Consultation And Relational Empathy Measure Scores Research Articles

Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care

BackgroundThere is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy.MethodsThis was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy.ResultsA total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000).ConclusionsThis study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully.Trial registrationJapanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.

Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study.

BackgroundRemission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed.ObjectiveTo quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up.MethodsA prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes.ResultsOf 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01–1.05, P = 0.01).ConclusionPrimary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.

Investigation of empathy amongst dietetic interns at selected primary and tertiary health-care facilities.

Empathy is an essential aspect in the delivery of quality nutrition care and promoting better outcomes in patients. With an increased emphasis of patient-centred care in dietetic practice, empathy should underpin the construct of the curriculum in dietetic education. The present study investigated the empathy level of dietetic interns through self-reporting measures and patients' perception. This cross-sectional study was conducted on a total of 57 dietetic interns and 99 patients from primary and tertiary health care settings. The dietetic interns completed the Toronto Empathy Questionnaire (TEQ) while the Consultation and Relational Empathy (CARE) measure was self-administered by patients. Socio-demographic information of participants was collected. The dietetic interns' mean (standard deviation [SD]) TEQ scores were 46.90 ± 5.28 and 47.78 ± 5.34 in primary and tertiary care, respectively. CARE measure scores rated by patients in the primary care were 38.61 ± 8.38 and for tertiary setting, the scores were slightly higher (39.47 ± 7.65). The settings, gender, ethnicity and period of internship did not affect dietetic interns' empathy level. In primary care, CARE scores were significantly different between patients' age grouping (P = 0.007). Findings from the present study showed that patients' age significantly affected their perception of dietetic interns' empathy in primary health care. These preliminary findings could facilitate an understanding of the level of empathy amongst interns for consideration in the future design of dietetic training.

Empathy in vaccination counselling: a survey on the impact of a three-day residential course

ABSTRACTBackground: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known.This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients’ ratings of the level of empathy of physicians and nurses working in vaccination centers.Methods: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children.Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups.Results: Analysis of the questionnaires showed an increase of “excellent” scores and statistically significant differences between the pre- and post -course median values.Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course.Conclusions: This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents’ adherence to vaccination programs.

Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses\u2019 consultations

BackgroundIncreasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses.MethodsPatient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland.ResultsFemale patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses.ConclusionsWithin this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.

Promoting empathy among medical students: A two-site randomized controlled study

ObjectiveTo assess the effects of Balint groups on empathy measured by the Consultation And Relational Empathy Measure (CARE) scale rated by standardized patients during objective structured clinical examination and self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. MethodsA two-site randomized controlled trial were planned, from October 2015 to December 2015 at Paris Diderot and Paris Descartes University, France. Eligible students were fourth-year students who gave their consent to participate. Participants were allocated in equal proportion to the intervention group or to the control group. Participants in the intervention group received a training of 7 sessions of 1.5-hour Balint groups, over 3months. The main outcomes were CARE and the JSPE-MS© scores at follow-up. ResultsData from 299 out of 352 randomized participants were analyzed: 155 in the intervention group and 144 in the control group, with no differences in baseline measures. There was no significant difference in CARE score at follow-up between the two groups (P=0.49). The intervention group displayed significantly higher JSPE-MS© score at follow-up than the control group [Mean (SD): 111.9 (10.6) versus 107.7 (12.7), P=0.002]. The JSPE-MS© score increased from baseline to follow-up in the intervention group, whereas it decreased in the control group [1.5 (9.1) versus −1.8 (10.8), P=0.006]. ConclusionsBalint groups may contribute to promote clinical empathy among medical students.Trial registration: NCT02681380

Patients' Perceptions of Dental Students' Empathic, Person-Centered Care in a Dental School Clinic in Malaysia.

Empathy has been identified as a crucial foundation in building an effective dentist-patient relationship. The aim of this study was to assess patients' perceptions of dental students' empathic care in the primary oral health care clinic at International Medical University in Kuala Lumpur, Malaysia in May-October 2014. The study also assessed the validity and reliability of the Consultation and Relational Empathy (CARE) Measure in this setting; the association between number of encounters and students' CARE Measure scores; and the association between students' empathy (measured by the Toronto Empathy Questionnaire) and CARE Measure scores. Participants were 283 patients (aged ≥18 years) who were asked to self-complete the ten-item CARE Measure immediately after their clinical encounter with students who provided care under supervision of the teaching staff. The results showed that the CARE Measure demonstrated good internal consistency (Cronbach's α=0.95). A single factor solution emerged, accounting for 69% of the variance. The mean CARE Measure score in the consultations was 43.55±6.14, and 26% of the students achieved the maximum possible score of 50. The mean number of encounters with each student was 2.33±2.78. An increase of one episode was associated with an insignificant average CARE score decrease of 0.05 (-0.28, 0.38), whereas students' empathy was associated with a small increase in average CARE Measure score of 0.63 (0.08, 1.18). These results provide evidence of the measure's ability to support feedback to dental students on their empathy when interacting with patients.

