Abstract
Information regarding treatment options and prognosis is essential for patient decision making. Patient perception of physicians as being less compassionate when they deliver bad news might be a contributor to physicians' reluctance in delivering these types of communication. To compare patients' perception of physician compassion after watching video vignettes of 2 physicians conveying a more optimistic vs a less optimistic message, determine patients' physician preference after watching both videos, and establish demographic and clinical predictors of compassion. Randomized clinical trial at an outpatient supportive care center in a cancer center in Houston, Texas, including English-speaking adult patients with advanced cancer who were able to understand the nature of the study and complete the consent process. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the videos observed by the patient. One hundred patients were randomized to observe 2 standardized, roughly 4-minute videos depicting a physician discussing treatment information (more optimistic message vs less optimistic message) with a patient with advanced cancer. Both physicians made an identical number of empathetic statements (5) and displayed identical posture. After viewing each video, patients completed assessments including the Physician Compassion Questionnaire (0 = best, 50 = worst). Patients' perception of physician compassion after being exposed to a more optimistic vs an equally empathetic but less optimistic message. Patients reported significantly better compassion scores after watching the more optimistic video as compared with the less optimistic video (median [interquartile range], 15 [5-23] vs 23 [10-31]; P < .001). There was a sequence effect favoring the second video on both compassion scores (P < .001) and physician preference (P < .001). Higher perception of compassion was found to be associated with greater trust in the medical profession independent of message type: 63 patients observing the more optimistic message ranked the physician as trustworthy vs 39 after the less optimistic message (P = .03). Patients perceived a higher level of compassion and preferred physicians who provided a more optimistic message. More research is needed in structuring less optimistic message content to support health care professionals in delivering less optimistic news. clinicaltrials.gov Identifier: NCT02357108.
Highlights
Higher perception of compassion was found to be associated with greater trust in the medical profession independent of message type: 63 patients observing the more optimistic message ranked the physician as trustworthy vs 39 after the less optimistic message (P = .03)
Patients perceived a higher level of compassion and preferred physicians who provided a more optimistic message
After adjustments for message and sequence effects, each point less degree of trust in the medical profession corresponded to a 1.75 point decrease in perception of physician compassion. In this randomized clinical trial, we found that physicians delivering a more optimistic message were perceived as more compassionate as compared with empathetic physicians delivering a less optimistic message
Summary
The Institutional Review Board (IRB) at the University of Texas MD Anderson Cancer Center approved this study, and all patients gave written informed consent. The MD Anderson Cancer Center IRB did not require registration of this trial in a clinical trials registry. The trial was registered retrospectively in clinicaltrials.gov. The trial protocol is available in Supplement 1. Patient Population Eligible patients who attended the Supportive Care Clinic at MD Anderson Cancer Center were screened and subsequently asked to participate. Patients with impaired cognition as determined by the interviewer on the basis of the ability to understand the nature of the study and consent process and those experiencing severe physical and/or emotional symptoms capable of substantially interfering with study participation as determined by the attending palliative care physician were excluded. The potential participants were informed that the messages they would view were not in any way a reflection of their current disease process
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