Consultation And Relational Empathy Measure Research Articles

CARECOS study: Medical students’ empathy as assessed with the CARE measure by examiners versus standardized patients during a formative Objective and Structured Clinical Examination (OSCE) station

Purpose To assess the Consultation And Relational Empathy (CARE) measure as a tool for examiners to assess medical students’ empathy during Objective and Structured Clinical Examinations (OSCEs), as the best tool for assessing empathy during OSCEs remains unknown. Methods We first assessed the psychometric properties of the CARE measure, completed simultaneously by examiners and standardized patients (SP, either teachers - SPteacher - or civil society members - SPcivil society), for each student, at the end of an OSCE station. We then assessed the qualitative/quantitative agreement between examiners and SP. Results We included 129 students, distributed in eight groups, four groups for each SP type. The CARE measure showed satisfactory psychometric properties in the context of the study but moderate, and even poor inter-rater reliability for some items. Considering paired observations, examiners scored lower than SPs (p < 0.001) regardless of the SP type. However, the difference in score was greater when the SP was a SPteacher rather than a SPcivil society (p < 0.01). Conclusion Despite acceptable psychometric properties, inter-rater reliability of the CARE measure between examiners and SP was unsatisfactory. The choice of examiner as well as the type of SP seems critical to ensure a fair measure of empathy during OSCEs.

The influence of "bad news" and "neutral/good news" on patients' perception of physician empathy during oncology consultations.

Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a "bad news" consultation using the consultation and relational empathy (CARE) measure. A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the "bad news" group, or the "neutral/good news" group along with information about the patient and the consultation. The patient was given the CARE measure after the visit. The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11 min longer. Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient.

Validity and reliability of the Spanish version of the consultation and relational empathy measure in dental students (Sp-Dent-CARE): A cross-sectional study.

An evaluation was made of the psychometric properties of a Spanish version of the Consultation and Relational Empathy Measure (CARE) to assess relational empathy in undergraduate dental students. In addition, the influence of demographic, socio-economic and consultation-related factors upon the degree of perceived empathy and overall satisfaction was studied. A cross-sectional study was carried out in patients seen in the Oral Surgery Unit by fourth year dental students. Dentists, specialized translators and psychologists developed the translation of the questionnaire. After a pilot test, a convenience sample of patients was included. Construct validity was tested by factor analysis using principal component analysis with varimax rotation and Kaiser standardization, and internal consistency was assessed by Cronbach's α. Two pilot tests were carried out with a panel of experts until the final version of the questionnaire was established. In the validation stage, 191 patients participated (92 men and 99 women), with a mean age of 52.5 ± 17 years. The mean score of the CARE measure was 47.2 ± 4.4, and 57.6% of the patients (n = 110) reported the maximum score on the questionnaire. The final version showed a 1-factor solution explaining 68.6% of the total variance, with excellent final internal consistency (α = 93.4%). The Spanish version of the CARE measure affords high reliability and validity in assessing relational empathy in dental students. Perceived empathy is related to overall satisfaction. Patient demographics and the number of visits do not influence perceived empathy.

QUANTITATIVE MEASUREMENT OF EMPATHY AND ANALYSIS OF ITS CORRELATION TO CLINICAL FACTORS IN KOREAN PATIENTS WITH HYPERTENSION

Objective: We aim to evaluate empathy using the Korean Consultation and Relational Empathy (CARE) measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension. Design and method: Empathy is the core of the physician-patient relationship. The CARE measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in hypertension patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension. Data were collected from patients with hypertension. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors. Results: A total of 143 patients with hypertension were included. About 60% of patients were male. The mean age was 62. They had an average number of 2.6 comorbid diseases. More than half of patients experienced overt cardiovascular diseases such as heart failure, and coronary heart disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6±7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. This trend was maintained in hypertensive patients. Conclusions: The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.

Patient Experience with Video Telemedicine Neurology Follow-up Visits at Community Clinics (P1-4.001)

