (RTS), the Stress from Uncertainty Scale (SUS), and the Malpractice Fear Scale (MFS). The study included data and physicians from four EDs: one urban, academic ED, two community, and one free-standing. A hierarchical, mixed-effects regression model was used to evaluate the association between emergency physician performance on the four scales and risk-adjusted CT imaging utilization. The model incorporated physician-specific CT utilization rates adjusted for propensity scores that were calculated using over 500 patient-level variables via random forest methods, physician demographics, and a random provider effect to account for the clustering of observations.ResultsCT variation analysis included 113,517 patients seen during the study period by the 74 eligible emergency physician survey respondents; 20,972 (18.5%) of these patients had at least one CT. The survey response rate was 74 of 82 (90.2%). Correlation coefficients between JSE and the other scales were not statistically significant. In subset analysis, there was a trend toward a physician's number of years in practice and RTS score contributing to CT utilization for traumatic head CT. There were no significant associations between performance on any of the psychometric scales and CT utilization.ConclusionsPerformance on the JSE, RTS, SUS, or MFS was not predictive of risk-adjusted CT utilization in the ED. The underlying physician-based factors that mediate interphysician variation remain to be clearly identified.
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Project description:Empathy is one of the essential components of physician-patient relationship that has a significant effect on treatment outcomes.The aim of this study was to assess the empathy score among medical students in Mashhad, Iran.In this cross-sectional study in 2015, 624 medical students at Mashhad University of Medical Science (Iran) completed the Jefferson Scale of Physician Empathy (JSPE). Data were analyzed by SPSS ver. 16, using independent-samples t-test, Chi-square, MANOVA, Spearman correlation, and Confirmatory factor analysis.Of the 38.4% males and 65% females who participated in this study, the mean score of JSPE in the sample was 103.67 (±15.34) which was higher in women than in men. Also, the mean scores for each of the three factors of the scale were calculated. The total empathy score, compassionate care, and taking perspectives among different age groups were significant (p=0.000). Furthermore, students having high interest in their field were more empathic (p=0.008). Empathy of interns in relation to three areas of basic sciences (the first year, the second year and the first half of the third year), physiopathology (the second half of the third year, and the fourth year), and clinical trainings (the fifth year, and the first half of the sixth year), experienced significant reduction (p≤0.001).This study showed that empathy was higher in women in their first medical year and who were of younger age. The overall rate of empathy in the basic sciences period was more than that in the clinical period. Therefore, the initial exposure to clinical education, especially patient education and empathy, has a very prominent effect on the ability of medical students.
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