The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong.

BackgroundThe increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.ObjectiveThis study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.MethodsThis was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors.ResultsWithin similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting.ConclusionFamily medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors’ training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors’ empathy and enablement for chronic illness patients.

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

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.

Validity and reliability of the Japanese version of the CARE Measure in a general medicine outpatient setting

Empathy is an important attribute in medicine, influencing both the process and outcome of consultations. However, there are no validated tools available in Japan to gather patient feedback on physicians' empathy. The Consultation and Relational Empathy (CARE) Measure developed in the UK is widely used internationally. To investigate the psychometric properties of a Japanese version of the CARE Measure. Following two cycles of translation and back translation, the Japanese CARE Measure was completed by 317 patients in a primary medical care clinic in Japan. Tests of internal reliability and validity included Cronbach's alpha, item-total correlations and factor analysis. Predicted associations between CARE Measure score and other variables were assessed by Spearman's rho. Low numbers of missing values (8.2-9.8%) and 'not applicable' responses (0-1.3%) suggested high acceptability and face validity of the Japanese CARE Measure. Internal reliability was high (Cronbach's alpha 0.984) and was reduced by the removal of any of 10 items. High corrected item-total correlations (0.897-0.946) suggested homogeneity. Factor analysis showed a single solution with high item loadings (0.917-0.957). Construct validity was supported by a significant relationship (Spearman's rho 0.74, P < 0.001) with overall satisfaction with the consultation. The Japanese CARE Measure appears to be valid and reliable in a primary medical care setting. Further work is required to determine its ability to discriminate between doctors.

The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong.

BackgroundThe Consultation and Relational Empathy (CARE) Measure is a widely used patient-rated experience measure which has recently been translated into Chinese and has undergone preliminary qualitative and quantitative validation. The objective of this study was to determine the reliability of the Chinese-version of the CARE Measure in reliably differentiating between doctors in a primary care setting in Hong KongMethodsData were collected from 984 primary care patients attending 20 doctors with differing levels of training in family medicine in 5 public clinics in Hong Kong. The acceptability of the Chinese-CARE measure to patients was assessed. The reliability of the measure in discriminating effectively between doctors was analysed by Generalisability-theory (G-Theory)ResultsThe items in the Chinese-CARE measure were regarded as important by patients and there were few 'not applicable' responses. The measure showed high internal reliability (coefficient 0.95) and effectively differentiated between doctors with only 15-20 patient ratings per doctor (inter-rater reliability > 0.8). Doctors' mean CARE measure scores varied widely, ranging from 24.1 to 45.9 (maximum possible score 50) with a mean of 34.6. CARE Measure scores were positively correlated with level of training in family medicine (Spearman's rho 0.493, p < 0.05).ConclusionThese data demonstrate the acceptability, feasibility and reliability of using the Chinese-CARE Measure in primary care in Hong Kong to differentiate between doctors interpersonal competencies. Training in family medicine appears to enhance these key interpersonal skills.

Validity and reliability of the CARE Measure in secondary care

PurposeThe Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The present study aims to evaluate the potential usefulness of the CARE Measure in secondary care in a single Hospital Trust in Scotland.Design/methodology/approachA total of 1,015 out‐patients attending 25 consultants across ten specialities anonymously completed the questionnaire immediately after their appointment. Overall satisfaction, estimated consultation length, satisfaction with consultation length, and demographic and socio‐economic variables were also recorded.FindingsThe number of missing values and “not applicable” responses to the ten CARE Measure items was extremely low (3.4 per cent). Almost 90 per cent of patients felt the CARE Measure items were of major importance. The measure had a high internal reliability (Cronbach's alpha 0.94) and reduced to a single factor. Overall CARE Measure score correlated with overall satisfaction (r=0.7, p&lt;0.0001), whether patients would recommend the doctor (r=0.6, p&lt;0.0001), and satisfaction with consultation length (r=0.6, p&lt;0.0001). Multi‐regression analysis showed that personal continuity of care, consultation length, and patient age positively influenced CARE Measure score, but the effect size was small. Patients' gender, marital status, general health, and socio‐economic factors did not influence scores. Reliability analysis indicated that 40 patients were required per doctor in order to achieve an overall reliability co‐efficient of above 0.7.Practical implicationsSecondary care patients across a range of specialities have endorsed the CARE Measure as a relevant tool. It has high face and concurrent validity, internal and structural reliability and is not subject to major influences by demographic or socio‐economic factors. These findings support the feasibility and reliability of the CARE Measure in secondary care.Originality/valueThis pilot study indicates that the CARE Measure is considered by most patients to be of high relevance to everyday out‐patient consultations in secondary care.