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Maximiano-Barreto MA, Luchesi BM, Matias M, Chagas MHN. Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up. Geriatr Nurs 2024; 57:1-10. [PMID: 38452492 DOI: 10.1016/j.gerinurse.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people. METHODS A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups. RESULTS Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention. CONCLUSIONS Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care. CLINICA LTRIAL REGISTRATION RBR-8kjtfx3.
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Affiliation(s)
- Madson Alan Maximiano-Barreto
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil.
| | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil; Três Lagoas Campus, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | - Marisa Matias
- Center for Psychology at University of Porto, Porto, Portugal
| | - Marcos Hortes Nisihara Chagas
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil; Neurociences and Behavioral Sciences Department, University of São Paulo, Ribeirão Preto, SP, Brazil
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Harsi ELMEL, Izel O, Benksim A, Cherkaoui M. Factors influencing older adults' satisfaction with caregivers' communication. Dement Neuropsychol 2023; 17:e20230069. [PMID: 38053648 PMCID: PMC10695440 DOI: 10.1590/1980-5764-dn-2023-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
Effective communication skills are crucial for caregivers to provide quality care and meet the unique needs of patients of all ages. However, older patients have specific communication requirements, and their satisfaction depends on several factors. Objective This study aimed to evaluate the level of satisfaction among older adults in Marrakech, Morocco, regarding the communication skills of their caregivers, and to identify the factors influencing this satisfaction. Methods This is a cross-sectional study conducted between March and July 2022 among 204 people aged 60 years and older who presented to the Mouhamed VI University Hospital of Marrakech, Morocco, for various care services. The older adults' satisfaction with caregivers' communication was assessed by the American Board of Internal Medicine (ABIM) patient satisfaction questionnaire. Sociodemographic and clinical characteristics of the participants were collected through interview and consultation of medical records. Multiple linear regression was used to determine potential factors influencing the total satisfaction score. Results The total satisfaction score of older adults with caregiver' communication was 2.55±0.95 and the mean scores of the lowest subscales were answering questions, greeting and listening. Analysis revealed that having visual disorders (B=-0.276±0.12; p=0.029) and receiving affective touch from caregivers (B=0.745±0.12; p=0.001) were the main factors associated with older adults' satisfaction with caregiver' communication. Conclusion Older people are not sufficiently satisfied with caregivers' communication skills, especially those with vision problems and those who have not received affective touch from caregivers. Caregivers need to be aware of the specific needs of older patients and use appropriate communication techniques.
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Affiliation(s)
- EL Mahjoub EL Harsi
- Cadi Ayyad University, Faculty of Sciences Semlalia, Laboratory of Pharmacology, Neurobiology, Anthropobiology and Environment, Marrakech 40000, Morocco
- Regional Health Directorate, Higher Institute of Nursing Professions and Health Techniques (ISPITS-M), Nursing Care Department, Marrakech 40000, Morocco
| | - Ouafa Izel
- Regional Health Directorate, Higher Institute of Nursing Professions and Health Techniques (ISPITS-M), Nursing Care Department, Marrakech 40000, Morocco
| | - Abdelhafid Benksim
- Cadi Ayyad University, Faculty of Sciences Semlalia, Laboratory of Pharmacology, Neurobiology, Anthropobiology and Environment, Marrakech 40000, Morocco
- Regional Health Directorate, Higher Institute of Nursing Professions and Health Techniques (ISPITS-M), Nursing Care Department, Marrakech 40000, Morocco
| | - Mohamed Cherkaoui
- Cadi Ayyad University, Faculty of Sciences Semlalia, Laboratory of Pharmacology, Neurobiology, Anthropobiology and Environment, Marrakech 40000, Morocco
