Let’s talk about empathy!

https://doi.org/10.1016/j.pec.2017.06.024Get rights and content

Highlights

  • Clinical empathy in oncology isn’t only emotional but cognitive and behavioral.

  • Empathy helps physicians in clinical practice.

  • Empathy protects physicians’ wellbeing and job satisfaction.

  • It’s hard to be empathic: It needs motivation, objectivity and favorable climate.

  • Pay attention to emotional fragility due to empathy.

Abstract

Background

Research faces a challenge to find a shared, adequate and scientific definition of empathy.

Objective

Our work aimed to analyze what clinical empathy is in the specific context of cancer care and to identify the effect of empathy in it.

Method

This study gives voice to physicians with extensive experience in cancer care. This original research combines qualitative data collection and quantitative data analysis. Semi-structured individual interviews were conducted with 25 physicians. The content of the interviews was analyzed according to the Content Analysis Technique.

Results

Empathy is described according to six dimensions that give a strong role to interpersonal and cognitive skills. This description integrates previous and various conceptualizations of clinical empathy. Physicians detail the beneficial effects of clinical empathy on patients’ outcomes and well-being as well as physicians’ practices. Physician interviews also revealed the relationship between empathic concerns and physicians’ emotional difficulties.

Conclusion

Empathy in cancer care is a complex process and a multicomponent competence.

Practice implications

This operational description of clinical empathy has three main implications: to draw up a training program for physicians, to detail recommendations for physicians’ work-related quality of life and to develop new tools to measure 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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