Empathic Communication Skills Research Articles

“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs

BackgroundPatients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.MethodsIn-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.ResultsThe patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.ConclusionsPatients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.

The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients?

Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.

Using the Skill of Noticing to Support Empathy for Third-Year Medical Students in Family Medicine.

Previous research has described a waning interest among third-year students to employ empathetic practice along with decreased opportunity to develop empathic communication skills. In this study we sought to address this decline using the skill of noticing (ie, the capacity to attune to specific aspects of practice and interactions) as an intervention for third-year medical students. We designed a qualitative study to address the following research question: How can a focused noticing tool encourage empathetic moments during the patient interview for third-year medical students? Eight third-year medical students used the Social Emotional Noticing Tool (SENT) during their 4-week family medicine rotation, then joined a focus group to share their experiences with SENT and articulate barriers and opportunities toward practicing empathy during clerkship. Student participants (a) described using the tool, including barriers and opportunities; (b) made connections between the practice of noticing using SENT and enacting empathy; and (c) emphasized how enacting empathy in their third year is largely influenced by interactions with clinical faculty. The use of SENT helped students notice empathy or lack thereof. However, making connections between individual capacity for empathic interactions and the impact of positive or negative role models is necessary. Based on our findings, we encourage the need for shared responsibility among students, faculty and preceptors, and organizations.

Comparison of Two Simulation Tools to Develop Empathic Communication Skills in Nursing Students Breaking Bad News: A Randomized Controlled Study

BackgroundThe announcement of a pathology that could have a negative impact on a patient's future (i.e., breaking bad news, BBN) is a common and difficult task that nurses feel unprepared for. This study compared the effectiveness of two online simulation-based training tools: a standardized patient, currently the most commonly used method, and 360° immersive videos, which could represent an alternative that demands fewer resources. MethodSixty-nine nursing students were involved in a randomized controlled noninferiority trial and allocated to one of three conditions: standardized patient (SP); 360° immersive videos (360IV); and control group (CG). In all three conditions, pre, post, and one-month follow-up measurements were based on recorded role-plays with patient-actors and questionnaires. Using recordings, external raters assessed students’ communication skills along three dimensions related to BBN: empathic communication, building shared understanding, and shared decision-making. Right after the prepost role-plays, patient-actors assessed perceived empathy and confidence. Participants completed questionnaires assessing empathy, stress, and self-efficacy. ResultsEmpathy perceived by the patient-actors increased in all conditions, but this increase was only maintained in the 360IV condition. In contrast, the SP condition produced the best communication results, as assessed by external raters. ConclusionsThe two training tools induced complementary changes in BBN skills among undergraduate nurses, opening up new possibilities for BBN training.

Consensus on relevant psychosocial interventions applied in health institutions to prevent psychological violence at work: Delphi method

ObjectiveStudies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied.ResultsThe consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.

The effects of empathic communication skills training on nurse practitioner students.

Evidence regarding the impact of empathic communication training on nurse practitioner (NP) students is lacking. Despite increasing emphasis within practice settings in the United States, formal communication training for NP students has been modestly integrated into curriculum, based on limited data supporting its efficacy. As such, we sought to evaluate the impact of empathic communication training on NP students' self-efficacy with empathic communication. This is a quasi-experimental study of a single group of NP students (n = 49) who participated in empathic communication training with pretraining/posttraining measurements using the Self-Efficacy-12 instrument. There were statistically significant improvements in students' comfort and confidence with nine of the 17 items surveyed. Several other domains also showed improvement approaching statistical significance. Based on our results, empathic communication training increases NP students' self-efficacy with empathic communication.

Cognitive empathy of osteopathic students: a longitudinal study with data comparisons to the Project in Osteopathic Medical Education and Empathy (POMEE).

Establishing an empathic bond of trust with patients is a characteristic that physicians need, because patients feel that physicians are more caring if they sense that they are empathetic. Former cross-sectional studies have shown an erosion of cognitive empathy as medical students progress through their education. This study aims to measure the changes in student cognitive empathy as they progress through their undergraduate osteopathic medical education. Cognitive empathy scores are compared to the nationwide norms established by the Project in Osteopathic Medical Education and Empathy (POMEE) study by Mohammadreza Hojat, PhD, and colleagues. During orientation to medical school, and at the beginning of each subsequent academic year, and just before graduation, the graduating classes of 2017-2019 participated in this longitudinal study by filling out the Jefferson Scale ofEmpathy-Student Version (JSE-S). A total of 345/459 Osteopathic Medical Student (OMS) I-IV students (75.2 % of the graduates) filled out the forms for all five time points. Desired specialty choice and sex were also collected. Specialty choice was divided into Core and Non-Core groups. Core specialties are "people-oriented" and have a large amount of patient contact and continuity of care, while Non-Core specialties are "technical- or procedure-oriented" and have little or no patient contact and/or continuity of care. Men selecting Non-Core specialties had significant drops in JSE-S scores (p=0.001); whereas men who selected the Core specialties did not have a significant decrease. Forwomen, there was no significant drop in JSE-S scores forthose selecting either Core or Non-Core specialties. Whencompared to POMEE norm data, none of the Campbell University School of Medicine students had JSE-S scores thatwere above the 50th percentile. Students selecting Core specialties do a better job of maintaining their cognitive empathy, which aids their ability to establish an empathic bond of trust with patients, when compared to students who desire Non-Core specialties. JSE-S scores not above the POMEE 50th percentile is concerning and indicate either a curricular change to betterenhance empathic communication skills and/or better applicant selection.