<h3>Objective:</h3> To assess patient satisfaction and perception of physician empathy following implementation of video telemedicine neurology follow-up visits at community clinics <h3>Background:</h3> There is a growing shortage of neurologists in the US who provide care outside of metropolitan areas[1]. Within the region of our academic medical center, neurologists drive approximately 2 hours round-trip each day to provide care at community clinics. Telemedicine minimizes travel time for both patients and physicians while maintaining/improving access. We aimed to develop a telemedicine service and assess patient experience. <h3>Design/Methods:</h3> We implemented video conferencing with tablet for patient to interact with neurologist and a pan and tilt zoom camera attached to a moveable cart to enable neurologist to perform neurological exam. Telemedicine visits were offered to patients who had previously been seen face-to-face by the neurologist performing follow-up. Implementation was at a clinic 45 miles from tertiary center(site 1) between February 2020–January 2021 and at a clinic 43 miles from tertiary center(site 2) between July 2021–January 2022. After the telemedicine visit, a survey was completed by patient and/or caregiver, which included the consultation and relational empathy(CARE)[1] and telemedicine patient satisfaction measures(TPSM)[2]. <h3>Results:</h3> 31 patients from site 1 and 38 patients from site 2 participated in telemedicine follow-up visit and completed the survey. Mean age was 66 years. Follow-up reasons were Parkinson disease/parkinsonism(36.2%), migraine(20.3%), dementia(17.4%), epilepsy(14.5%), and other(11.6%). CARE measure mean responses indicated patients’ perception of relational empathy was excellent(65%), and very good(25%). TPSM mean responses were strongly agreed(71%) and agreed(28%) with regard to patient satisfaction. The neurologists involved anecdotally reported improved work-life balance. <h3>Conclusions:</h3> Patient satisfaction and perceived physician empathy was high for video telemedicine neurology follow-up at our community clinics, supporting expansion of this model. This model also improved work-life balance for the neurologist. Study of care outcomes and use for new patient consultations is needed. <b>Disclosure:</b> Dr. Truitt has stock in NVTA. Dr. Truitt has stock in QTRX. Dr. Truitt has stock in EXAS. Dr. Truitt has stock in ALC. Dr. Truitt has stock in ACAD. Dr. Truitt has stock in ABBV. Dr. Truitt has stock in NVS. Dr. Truitt has stock in VRTX. Dr. Truitt has stock in MRK. Dr. Truitt has stock in ATRI. Dr. Truitt has stock in HZNP. Dr. Truitt has stock in ZM. Dr. Arumaithurai has nothing to disclose. Dr. Young has nothing to disclose.

Implementation, results and face validity of the Consultation and Relational Empathy measure in a Canadian department of surgery.

The Consultation and Relational Empathy (CARE) Measure, a validated questionnaire designed to assess patients' perceptions of their physician's communication skills and empathy, has been used to assess empathy in medical specialties but has seldom been applied to surgery. We assessed empathy and communication skills among a group of surgeons within a single academic institution. All surgeons within our department of surgery were invited to participate. Patients seen in clinics of participating surgeons were recruited prospectively from July 2018 to February 2019. At the end of each clinical encounter, they were asked to complete a CARE survey. Surveys were analyzed according to previously validated inclusion and exclusion criteria. We calculated mean scores for each surgeon and surgical division. About 6 months after study completion, surgeons were provided with their individual score and de-identified division scores, and were asked to complete a follow-up survey assessing their attitudes toward the CARE Measure. Of the 82 surgeons invited, 51 (62%) agreed to participate; 7 had fewer than 25 completed surveys and were excluded from analysis. A total of 1801 surveys for 44 surgeons (33 male and 11 female) were included in the final analysis. The average CARE score across the department was 46.9 (95% confidence interval [CI] 46.6-47.1). Female surgeons received significantly higher scores than male surgeons (mean 47.6 [95% CI 47.1-48.0] v. 46.7 [95% CI 46.4-48.0]). Of the 35 surgeons who responded to the follow-up survey, 31 (89%) felt that the questions in the CARE Measure applied to their practice, and half of these reported that they intended to make changes in response to the feedback. We found high communication and empathy scores among surgeons in the outpatient setting, with enough variability to encourage continued improvement. The CARE Measure appears to have face validity among surgeons, and the vast majority found it relevant to their practice. Further study is needed to formally assess the relevance, performance, reliability and construct validity of this measure.

Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure

BackgroundNo validated tool is available to assess patients’ perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure—originally developed in English and widely used internationally—and to examine its reliability and validity.MethodsThe CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach’s alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure.ResultsThe Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach’s alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77–0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett’s test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit.ConclusionThis study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.

Reliability and validity of the Arabic version of the Consultation and Relational Empathy (CARE) measure.

Empathy is the ability to communicate an understanding of an individual's subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring and studying empathy in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-item questionnaire that measures patient assessment of physician's empathy in primary care. To our knowledge, there are no validated measures of empathy in the clinical setting in Arabic. This study aims at validating the CARE in Arabic. Data collection took place between October 2019 and February 2020. A total of 220 patients completed the questionnaire which consisted of the 10 CARE items, participants' opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations, and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation. High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version. Our findings showed significant positive correlations between CARE score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients' satisfaction with consultation duration and whether they would recommend the doctor to others. The Arabic version of the CARE measure appears to be valid and reliable. It is available for use in research, education, and assessment of physicians' empathy.