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Kim H, Kwak S, Yoo SY, Lee EC, Park S, Ko H, Bae M, Seo M, Nam G, Lee JY. Facial Expressions Track Depressive Symptoms in Old Age. SENSORS (BASEL, SWITZERLAND) 2023; 23:7080. [PMID: 37631616 PMCID: PMC10459725 DOI: 10.3390/s23167080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Facial expressions play a crucial role in the diagnosis of mental illnesses characterized by mood changes. The Facial Action Coding System (FACS) is a comprehensive framework that systematically categorizes and captures even subtle changes in facial appearance, enabling the examination of emotional expressions. In this study, we investigated the association between facial expressions and depressive symptoms in a sample of 59 older adults without cognitive impairment. Utilizing the FACS and the Korean version of the Beck Depression Inventory-II, we analyzed both "posed" and "spontaneous" facial expressions across six basic emotions: happiness, sadness, fear, anger, surprise, and disgust. Through principal component analysis, we summarized 17 action units across these emotion conditions. Subsequently, multiple regression analyses were performed to identify specific facial expression features that explain depressive symptoms. Our findings revealed several distinct features of posed and spontaneous facial expressions. Specifically, among older adults with higher depressive symptoms, a posed face exhibited a downward and inward pull at the corner of the mouth, indicative of sadness. In contrast, a spontaneous face displayed raised and narrowed inner brows, which was associated with more severe depressive symptoms in older adults. These findings suggest that facial expressions can provide valuable insights into assessing depressive symptoms in older adults.
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Affiliation(s)
- Hairin Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Seyul Kwak
- Department of Psychology, Pusan National University, Busan 46241, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Eui Chul Lee
- Department of Human-Centered Artificial Intelligence, Sangmyung University, Hongjimun 2-Gil 20, Jongno-Gu, Seoul 03016, Republic of Korea
| | - Soowon Park
- Division of Teacher Education, College of General Education for Truth, Sincerity and Love, Kyonggi University, Suwon 16227, Republic of Korea
| | - Hyunwoong Ko
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul 06355, Republic of Korea
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Minju Bae
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Myogyeong Seo
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Gieun Nam
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
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Brown LE, Chng E, Kortlever JTP, Ring D, Crijns TJ. There is Little or No Association Between Independently Assessed Communication Strategies and Patient Ratings of Clinician Empathy. Clin Orthop Relat Res 2023; 481:984-991. [PMID: 36417406 PMCID: PMC10097532 DOI: 10.1097/corr.0000000000002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Quality of care is increasingly assessed and incentivized using measures of patient-reported outcomes and experience. Little is known about the association between measurement of clinician communication strategies by trained observers and patient-rated clinician empathy (a patient-reported experience measure). An effective independent measure could help identify and promote clinician behaviors associated with good patient experience of care. QUESTIONS/PURPOSES (1) What is the association between independently assessed clinician communication effectiveness and patient-rated clinician empathy? (2) Which factors are associated with independently assessed communication effectiveness? METHODS One hundred twenty adult (age > 17 years) new or returning patients seeking musculoskeletal specialty care between September 2019 and January 2020 consented to video recording of their visit followed by completion of questionnaires rating their perceptions of providers' empathy levels in this prospective study. Patients who had operative treatment and those who had nonoperative treatment were included in our sample. We pooled new and returning patients because our prior studies of patient experience found no influence of visit type and because we were interested in the potential influences of familiarity with the clinician on empathy ratings. We did not record the number of patients or baseline data of patients who were approached, but most patients (> 80%) were willing to participate. For 7% (eight of 120 patients), there was a malfunction with the video equipment or files were misplaced, leaving 112 records available for analysis. Patients were seen by one provider among four attending physicians, four residents, or four physician assistants or nurse practitioners. The primary study question addressed the correlation between patient-rated clinician empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and clinician communication effectiveness, independently rated by two communication scholars using the Liverpool Communication Skills