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What are the benefits of empathy in Healthcare?



How to Maintain Empathy in Healthcare   
What it means and why it matters.
March 13, 2019
How Does Practicing Empathy in healthcare Benefit Patients and Nurses?

1. Increased patient satisfaction.
Patients feel valued, respected and satisfied with their care when they are shown empathy. Although the patient may be going through a stressful time, empathy from the nurse promotes a more positive environment in which trust can grow.

2. Improved patient outcomes.
When nurses treat patients with a higher degree of empathy, patient outcomes tend to be better. One studyfound that the patients of nurses who had attended an empathy training program “showed significantly less anxiety and hostility.”
3. More complete diagnosis.
Empathy facilitates trust. Trust between the nurse and patient is paramount in an accurate assessment, diagnosis, and treatment plan. Patients are more likely to be honest with you about their health history and lifestyle if they trust you.

4. Higher job satisfaction and career growth for nurses.
Nurses look to their employers and nurse leaders to foster engagement and professional growth. Organizational leaders who encourage empathetic and compassionate care recognize the value of a truly holistic employee. Higher nurse engagement and display of clinical empathy can reduce burn out while simultaneously promoting a positive work environment and boosting productivity."




Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members A Qualitative Study
July 6, 2018
Tessie W. October
Zoelle B. Dizon,
Robert M. Arnold,
When physicians responded using unburied empathetic statements and allowed time for family members to respond, they were more likely to learn important information about the family’s fears, values, and motivations.


"Findings show that empathetic care predicts patient safety, but only under some circumstances.  Specifically, patient load, overtime work, and financial hardship dampen the otherwise positive relationship between empathetic care and safety. The authors discuss the implications of these findings for the design of care jobs."


Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis
Jeremy Howick, Andrew Moscrop...
"Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain.""Practitioners who take time to enhance how they express empathy and deliver positive messages are likely to bring small improvements to a range of psychological and physical patient conditions, improve overall patient satisfaction with care, without inducing any harm. "

A dose of empathy may support patients in pain
April 20, 2018
"Research published in the Journal of the Royal Society of Medicine suggests that empathic, positive messages from doctors may be of small benefit to patients suffering from pain, and improve their satisfaction about the care received."


Are Empathic Doctors Seen as More Competent?
HELEN RIESS 
 OCTOBER 3, 2017
"Studies have shown that when physicians behave empathically, patients are more satisfied, trust them more, adhere better to treatment recommendations, file fewer malpractice claims, and end up healthier. Meanwhile, the physicians make fewer medical errors and have higher job satisfaction—all positives, for sure.

Recent research shows that when physicians show empathy, their patients also rate them as more competent and better caregivers."

"Results showed that the physicians who displayed nonverbal empathy were judged to be both warmer and more competent than the non-empathic physicians. A participant’s mood had no effect on these results."




 "A growing number of trials show that enhanced practitioner empathy can
  •  reduce pain and anxiety, together with several other health outcomes,6,7
  • while improving general quality of care.8 
  • Empathic care also increases patient satisfaction, 
  • and can benefit the growing number of multimorbid patients,9 
  • increase practitioner wellbeing while reducing stress and burnout,10
  • and diminish medico-legal risks.11"



Oxford Empathy Programme International Colloquium
A growing body of evidence suggests that when healthcare practitioners enhance the way they express empathy, that this may improve healthcare outcomes. Specifically, enhanced empathy appears to:
  • reduce patient pain, depression, anxiety 1,2
    • 1. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet 2001; 357(9258): 757-62.
    • 2. Mistiaen P, van Osch M, van Vliet L, et al. The effect of patient-practitioner communication on pain: a systematic review. Eur J Pain 2015.
  • increase patient satisfaction 3 
    • 3. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract 2013; 63(606): e76-84.
  • and improve patient well-being 4
    • DiLalla LF, Hull SK, Dorsey JK, Department of F, Community Medicine SIUSoMCUSAlse. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teaching and learning in medicine 2004; 16(2): 165-70.
  • improve medication adherence 5
    • Attar HS, Chandramani S. Impact of physician empathy on migraine disability and migraineur compliance. Annals of Indian Academy of Neurology 2012; 15(Suppl 1): S89-94.
  • reduce practitioner burnout 6
    • Thomas MR, Dyrbye LN, Huntington JL, et al. How do distress and well-being relate to medical student empathy? A multicenter study. Journal of General Internal Medicine 2007; 22(2): 177-83.
  • reduce patient complaints and medico-legal risk 7
    • Moore PJ, Adler NE, Robertson PA. Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med 2000; 173(4): 244-50.
  • reduce medication use 8
    • Howick J, Fanshawe TR, Mebius A, et al. Effects of changing practitioner empathy and patient expectations in healthcare consultations. Cochrane Database of Systematic Reviews 2015.




