Missed Opportunities for Interval Empathy in Lung Cancer Communication

Morse, Diane S.; Edwardsen, Elizabeth A.; Gordon, Howard S.

doi:10.1001/archinte.168.17.1853

Cited by 161 publications

(117 citation statements)

References 35 publications

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“…Prior studies have examined provider-patient communication for patient clues about emotional states or illness concerns [26][27][28][29] with the aim of identifying opportunities for physicians to provide empathy and support. Consistent with prior results, we found that patients with heart failure may not explicitly verbalize a desire to engage in sensitive conversations but instead offer implicit statements indicating their desire to do so.…”

Section: Discussionmentioning

confidence: 99%

“…However, this behavior might be associated with longer visits because we found that among the 21 missed opportunities identified, 11 opportunities were repeated patient statements that were initially unacknowledged and unaddressed by the physician. Data from prior studies 27,29,37 suggest that visits with missed opportunities for providing empathic communication may be longer than visits where physicians responded immediately and empathically to their patients' statements about their emotional experiences, primarily because patients would not have to repeat their initial concern. In our study, physician acknowledgment of the concern and provision of a basic level of information seemed to satisfy the patient-of the 4 taken opportunities we identified, all of them concluded after a brief response to the patient's statement or question.…”

Section: Discussionmentioning

confidence: 99%

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Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

et al. 2011

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BACKGROUND: Early provider-patient communication about future care is critical for patients with heart failure (HF); however, advance care planning (ACP) discussions are often avoided or occur too late to usefully inform care over the course of the disease. OBJECTIVE: To identify opportunities for physicians to engage in ACP discussions and to characterize physicians' responses to these opportunities. DESIGN: Qualitative study of audio-recorded outpatient clinic visits. PARTICIPANTS: Fifty-two patients≥65 years recently hospitalized for HF with one or more post-discharge follow-up outpatient visits, and their physicians (n=44), at two Veterans Affairs Medical Centers. APPROACH: Using content analysis methods, we analyzed and coded transcripts of outpatient follow-up visits for 1) patient statements pertaining to their future health or their future physical, psychosocial and spiritual/existential care needs, and 2) subsequent physician responses to patient statements, using an iterative consensus-based coding process. RESULTS: In 13 of 71 consultations, patients expressed concerns, questions, and thoughts regarding their future care that gave providers opportunities to engage in an ACP discussion. The majority of these opportunities (84%) were missed by physicians. Instead, physicians responded by terminating the conversation, hedging their responses, denying the patient's expressed emotion, or inadequately acknowledging the sentiment underlying the patient's statement. CONCLUSIONS: Physicians often missed the opportunity to engage in ACP despite openers patients provided that could have prompted such discussions. Communication training efforts should focus on helping physicians identify patient openers and providing a toolbox to encourage appropriate physician responses; in order to successfully leverage opportunities to engage in ACP discussions.KEY WORDS: qualitative research; advance care planning; heart failure; physician-patient communication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

et al. 2011

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“…Interventions have been developed to improve empathy in 4 clinical encounters [16,17]. Nevertheless, recent research has shown that physicians do not always demonstrate empathy to patients [18] and it is important therefore to continue improving and measuring empathy in clinical encounters. Several measures have been developed to measure empathy, for example, the Reynolds Empathy Scale [19], developed for use in nursing care, and the Jefferson Scale of Physician Empathy [20], a scale that was clinically led in its development.…”

Section: Introductionmentioning

confidence: 99%

The consultation and relational empathy measure: an investigation of its scaling structure

Kersten

White

Tennant

2011

Disability and Rehabilitation

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The Consultation and Relational Empathy measure: an investigation of its scaling structure Abstract PurposeThe Consultation and Relational Empathy (CARE) measure is recommended to evaluate the quality of care. However, there is no evidence it is valid in rehabilitation. Aims 1) to examine the internal construct (factorial) validity of the CARE in the assessment of the patienttherapist relationship. MethodCARE data were part of an experimental study of acupuncture and different currently used acupuncture placebo controls, including 213 patients (age 66.8, SD 8.3, 58% female) with chronic stable hip or knee pain of mechanical origin, waiting for a joint replacement. CARE was completed two weeks into the study and on completion two weeks later. Data analysis:Cronbach alpha, factor analysis and Rasch analysis. ResultsInternal construct validity was supported (82% of variance explained by the first factor; fit to the Rasch model χ 2 =18.2, P=0.57). CARE was unidimensional, had local independence of items, good item fit, absence of Differential Item Functioning and invariance over time.Three percent of people did not complete items 9&10. ConclusionsCARE satisfied strict criteria for internal construct validity. An interval scale transformation is available that can be used in clinical practice and research. Further work is required to investigate item non-response and how this may be dealt with in clinical settings.3

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“…8 Here is a sample of one such encounter of a physician with a cancer-patient faced with their impending mortality: Patient: BI don't know what the average person does in 2 years, 3 years, a year?^Physician: BI think that … you certainly could live 2 or 3 years. I think it would be very unlikely … But I would say that an average figure would be several months to a year to a little bit more^[Encounter 2] (Morse et al 2008). 9 An exception maybe when there is a medical emergency within one's immediate family.…”

Section: Endnotesmentioning

confidence: 99%

Can Doctors Maintain Good Character? An Examination of Physician Lives

Fatima

2016

J Med Humanit

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Can doctors maintain good character? This paper shifts the focus from patient care to ethical considerations that bear on the physician and impact her as a person. By decentering patient care, the paper highlights certain factors that habituate a particular way of reasoning that is not conducive to inculcating good character. Such factors include, standards of professionalism, being influenced by external monitors, and emphasis on adherence to guidelines. While such factors may benefit patients, they often adversely affect the character of physicians.Keywords Character . Physician . Professionalism . Virtue . Empathy . Compassion Dr. Philips' day at the clinic was finally ending. She had seen twenty-five patients in a span of eight hours, and just as she was ready to go home, her pager buzzed. Her forty-week-pregnant patient was just admitted in active labor, only four cm dilated. As she changed into her green scrubs, she could not help but think about missing yet another family dinner and possibly staying on-call overnight. Natural labor can take up to sixteen hours to deliver a baby. However, if the labor is augmented with medication or with early breaking of the amniotic fluid, it can progress faster. Her patient was full term and could potentially benefit from a timely delivery, but an induced labor could also increase the patient's chances of a Caesarian birth. Dr. Phillips decides to proceed with induced labor. The next morning, Dr. Phillips is admiring the picture of herself with the baby and the mother. Of course she missed seeing her kids for dinner, but she was able to rest before her morning shift, and the new mother and baby were doing well. This paper examines the myriad reasons that a doctor invariably takes into consideration while making medical decisions within everyday settings and the way that such reasoning impacts character. By 'everyday setting,' I refer to the real life circumstances that physicians in the United States operate in, where established standards of care aim at achieving optimum

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Missed Opportunities for Interval Empathy in Lung Cancer Communication

Cited by 161 publications

References 35 publications

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

The consultation and relational empathy measure: an investigation of its scaling structure

Can Doctors Maintain Good Character? An Examination of Physician Lives

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