Assessment Scale. Based on a subset of 68 videos (61%), the interrater reliability was considered good for individual items on the Liverpool Communication Skills Assessment Scale (intraclass correlation coefficient [ICC] 0.78 [95% confidence interval (CI) 0.75 to 0.81]) and excellent for the sum of the items (that is, the total score) (ICC = 0.92 [95% CI 0.87 to 0.95]). To account for the potential association of personal factors with empathy ratings, patients completed measures of symptoms of depression (the Patient-Reported Outcome Measurement Information System depression computerized adaptive test), self-efficacy in response to pain (the two-item Pain Self-Efficacy Questionnaire), health anxiety (the five-item Short Health Anxiety Inventory), and basic demographics. RESULTS Accounting for potentially confounding variables, including specific clinicians, marital status, and work status in the multivariable analysis, we found higher independent ratings of communication effectiveness had a slight association (odds ratio [OR] 1.1 [95% CI 1.0 to 1.3]; p = 0.02) with higher (dichotomized) ratings of patient-rated clinician empathy, while being single was associated with lower ratings (OR 0.40 [95% CI 0.16 to 0.99]; p = 0.05). Independent ratings of communication effectiveness were slightly higher for women (regression coefficient 1.1 [95% CI 0.05 to 2.2]); in addition, two of the four attending physicians were rated notably higher than the other 10 participants after controlling for confounding variables (differences up to 5.8 points on average [95% CI 2.6 to 8.9] on a 36-point scale). CONCLUSION The observation that ratings of communication effectiveness by trained communication scholars have little or no association with patient-rated clinician empathy suggests that either effective communication is insufficient for good patient experience or that the existing measures are inadequate or inappropriate. This line of investigation might be enhanced by efforts to identify clinician behaviors associated with better patient experience, develop reliable and effective measures of clinician behaviors and patient experience, and use those measures to develop training approaches that improve patient experience. LEVEL OF EVIDENCE Level I, prognostic study .
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Affiliation(s)
- Laura E. Brown
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, Texas, USA
| | - Emmin Chng
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, Texas, USA
| | - Joost T. P. Kortlever
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, Gelderland, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, Texas, USA
| | - Tom J. Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, Texas, USA
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Moye J. Enhancing Long Term Care and Caregiving. Clin Gerontol 2022; 45:1055-1057. [PMID: 36098346 DOI: 10.1080/07317115.2022.2110754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Maximiano-Barreto MA, Ottaviani AC, Luchesi BM, Chagas MHN. Empathy Training for Caregivers of Older People: A Systematic Review. Clin Gerontol 2022:1-12. [PMID: 36148523 DOI: 10.1080/07317115.2022.2127390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To identify empathy training models and the effects on psychological concerns in paid and unpaid caregivers of older people. METHODS A systematic review was conducted. Searches for relevant articles were performed in the Embase, LILACS, PsycInfo, Pubmed, Scopus and Web of Science databases using the following search strategy: "Empathy AND (Education OR Training OR Intervention) AND Caregiver." No restrictions were imposed regarding language or year of publication. RESULTS Empathy training for caregivers of older people were performed in six studies, three of which identified a significant increase in empathy levels and consequent reduction in psychological concerns. Empathy training focused on aspects of empathy and/or the caregiver had significant effects on the outcome variables. Moreover, training conducted online, by telephone and/or in person can generate satisfactory results. The other three studies that conducted training with a focus on aspects of dementia and/or old age did not present any effect on the outcome variables. CONCLUSIONS Empathy training for caregivers of older people can increase levels of this ability, especially in the cognitive domain, as well as diminish psychological concerns caused by the negative impact of providing care. CLINICAL IMPLICATIONS Empathy training directed at empathic abilities and/or aspects of providing care can be effective at increasing levels of this ability. Moreover, training in different care contexts can minimize the negative impacts of providing care.