Effects of changing practitioner empathy and patient expectations in healthcare consultations
(HOWICK + 2015)
Authors: Jeremy Howick, Thomas R Fanshawe, Alexander Mebius, George Lewith, Carl J Heneghan, Felicity Bishop, Paul Little, Patriek Mistiaen,  Nia W Roberts 

Benefits
  • "For example, empathy and positive expectations are suspected to reduce anxiety and stress (Everly 2002) which in turn could reduce pain, depression, and various other conditions (Grossman 2004)."
    • - anxiety
    • stress
    •  - pain, 
    • - depression,
  • Improving practitioner empathy and inducing positive patient expectations can also affect overall wellbeing (Thomas 1987).
    • overall wellbeing 
"While some anxiety or stress is necessary to enhance performance and focus, about half of American working adults claim to be concerned that they have too much stress (APA 2013). Under stress, or the 'fight or flight' response (Cannon 1915), the body produces hormones such as adrenaline and cortisol (Jansen 1995), which, in turn, have numerous downstream affects on the body's immune system (Segerstrom 2004), 
Evidence from the basic sciences (Benedetti 2009), as well as clinical trials indicates that physician empathy (Sarinopoulos 2013) and positive expectations (Brummett 2006) could reduce stress and anxiety, and thus are likely to help treat numerous stress-related conditions."
  • - pain
  • - stress 
  • - negative health effects of stress
  • - anxiety
  • - fatigue
  • - neurodegenerative disorders 
  • + wound healing 
  • + mental health
  • - mortality 
  • + "patients are more likely to provide accurate and sufficient information about their symptoms "



"Empathy is particularly important in the context of medicine, where evidence suggests it is related to numerous positive outcomes [for a review, see 10]
  •  including increased patient satisfaction [11], 
  • good patient rapport [12], 
  • increased adherence to treatment [13], 
  • increased diagnostic accuracy [14], 
  • reduced medical errors [15],
  •  and positive health outcomes [1618] (though see [19]; "

10. Hall JA, Roter DL. Physician-patient communication. Foundations of health psychology. 2007:325–57. * View Article PubMed/NCBI Google Scholar
"There is some evidence that doctors with high empathy scores have 
  • more job satisfaction and less burnout. 62, 63  
Despite the literature in support of empathy in medical training and practice, this has not been translated into effective actions and attitudes. 35 
  • Empathy has been linked to improved patient satisfaction, 34 
  • better concordance with medical advice, 64 
  • decrease of anxiety and distress, 65 
  • improved diagnosis 66 and clinical outcomes. 34, 67 
  • Perhaps the best understood pathway by which empathy improves health outcomes is in the generation of trust between the patient and doctor. 68, 69, 70  " (JEFFREY 2016)
 
References
    • 34. Derksen F, Bensing J and Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Prac 2013; 63: 76–84.
    • 35. Decety J. Introduction. In: Decety JHS (ed.) Empathy: from bench to bedside. Cambridge, MA: MIT Press, 2011, pp.vi–ix.
    • 62. Larson E and Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA 2005; 293: 1100–1106.
    • 63. Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Int Med 2007; 22: 177–183.
    • 64.  Hojat M, Mangione S, Gonnella JS, Nasca T, Veloski  JJ and Kane G. Empathy in medical education and patient care. Acad Med 2001; 76: 669
    • 65. van Dalen J. In the news! An opinion feelings about students’ emotions. Educ Health 2010; 23: 515.
    • 66. Levinson W, Lesser CS and Epstein RM. Developing physician communication skills for patient-centered  care. Health Affairs 2010; 29: 1310–1318.
    • 67. Mercer SW, Neumann M, Wirtz M, Fitzpatrick B and Vojt G. General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland – a pilot prospective study using structural equation modeling. Patient Educ Counsel 2008; 73: 240–245 
    • 68. Halpern J. Gathering the patient’s story and clinical empathy. Permanente J 2012; 16: 1. 
    • 69. Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W and Inui TS. Communication patterns of primary care physicians. JAMA 1997; 277: 350–356. 
    • 70. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D and Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care 1998; 36: 1138–1161.

 

"Research has shown that patients consistently rate empathy and the human aspects of care as top priorities (Mercer & Reynolds, 2002; Mercer et al., 2004, 2007).  (CARE Approach)"

  • Mercer SW, Maxwell M, Heaney D, Watt GCM (2004) The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice, 21(6): 699-705

  • Mercer SW, Cawston PG, Bikker AP. Quality in general practice consultations; a qualitative study of the views of patients living in an area of high socio-economic deprivation in Scotland. BMC Family Practice 2007; 8:22

  •  Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract 2002; 52: S9-S12   



Editorial: Empathy and Health Care QualityMohammadreza Hojat, Daniel Z. Louis, Vittorio Maio, Joseph S. Gonnella,
"Empathic engagement in patient care leads to improved patient outcomes."
"the association between higher physician empathy and a lower incidence of acute metabolic complications that required hospitalization was confirmed."


