Let’s talk about empathy!
Introduction
The concept of clinical empathy has existed since the 1960s and yet systematic and scientific studies on the subject appeared in the last decade [1], [2], [3], [4]. These have identified the many advantages of empathy in medical practice: quality of care, therapeutic results, quality of life and satisfaction (see details below).
Although we all have a concept of empathy in daily life, research struggles to find a general agreement about an adequate and scientific definition [5]. For example, Bayne [6] considers that this difficulty could come from the place given to emotion in the definition of empathy: could “empathy consist of recognizing the emotion of a patient, or experiencing it, or both?” In the medical context, empathy is mainly considered a cognitive quality involving an understanding of the patient, his/her experiences, concerns and point of view, associated with the ability to communicate this understanding and check its accuracy in order to provide therapy [7]. However, rather than the perception or the understanding of others, Eisenberg [8] places emotional feeling at the core of his definition of empathy. He thus considers empathy an effective response to the emotions of others. There are also descriptions of empathy based on these two components: one cognitive and one affective [6], [9]. Lastly, there is debate about the addition or not of a behavioral component in the definition of empathy [7], [8].
Benefits of empathy on patients are regularly studied and many are identified [10], [11]. Concerning cancer care, Lelorain and colleagues [1] highlight the direct benefits for the patient: greater satisfaction with their care, a better psychosocial adaptation, less psychological distress and less need for information. Clinical empathy increases patients’ compliance to treatment [12] and health outcomes also seem more favorable with it [13]. Physicians who adopt empathic concern are more effective than those who stay formal and show no emotional care [14]. In addition, clinical empathy has positive and direct effects on physicians. Some research has demonstrated the protective factors of empathy against professional dissatisfaction and burnout [15] as well as it being a potential factor of well-being [13]. Empathy is strongly associated with personal accomplishment and job satisfaction for physicians because it enables them to find pleasure and satisfaction in their work [9], [16], [17]. However, we need to be vigilant, developing empathic skills with patients can also represent some risks for physicians [18]: emotional exhaustion [19], emotional distress [17], even empathy may create burnout [4], [20].
Despite the increasing data concerning clinical empathy, previous researches may present some limitations [21]. Thus for example, results from quantitative cross-sectional studies do not allow the clear identification of the determinants and components of empathy. Observational studies may help to distinguish the causality effects of empathy on health outcomes [10], especially if they generate hypotheses that could be tested thanks to longitudinal cohort or randomized controlled trial (RCT) studies. Those kinds of design would offer the possibility to assess the effectiveness of empathy, and to strongly define statistically the size and the significance of those effects. Recently, a meta-analysis of 13 randomized controlled trials indicated that the patient-physician relationship has a small but statistically significant effect on clinical outcomes [22]. Some limitations of current studies may be due to empathy measurement tools used, which may present some restrictions: (1) most of it are self evaluation which may present social desirability bias [23]; and (2) are not psychometrically robust and do not cover all the domains of empathy [24]. Thus if recent quantitative studies may help to infer what could be the components of this empathy, knowing better intra- and interindividual components and determinants of empathy is necessary and will be possible by conducting cross-sectional studies based on observations of physician-patient interactions. Moreover, qualitative studies are helpful to detail their nature, their origins and/or their impact especially when we want to include physicians’ experiences, their interpretations, but also the context in which empathy is developed and practiced.
Thus, this study develops a specific approach, one that is both qualitative and quantitative. The goal is to explore the physicians’ views of empathy with the intent of (a) building a description of empathy in oncology, and (b) identifying how empathy helps or limits them in their clinical practices.
Section snippets
Method
According to recent recommendations [21], [25] and in the perspective of an exploratory descriptive approach [26], [27], [28], [29], we chose to develop a specific approach which combines a qualitative data collection and a quantitative data analysis. This design provides a better understanding by converging broad numeric trends from quantitative research and the detail of qualitative research [26], [30].
Faced with a pejorative representation, various tools have been developed to improve
Results
Twenty-five physicians, aged from 32 to 68 years, voluntarily participated (Mage = 50.52 years and SD = 8.43; 56% women). Different medical specialties are represented in the present sample: palliative care (36%), medical oncology (24%), pulmonology (20%), and gastroenterology and cancer surgery (20%). Sociodemographic and professional characteristics of the participants are presented in Table 1.
Discussion
The two objectives of our study were (a) to obtain a description of empathy that is specific to cancer care, and (b) to identify the effects of empathy according to physicians. Our analysis allows us to describe clinical empathy into six dimensions: (1) patient- physician encounter, (2) standing in another person’s shoes, (3) adjustment to patient, (4) communication skills, (5) building interpersonal relationship and giving information and (6) teaching skills. Moreover, results indicate various
Conflicts of interest statement
No conflict of interest
Acknowledgements
This study was conducted when the first author was a PhD. student in Paris Descartes University. The first author also thanks the Lariboisière Hospital for their support during the writing of the article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
We confirm all personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.
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2022, Nurse Education in PracticeCitation Excerpt :Some studies indicate that health care professionals lack empathy and understanding toward older adults (Chen et al., 2015, 2015; Dickinson, Schwarzmueller and Martin, 2014; Nunes et al., 2011; Parke and Hunter, 2014; Rush et al., 2017). Furthermore, there is evidence that health care without empathy results in a wide range of negative physiological outcomes (Robieux et al., 2018). In fact, Vives, Orte and Sanchez highlight that one of the main competencies that a professional working in the healthcare setting with older adults should acquire is empathy (Vives, Orte and Sánchez, 2016).
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2022, Patient Education and CounselingCitation Excerpt :Another review aligning with our study highlighted discordant views between healthcare professionals and patients influencing the implementation of OA guidelines in primary care [58]. Clinical empathy involves perspective-taking, recognising patient priorities and concerns, and responding and acting in a way to demonstrate understanding [59,60]. Establishing an empathic interaction provides a building block for creating shared understanding and goals for management, and has the potential to enhance patient satisfaction and improve clinical outcomes [61].
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2021, Patient Education and CounselingCitation Excerpt :Haider and colleagues’ [17] focus groups with 109 medical students, residents, and clinical teachers yielded five themes defining empathic clinical practice: feeling someone’s pain via taking their perspective, and being kind, sensitive, compassionate, and caring. Moving into more systematic measurement, automated content analysis was conducted by Robieux and colleagues [18] based on word frequencies and co-occurrences in 25 interviews with cancer care physicians. Themes that emerged included standing in the patients’ shoes, adjusting to the patient, developing relationship, and effective communication skills.