Measuring empathic, person-centred communication in primary care nurses: validity and reliability of the Consultation and Relational Empathy (CARE) Measure.

Annemieke P Bikker,Stewart W Mercer,Douglas Murphy,Bridie Fitzpatrick

doi:10.1186/s12875-015-0374-y

Annemieke P Bikker, Stewart W Mercer + Show 2 more

Open Access

https://doi.org/10.1186/s12875-015-0374-y

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Abstract

BackgroundEmpathic patient-centred care is central to high quality health encounters. The Consultation and Relational Empathy (CARE) Measure is a patient-rated experience measure of the interpersonal quality of healthcare encounters. The measure has been extensively validated and is widely used by doctors in primary care but has not been validated in nursing. This study assessed the validity and reliability of the CARE Measure in routine nurse consultations in primary care.MethodsSeventeen nurses from nine general medical practices located in three Scottish Health Boards participated in the study. Consecutive patients (aged 16 years or older) were asked to self-complete a questionnaire containing the CARE Measure immediately after their clinical encounter with the nurse. Statistical analysis included Spearman’s correlation and principal component analysis (construct validity), Cronbach’s alpha (internal consistency), and Generalisability theory (inter-rater reliability).ResultsA total of 774 patients (327 male and 447 female) completed the questionnaire. Almost three out of four patients (73 %) felt that the CARE Measure items were very important to their current consultation. The number of ‘not applicable’ responses and missing values were low overall (5.7 and 1.6 % respectively). The mean CARE Measure score in the consultations was 45.9 and 48 % achieved the maximum possible score of 50. CARE Measure scores correlated in predicted ways with overall satisfaction and patient enablement in support of convergent and divergent validity. Factor analysis found that the CARE Measure items loaded highly onto a single factor. The measure showed high internal consistency (Cronbach’s alpha coefficient = 0.97) and acceptable inter-rater reliability (G = 0.6 with 60 patients ratings per nurse). The scores were not affected by patients’ age, gender, self-perceived overall health, living arrangements, employment status or language spoken at home.ConclusionsThe CARE Measure has high face and construct validity, and internal reliability in nurse consultations in primary care. Its ability to discriminate between nurses is sufficient for educational and quality improvement purposes.

Highlights

Empathic patient-centred care is central to high quality health encounters
In carrying out the current study we have a number of hypotheses to be tested based on our previous work on empathy and the Consultation and Relational Empathy (CARE) Measure: 1. We would expect the CARE measure to be relevant to most consultations with practice nurses, as we have found for primary care and secondary care doctors [22, 25, 26]
Completed questionnaires were obtained for 774 practice nurse consultations (37– 55 per nurse)

Summary

Introduction

Empathic patient-centred care is central to high quality health encounters. The Consultation and Relational Empathy (CARE) Measure is a patient-rated experience measure of the interpersonal quality of healthcare encounters. This study assessed the validity and reliability of the CARE Measure in routine nurse consultations in primary care. Patients consistently score empathy and the human aspects of care as top priorities in their health care [1,2,3,4]. Healthcare practitioners are increasingly expected to demonstrate their interpersonal skills in terms of empathic, patient-centred care in practice and training [20, 21]. The Consultation and Relational Empathy (CARE) Measure is a patient-assessed measure of the quality of the encounter with healthcare professionals [3, 21]. Ten items ask patients’ perception of the practitioner’s ‘relational empathy’, defined as the healthcare practitioner’s ability to: a) understand the patient’s situation, perspective and feelings (and their attached meanings); b) communicate that understanding and check its accuracy, and c) act on that understanding with the patient in a helpful (therapeutic) way [3, 21]

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