A 2-item version of the Japanese Consultation and Relational Empathy measure: a pilot study using secondary analysis of a cross-sectional survey in primary care.

The Consultation and Relational Empathy (CARE) measure is a patient-reported measure of physician empathy which is widely used internationally. The Japanese version of the CARE measure has very high internal reliability, suggesting that a shorter version may have adequate validity and reliability. To investigate a valid shorter version of the Japanese CARE measure. We conducted a pilot study using secondary analysis of previous data obtained from 9 general practitioners and 252 patients and used to develop the Japanese CARE measure. All 1,023 possible combinations of the Japanese CARE items (n = 1-10) were candidates for the short measure. The internal consistency (Cronbach's alpha) and the correlations between candidate short questionnaires and the original questionnaire were calculated. After selecting the most valid short questionnaire, inter-rater reliability was determined using generalizability theory, and construct validity (Spearman's rho) was determined using patient satisfaction. Two items were selected for a pilot shorter version: item 6 "Showing care and compassion" and item 9 "Helping you to take control." These showed high internal consistency and correlations with the 10-item measure (Cronbach's alpha = 0.920, correlation = 0.979). Forty-five questionnaires per doctor allowed us to reliably differentiate between practitioners. The construct validity for the pilot short measure was high (Spearman's rho 0.706, P < 0.001). We generated a pilot 2-item version of the Japanese CARE measure. This pilot 2-item version provides a basis for future validation studies of short CARE measures in other languages.

Development of the Italian version of the Consultation and Relational Empathy (CARE) measure: translation, internal reliability, and construct validity in patients undergoing rehabilitation after total hip and knee arthroplasty

Purpose To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. Materials and methods The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. Results Face validity was high. Patients answered all questions and the “does not apply” option was never selected. Internal reliability (Cronbach’s α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. Conclusions The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA. IMPLICATIONS FOR REHABILITATION Internal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure. The Italian CARE measure can be used to assess patient’s perceived therapist’s empathy in patients undergoing physical therapy after THA and TKA. Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts.

Building empathy awareness in undergraduate traditional Chinese Medicine students via an undercover ‘mystery shopper’ experience

ObjectiveTo measure empathy within the therapeutic relationship between fourth year Traditional Chinese Medicine (TCM) intern practitioners and their patients, who are first-year students within the same program. MethodsAn observational design was used to examine the interns’ empathic communication, evaluated by first year students ‘mystery shoppers’ using the Consultation and Relational Empathy Measure (CARE). First year TCM students went undercover to experience a clinical treatment (acupuncture) by a fourth-year intern in a public Chinese Medicine clinic attached to a metropolitan university in Sydney, Australia. ResultsThirty-nine consultations were assessed by 39 undercover shopper students. The Intern practitioners’ consultation and relational empathy was rated as a mean 76.4% (38.2 points of a possible 50 (median 78%; 39); range 24–50. Significant response differences were found between female and male interns with males rated higher. The underlying elements are presented and discussed. ConclusionThe intern practitioners’ level of empathy averaged 76.4% which is consistent with empathy ratings for international studies of healthcare students. Results showed that males were rated higher for empathy than females, indicating further studies examining the specific behaviours that characterise empathy of different genders would be a useful addition to knowledge and assist teaching.

Application of the Spanish-Language Consultation and Relational Empathy (CARE) Measure to Assess Patient-Centered Care Among Latino Populations.

Reliable and valid measures are needed to assess the patient-centeredness of clinical care among Latino populations. We translated the Consultation and Relational Empathy (CARE) measure from English to Spanish and assessed its psychometric properties using data from 349 Latino parents/guardians visiting a pediatric clinic. Using confirmatory factor analysis, we examined the psychometric properties of the Spanish CARE measure. Internal reliability of the Spanish CARE measure was high (Omega coefficient = 0.95). Similar to the English-language CARE measure, factor analysis of the Spanish CARE measure yielded a single domain of patient-centeredness with high item loadings (factor loadings range from 0.79 to 0.96). This preliminary analysis supports the reliability and validity of the Spanish version of the CARE measure among Latinos in pediatric care settings. With further testing, the Spanish CARE measure may be a useful tool for tracking and improving the health care delivered to Latino populations.

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.

Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis.

IntroductionEmpathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy.MethodsUsing a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity.ResultsEighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance.ConclusionThese data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity.Trial registrationRegistration (PROSPERO): CRD42019142809.

Reliability and validity of the Spanish (Spain) version of the consultation and relational empathy measure in primary care

Empathy is an essential competence in the medical field. There are no validated patient-rated empathy measures in Spanish (Spain). The Consultation and Relational Empathy (CARE) measure is a widely used patient-rated measure of physician empathy. To analyse the reliability and validity of the Spanish (Spain) version of the CARE measure in primary care. After translation, back translation and pilot testing, a convenient sample of 369 patients recruited through 21 primary care physicians in five primary care centres in Pamplona (Navarre, Spain) completed the Spanish (Spain) CARE (Sp-CARE) measure. The number of 'does not apply' or blank responses was calculated to assess acceptability. We analysed internal reliability by means of Cronbach's alpha and ordinal alpha and homogeneity with corrected item-total correlations. The construct validity was examined by confirmatory factor analysis (CFA) and concurrent validity by Spearman's correlation. We observed high acceptability; only 37 (1%) responses were marked 'does not apply' and only 3 (0.08%) were left blank. Cronbach's alpha and ordinal alpha for the Sp-CARE measure were 0.953 and 0.970, respectively, and all corrected item-total correlations exceeded the accepted cut of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The Sp-CARE measure total score was significantly correlated with overall patient satisfaction (Spearman's rho 0.45, P < 0.001). The results support the reliability and validity of the Sp-CARE measure as a patient-rated empathy measure in the primary care setting.

Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution.

Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.

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.

Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure.

The mechanisms associating physician empathy (PE) with patient outcomes remain unclear. PE can be considered as a whole (one process) or three subcomponents can be identified (an establishing rapport process; an emotional process; a cognitive process). The objective was to test two competitive models of PE in cancer care: a three-process model adapted from Neumann's model versus a one-process model, with the use of the Consultation and Relational Empathy measure (CARE). The CARE was completed by 488 oesogastric cancer patients from the national French database FREGAT. A confirmatory factor analysis (CFA) and a bifactor model were performed to test the two competitive models. The CFA revealed that the one-factor structure showed a moderate fit to the data whereas the three-factor structure showed a good fit. However, the bifactor model favoured unidimensionality. We cannot provide a clear-cut conclusion about whether PE should be considered as on unique process or not. Further work is still needed. Meanwhile, one should not preclude the use of three subscores in cancer care if specific elements of the encounter need to be assessed.

Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis

IntroductionClinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities...

Exploring the educational opportunity and implementation of CARE among dental students in India.

CONTEXT:Empathy is considered to be backbone of the patient–physician relationship. The consultation and relational empathy (CARE) measure is widely used internationally to measure empathy. However, no validated tool is available to gather patient feedback on dentists’ empathy in India.OBJECTIVE:The objective of this study was to explore the reliability and validity of a CARE measure and to assess the factors influencing CARE score and to determine if there was an association between their CARE score and satisfaction of the patient.SETTING AND DESIGN:A cross-sectional study was done in dental colleges.SUBJECTS AND METHODS:A questionnaire study was carried out among 100 patients from 6 dental colleges in Bangalore using validated CARE measure.STATISTICAL ANALYSIS:Internal consistency of items was evaluated by the Cronbach's alpha, and construct validity was assessed by confirmatory factor analysis. Satisfaction was assessed by a question response on 5-point Likert scale. Descriptive and inferential statistics were performed with significance set at 5%.RESULTS:The mean CARE score was 43.80 ± 5.36. Internal reliability was high (Cronbach's alpha: 0.859) and was reduced by the removal of any of 10 items. High corrected item-total correlations ranged from 0.752 to 0.847. Factor analysis showed a single solution with high item loadings (>0.80). Self-perception of overall health (odds ratio [OR] = 3.78), relationship with family (OR = 4.61) and friends (OR = 3.78), and previous dental experience (OR = 16.00) were more likely, whereas dentist-provided treatment (OR = 0.20), number (OR = 0.07) and dental treatment taken (OR = 0.13), presence of anxiety (OR = 0.03), and fear (OR = 0.05) were less likely to have CARE score. The satisfaction of the patient regressed significantly with the relationship with family members (ß = 0.77) and CARE score (ß = 0.21).CONCLUSION:This study confirms the educational opportunity and implementation of CARE in dental students. CARE scores among patients varied depending on personal factors and dental treatment-related factors. The satisfaction of the patient was influenced by the relationship with family members and CARE scores.