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Affiliation(s)
| | | | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Campus de Três Lagoas, Federal University of Mato Grosso Do Sul, Três Lagoas, Brazil
| | - Marcos Hortes Nisihara Chagas
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Bairral Institute of Psychiatry, Itapira, Brazil
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Maximiano-Barreto MA, Fabrício DDM, de Moura AB, Brito TRPD, Luchesi BM, Chagas MHN. Relationship of burden with depressive symptoms, mental disorders and older adults' functional dependence: A study with paid and unpaid caregivers in Brazil. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1785-e1793. [PMID: 34655132 DOI: 10.1111/hsc.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to identify the relationship of burden with depressive symptoms, mental disorders and older adults' functional dependence in paid and unpaid caregivers. This is a quantitative and cross-sectional study, carried out in the inland of the state of São Paulo with 111 caregivers, 60 of whom were unpaid and 51 were paid. The caregivers answered a questionnaire for the assessment of sociodemographic and care characteristics, the Zarit Burden Inventory (ZBI), the Patient Health Questionnaire (PHQ-9), the Self-Report Questionnaire (SRQ-20), and the Functional Assessment Questionnaire (FAQ). Unpaid caregivers were older, married, have been providing care for a longer period of time, and devoted more days and hours per week to care when compared to paid caregivers. Depressive symptoms and mental disorders (non-psychotic) are related to the levels of burden in both paid and unpaid caregivers (p < 0.001). The care process causes harm such as burden, depressive symptoms, and mental disorders in paid and unpaid caregivers. Thus, it is important to think about coping strategies to minimize the psychological consequences of the care process.
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Affiliation(s)
- Madson Alan Maximiano-Barreto
- Federal University of São Carlos, São Carlos, Brazil
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Daiene de Morais Fabrício
- Federal University of São Carlos, São Carlos, Brazil
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Amanda Barros de Moura
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
| | | | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Marcos Hortes Nisihara Chagas
- Federal University of São Carlos, São Carlos, Brazil
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Bairral Institute of Psychiatry, Itapira, Brazil
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Maximiano-Barreto MA, de Morais Fabrício D, de Lima Bomfim AJ, Luchesi BM, Chagas MHN. Psychological Concerns Associated with Empathy in Paid and Unpaid Caregivers of Older People: A Systematic Review. Clin Gerontol 2022:1-14. [PMID: 35726494 DOI: 10.1080/07317115.2022.2090879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Identify associations between psychological concerns and empathy (affective and cognitive domains) in paid and unpaid caregivers of older people. METHODS A systematic review of the literature was conducted. Searches were performed in the Pubmed, Web of Science, PsycINFO, Scopus and Embase databases using the search terms "Empathy," "Caregiver," "Depression," "Burnout," Anxiety", Caregiver Burden" and "Psychological Stresses" and the Boolean operators "AND" and "OR." No restrictions were imposed regarding language or year of publication. This review was registered in PROSPERO (CRD42021267276). RESULTS Twelve articles met the inclusion criteria and were included in the present review. Most studies involved the participation of unpaid caregivers. Higher levels of empathy were associated with greater psychological concerns. Regarding affective empathy, direct associations were found with depressive symptoms, anxiety and stress. In contrast, high levels of cognitive empathy were associated with fewer depressive symptoms as well as less stress and burnout syndrome. CONCLUSIONS An association was found between greater affective empathy and psychological impairment in caregivers of older people. Higher levels of cognitive empathy can help minimize psychological concerns. CLINICAL IMPLICATIONS Working on empathic ability among caregivers of older people in different environments can contribute positively to the emotional impact of caregiving. Moreover, empathetic cognitive training among caregivers can serve as a strategy to minimize the negative consequences of the impact of caregiving.
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Affiliation(s)
| | - Daiene de Morais Fabrício
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Julia de Lima Bomfim
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, Brazil
| | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Campus de Três Lagoas, Federal University of Mato Grosso Do Sul, Três Lagoas, Brazil
| | - Marcos Hortes Nisihara Chagas
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, Brazil
- Bairral Institute of Psychiatry, Itapira, Brazil
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