The Effects of Physician Empathy on Patient Satisfaction and Compliance
"The present study attempted to develop new scales of patient-perceived, empathy-related constructs and to test a model of the relationships of physician empathy and related constructs to patient satisfaction and compliance. Five hundred fifty outpatients at a large university hospital in Korea were interviewed with the questionnaire. The data were analyzed using structural equation modeling.

Patient-perceived physician empathy significantly influenced patient satisfaction and compliance via the mediating factors of information exchange, perceived expertise, inter-personal trust, and partnership. Improving physician empathic communication skills should increase patient satisfaction and compliance. Health providers who wish to improve patient satisfaction and compliance should first identify components of their empathic communication needing improvement and then try to refine their skills to better serve patients."


An Overview of Empathy
James T Hardee, MD
"Empathy is a powerful commun ication skill that is often misunderstood and underused. Initially, empathy was referred to as “bedside manner”; now, however, authors and educators consider empathetic communication a teachable, learnable skill that has tangible benefits for both clinician and patient: Effective empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship. Appropriate use of empathy as a communication tool facilitates the clinical interview, increases the efficiency of gathering information, and honors the patient."




Empathy is a protective factor of burnout in physicians: new neuro-phenomenological hypotheses regarding empathy and sympathy in care relationship
Berangere THIRIOUXFrançois BIRAULT  and Nematollah JAAFARI
"the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. 

Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. 

Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. 

Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care."

THIRIOUX B, BIRAULT F and JAAFARI N (2016). Empathy is a protective factor of burnout in physicians: new neuro-phenomenological hypotheses regarding empathy and sympathy in care relationship. Front. Psychol. 7:763. doi: 10.3389/fpsyg.2016.00763



Doctors have become less empathetic, but is it their fault?
David Scales is a resident physician in internal medicine at the Cambridge Health Alliance.
"At times, empathy’s impact seems more magical than biological. When empathy scores are higher, patients recover faster from the common cold, diabetics have better blood-sugar control, people adhere more closely to treatment regimens, and patients feel more enabled to tackle their illnesses. Empathetic physicians report higher personal wellbeing and are sued less often."


  • 1. Compassion Reduces Patients Physiology
  • 2.  Compassion Reduces Pain
  • 3.  Compassion Reduces Re admissions
  • 4.  Compassion Prolongs Survival 
  • 5.  Compassion Reduces Morality
  • 6.  Compassion Improves Glucose Control
  • 7.  Compassion Improves Trauma Outcomes
  • 8.  Compassion Increases Patient Adherence
  • 9.  Compassion Boots Immune Function
  • 10.  Compassion Reduces Health Costs

"Patients consider empathy as a basic component of all therapeutic relationships and a key factor in their definitions of quality of care."
Effectiveness of empathy ingeneral practice:a systematic review
Frans Derksen, Jozien Bensing and Antoine Lagro-Janssen


Children learn empathy growing up, but can we train adults to have more of it?
John Malouff
"Studies support its value. Health professionals who show high levels of empathy tend to get better adherence to treatment from their patients and better patient outcomes. And beyond health care, empathy is associated with better personal relationships and more successful social behaviour."




The Effects of Physician Empathy on Patient Satisfaction and Compliance
Sung Soo Kim, Stan Kaplowitz, Mark V. Johnston
September 1, 2004
"The present study attempted to develop new scales of patient-perceived, empathy-related constructs and to test a model of the relationships of physician empathy and related constructs to patient satisfaction and compliance. Five hundred fifty outpatients at a large university hospital in Korea were interviewed with the questionnaire. T

he data were analyzed using structural equation modeling. Patient-perceived physician empathy significantly influenced patient satisfaction and compliance via the mediating factors of information exchange, perceived expertise, inter-personal trust, and partnership. 

Improving physician empathic communication skills should increase patient satisfaction and compliance. Health providers who wish to improve patient satisfaction and compliance should first identify components of their empathic communication needing improvement and then try to refine their skills to better serve patients."

  • + patient satisfaction
  • +  compliance via the mediating factors of information exchange
  • + perceived expertise
  • + inter-personal trust,
  • + partnership



Why Is Empathy Training Beneficial?
Research indicates that widespread empathy
throughout a healthcare organization
contributes to:
  • --a healthy work environment.
  • --higher patient satisfaction scores.
  • --greater financial reimbursements from CMS.
  • --a decrease in medical malpractice suits.
  • --a decrease in an organization's turnover rates.
  • --and a decrease in physician burnout and
  • compassion fatigue.

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