The Effect of Message Content and Clinical Outcome on Patients' Perception of Physician Compassion: A Randomized Controlled Trial

Tanco, Kimberson; Azhar, Ahsan; Rhondali, Wadih; Rodríguez-Núñez, Alfredo; Liu, Diane; Wu, Jimin; Bruera, Éduardo

doi:10.1634/theoncologist.2017-0326

Cited by 7 publications

(18 citation statements)

References 43 publications

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“…The methodology (blinded, randomized controlled trial design) and all the tools used in our study are validated. We have found them to be robust in measuring the patient‐reported outcomes in similar studies on patients’ preferences regarding physician posture , style, content and delivery of message , and the presence or absence of a computer during the clinic encounter . Our results strongly suggest that in the advanced cancer setting, patients had no preference for formal physician attire.…”

Section: Discussionmentioning

confidence: 55%

“…No significant differences were seen between the formal and casual attire groups, after watching the first video, for compassion (median [IQR], 25 vs. 20 , respectively; p =.31) and professionalism (17 vs. 18 , respectively; p = .42).…”

Section: Resultsmentioning

confidence: 96%

“…The Patient Assessment of Physician Compassion [46] is a validated five-item tool consisting of a numerical rating scale from 0 to 10 that assesses five dimensions: warm to cold, pleasant to unpleasant, compassionate to distant, sensitive to insensitive, and caring to uncaring. The sum of the five scales gave a final score representing physician's compassion on a scale of 0 to 50 [30,47].…”

Section: Patient Assessment Of Physician Compassionmentioning

confidence: 99%

“…After viewing each video, patients completed validated questionnaires rating their perception of physician compassion (0 = best, 50 = worst) [1,30,31,46], which was the primary outcome of the study. The secondary outcome was the patient's rating of their perception of physician professionalism (5 = poor, 25 = very good).…”

Section: The Scriptmentioning

confidence: 99%

“…Hence, we conducted this study to address this knowledge gap. In the past, we have successfully used video interventions with blinding to determine the impacts of physician posture [29], message content [1,30], and the effects of computer and electronic health record use in the clinic room [31] on patient perceptions regarding physicians' level of compassion and professionalism, along with patient preferences using validated outcome measurement tools. Importantly, the video vignettes presented to patients were carefully controlled to ensure that the scripts and actors were consistent between videos with the exception of the parameter to be tested.…”

Section: Introductionmentioning

confidence: 99%

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Challenging the Status Quo of Physician Attire in the Palliative Care Setting

et al. 2020

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Background, Aim, and Hypothesis This randomized controlled trial aimed to compare the impact of a physician's attire on the perceptions of patients with cancer of compassion, professionalism, and physician preference. Our hypothesis was that patients would perceive the physician with formal attire as more compassionate than the physician wearing casual attire. Materials and Methods One hundred five adult follow‐up patients with advanced cancer were randomized to watch two standardized, 3‐minute video vignettes with the same script, depicting a routine physician‐patient clinic encounter. Videos included a physician in formal attire with tie and buttoned‐up white coat and casual attire without a tie or white coat. Actors, patients, and investigators were all blinded to the purpose and videos watched, respectively. After each video, patients completed validated questionnaires rating their perception of physician compassion, professionalism, and their overall preference for the physician. Results There were no significant differences between formal and casual attire for compassion (median [interquartile range], 25 [10–31] vs. 20 [8–27]; p = .31) and professionalism (17 [13–21] vs. 18 [14–22]; p = .42). Thirty percent of patients preferred formal attire, 31% preferred casual attire, and 38% had no preference. Subgroup analysis did not show statistically significant differences among different cohorts of age, sex, marital status, and education level. Conclusion Doctors’ attire did not affect the perceptions of patients with cancer of physician's level of compassion and professionalism, nor did it influence the patients’ preference for their doctor or their trust and confidence in the doctor's ability to provide care. There is a need for more studies in this area of communications skills. Clinical trial identification number. NCT03168763 Implications for Practice The significance of physician attire as a means of nonverbal communication has not been well characterized. It is an important element to consider, as patient preferences vary geographically, are influenced by cultural beliefs, and may vary based on particular care settings. Previous studies consisted of nonblinded surveys and found increasing confidence in physicians wearing a professional white coat. Unfortunately, there are no randomized controlled trials, to the authors’ knowledge, to confirm the survey findings. In this randomized, blinded clinical trial the researchers found that physician's attire did not affect patients’ perception of the physician's level of compassion and professionalism. Attire also did not influence the patients’ preferences for their doctor or their trust and confidence in the doctor's ability to provide care.

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Section: Discussionmentioning

confidence: 55%

Section: Resultsmentioning

confidence: 96%

Section: Patient Assessment Of Physician Compassionmentioning

confidence: 99%

Section: The Scriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Challenging the Status Quo of Physician Attire in the Palliative Care Setting

et al. 2020

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Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Forth,

Hammerle,

König

et al. 2024

JAMA Netw Open

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ImportanceIn the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.ObjectiveTo examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.Design, Setting, and ParticipantsThis crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.InterventionsAlternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).Main Outcomes and MeasuresThe primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.ResultsOf 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P &lt; .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, −0.34; −1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, −0.55; 95% CI, −1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P &lt; .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).Conclusions and RelevanceWhen given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.Trial RegistrationGerman Clinical Trials Register (DRKS): DRKS00024466

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