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Antoun J, Khater B, Itani H, Naous J, Romani M. Effectiveness of a modified Balint group process on empathy and psychological skills employing Kirkpatrick's evaluation framework. PeerJ 2023; 11:e15279. [PMID: 37483957 PMCID: PMC10362841 DOI: 10.7717/peerj.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 07/25/2023] Open
Abstract
Background To evaluate, using Kirkpatrick's evaluation model, a modified Balint group (BG) by adding 5-10 min at the end of the session, where the facilitators will debrief the residents about critical themes mentioned in the session. Methods A quasi-experimental study with a mixed-method design was conducted among family medicine residents over 1 year, using focus groups and validated tools filled by residents and their corresponding patients. The residents' empathy through self and patient evaluation, psychological skills, and satisfaction with the educational activity were measured. Results The focus group revealed that the residents were aware of the change and considered it a closure to the encounter, helping decrease some uncertainty. Most of the residents did not consider the change helpful. Using validated instruments, BG was ineffective at improving the residents' empathy and psychological skills. There was a statistically significant main effect of time on Psychological Medicine Inventory (PMI) scores, F (1,13) = 7.709, p = 0.016. Conclusion Debriefing at the end of BG by the facilitators about key themes may help give the residents closure, decrease the uncertainty, and make them more aware of their feelings. Nevertheless, Balint groups are still not very well accepted by the residents, and they prefer direct feedback and support groups.
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Affiliation(s)
- Jumana Antoun
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Beatrice Khater
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Hala Itani
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jihane Naous
- Family Medicine, American University of Beirut, Beirut, Lebanon
- Community Health and Family Medicine, University of Florida, Florida, United States
| | - Maya Romani
- Family Medicine, American University of Beirut, Beirut, Lebanon
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2
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Natali F, Corradini L, Sconza C, Taylor P, Furlan R, Mercer SW, Gatti R. Development of the Italian version of the Consultation and Relational Empathy (CARE) measure: translation, internal reliability, and construct validity in patients undergoing rehabilitation after total hip and knee arthroplasty. Disabil Rehabil 2023; 45:703-708. [PMID: 35191359 DOI: 10.1080/09638288.2022.2037742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. MATERIALS AND METHODS The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. RESULTS Face validity was high. Patients answered all questions and the "does not apply" option was never selected. Internal reliability (Cronbach's α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. CONCLUSIONS The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA.IMPLICATIONS FOR REHABILITATIONInternal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure.The Italian CARE measure can be used to assess patient's perceived therapist's empathy in patients undergoing physical therapy after THA and TKA.Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts.
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Affiliation(s)
- Fabrizio Natali
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Laura Corradini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristiano Sconza
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Patricia Taylor
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaello Furlan
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Stewart W Mercer
- Usher Institute Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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3
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Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. Understanding of empathetic communication in acute hospital settings: a scoping review. BMJ Open 2022; 12:e063375. [PMID: 36171029 PMCID: PMC9528576 DOI: 10.1136/bmjopen-2022-063375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented. DESIGN Scoping review. DATA SOURCES Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted. STUDY SELECTION All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers. DATA EXTRACTION Data were assessed through the use of a pre-set analysis tool. RESULTS After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process. CONCLUSION Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures. PRACTICE IMPLICATIONS Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.
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Affiliation(s)
| | - Karen McBride-Henry
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Caz Hales
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Helen Rook
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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4
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Pandya S, Sedani AB, Syros A, Yakkanti RR, Dodds SD, Aiyer AA. The Effects of Face Masks on the Doctor-Patient Relationship in Orthopaedics. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:267-273. [PMID: 35821919 PMCID: PMC9210425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, the widespread use of face masks has grown exponentially. There is limited data highlighting the patient perception of face mask use during this pandemic, specifically in orthopaedic clinics. The purpose of this study was to determine the patient's perception of the implementation of face masks in the orthopaedic clinic during a period of mask mandates and if this change impacted the success of their interactions with physicians. The secondary aim includes measures of patient satisfaction such as the ability to understand conversation and communicate effectively with the physician. METHODS Participants were recruited on the day of their appointment at our institution's orthopaedic clinic and provided with instructions via email. The online, anonymous survey included the CARE questionnaire - a tool to examine patient satisfaction by assessing perception of empathy and was conducted using Qualtrics. RESULTS Does patient preference to have their physician wear a face mask impact the success of their interactions with physicians? Overall, the use of face masks by physicians did not negatively impact patient encounters. CARE scores for patients who preferred masks (37.2) were similar to those who preferred their physician did not wear a mask (37.5). Is patient satisfaction affected by the use of face masks in the orthopaedic clinic? Patients who preferred that their doctor wear a face mask stated that it had no negative impact on the effect of communication or conversation with the physician. Other factors such as how well the patients knew the physician and patient gender had a greater impact on the CARE score than masks did. CONCLUSION Our study determined that the preference of face masks by patients does not impact the success of their interactions with physicians using the CARE score. The findings of this study are valuable in informing orthopaedic physicians about patient attitudes towards mask use and could influence decision making for not only the COVID-19 pandemic, but also future infectious outbreaks that may arise. Level of Evidence: III.
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Affiliation(s)
- Shivani Pandya
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Anil B. Sedani
- Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ramakanth R. Yakkanti
- Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | - Seth D. Dodds
- Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedics, John Hopkins University, Baltimore, Maryland, USA
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5
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Feo R, Kumaran S, Conroy T, Heuzenroeder L, Kitson A. An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship. Nurs Inq 2021; 29:e12425. [PMID: 34076309 DOI: 10.1111/nin.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Sheela Kumaran
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- * E-mail:
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Dobransky J, Gartke K, Pacheco-Brousseau L, Spilg E, Perreault A, Ameen M, Finless A, Beaulé PE, Poitras S. Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution. J Patient Exp 2020; 7:1549-1555. [PMID: 33457613 PMCID: PMC7786763 DOI: 10.1177/2374373520968972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.
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Affiliation(s)
- Johanna Dobransky
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kathleen Gartke
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Spilg
- Division of Geriatrics, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ashley Perreault
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mohammad Ameen
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Finless
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
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Patient-rated physician empathy and patient satisfaction during pain clinic consultations. Ir J Med Sci 2019; 188:1379-1384. [PMID: 30919198 DOI: 10.1007/s11845-019-01999-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Little is known about the influence of patient-perceived healthcare provider empathy on patient satisfaction in the setting of a hospital pain clinic consultation. The objective of this research was to examine the relationship between patient-rated physician empathy and patient satisfaction after a single new pain clinic consultation. METHODS After institutional ethics committee approval, a sample of 140 adult patients completed a two-page questionnaire, directly after a pain clinic consultation. This included a brief sociodemographic questionnaire, the Consultation and Relational Empathy (CARE) measure and an overall satisfaction rating. RESULTS The sample, N = 140 patients, was balanced for gender and 80% of participants ranged in age from 30 to 70. Of these patients, 80.7% had been living with chronic pain between 1 and 5 years. The data were deemed to be non-parametric and a Spearman's ranked order correlation analysis yielded a strong positive correlation between patient-rated physician empathy and patient consultation satisfaction. CONCLUSION Patient-rated physician empathy was strongly correlated with patient satisfaction in a pain clinic consultation. Patient satisfaction plays a significant role in adherence to treatment and contributes to a positive working patient-physician therapeutic relationship. This research supports the growing body of research citing the importance of investing in, promoting and developing educational programs for physicians and medical trainees to enhance empathic communication skills within the clinical setting.
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