Getting ready for prime time: Recommended adaptations of an Empathic Communication Skills training intervention to reduce lung cancer stigma for a national multi-center trial.

Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients' experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N = 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest. ClinicalTrials.gov Identifier: NCT05456841.

Beliefs and Predictors of Negative Attitudes Toward Obesity Among Turkish Healthcare Professionals: Assessing the Bias with Sub-group Analysis.

This study aimed to examine Turkish healthcare professionals' beliefs and predictors of negative attitudes toward obesity and to investigate whether those beliefs and negative attitudes differ per their profession and sociodemographic and familial variables. In this cross-sectional study, healthcare professionals (n = 495) working in four hospitals of Ankara completed a sociodemographic questionnaire and two self-report scales: the Attitudes Toward Obese Persons Scale and the Beliefs About Obese Persons Scale. Data were collected during May, 2018. Female healthcare professionals had significantly higher (p = 0.03) positive attitude scores than males, and nurses had significantly higher (p = 0.04) Beliefs About Obese Persons Scale scores than physicians, representing their belief that obesity is not under the control of the individual. The Attitudes Toward Obese Persons Scale scores of university hospital healthcare professionals were significantly higher (p = 0.00) than those of public hospital and private hospital healthcare professionals, and Attitudes Toward Obese Persons Scale scores of healthcare professionals who have a family member with a chronic disease were significantly higher (p = 0.027) than those who do not. The work experience, spending more time with a patient, and having a member of the family with a chronic illness lead to a more positive attitude toward people with obesity. This result emphasizes the importance of interventions that promote sensitive and empathic communication skills.

Empathic communication skills training: Randomized controlled trial to reduce lung cancer stigma in lung cancer care.

TPS12152 Background: Stigma is commonly experienced by people diagnosed with lung cancer and is often triggered during clinical encounters with their oncology care provider (OCP), particularly associated with routine assessment of smoking history. Lung cancer stigma is associated with gaps in quality of care as well as poorer psychological and physical health-related outcomes for patients. The overall objective of this multi-site national clinical trial is to test whether an OCP-facing training intervention in empathic communication skills (ECS) reduces stigma and distress and promotes patient engagement. Our prior pilot work has demonstrated that the ECS intervention is both feasible and efficacious to reduce stigma during clinical encounters. Methods: This NCI-funded multi-site national trial employs a cluster randomized design comparing usual care (waitlist control) with ECS training (intervention). With outreach and site recruitment support provided by GO2 for Lung Cancer and the American Cancer Society, community oncology sites (n = 16) nationwide will be randomized 1:1 to each arm. 9-11 OCPs will be recruited per site with 6 unique patients per OCP enrolled (total 54-66 patients/site). Statistical analysis will evaluate the effect of ECS training on primary OCP outcomes (e.g., empathic skill uptake) and secondary patient-reported outcomes (e.g., psychological distress). The 2.5 hour ECS training is delivered live using a videoconference platform. The didactic content covers knowledge and consequences of stigma on patients with lung cancer and in-depth review of specific ECS strategies. Participants then engage in experiential small-group role-play sessions with trained patient actors, where they are given tailored feedback by trained facilitators and their peers. Eligible sites must have at least 15 OCPs and clinic volume of at least 20 new patients with lung cancer per month. Eligible OCPs (physicians, NPs and PAs) must currently be treating and conducting outpatient clinic consultations with at least 1 patient with lung cancer per week. Eligible patients must be receiving treatment for lung cancer, English and/or Spanish speaking, currently or formerly smoking, and have had no more than 5 prior visits with the participating OCP. Currently, this trial is open to accrual and has 5 sites across the nation completing paperwork for activation. Clinical trial information: NCT05456841 .

The Effects of an Empathic Communication Workshop on Internal Medicine Residents' Self-Perceived Empathy and Their Patients' Perception of Physician's Empathy: A Single-Group Experimental Study.

Background: Empathetic communication improves the physician-patient relationship and enhances patient and physician satisfaction. This study aims to evaluate the impact of empathic communication skills training on physicians' self-perceived performance and patient satisfaction regarding the empathetic quality of their relationship with their physicians. Methods: In this single-group before-after experimental study, we recruited 50 internal medicine residents at a large teaching hospital. We assessed the residents' empathy using the Jefferson Scale of Empathy before and 3 weeks after an 8-hour workshop on empathic communication skills. We also recruited 50 of their patients before and another 50 patients 3 weeks after the training to assess the patient's perceptions of their physician's empathy using the Consultation and Relational Empathy scale. Physicians' and patients' mean scores on empathetic care at the beginning of the study were then compared using paired t-tests with their scores after the workshop. Results: The residents' mean score on Jefferson Empathy Scale increased from 81.1(95%CI:78.8-83.3) at baseline to 96.8(95%CI:93.6-100) following the workshop (p < 0.001). Before the empathetic communication skills training, patients assessed their doctors' empathy at 68.3(95%CI:63.5-73.2). After the intervention, this improved to 84.9(95%CI:82.2-87.5) (p < 0.001). Conclusion: In this study, both the residents and their patients stated that the residents' empathy skills had significantly improved after an empathetic communication workshop for internal medicine residents.

Developing and pilot testing a frailty-focused education and communication training workshop.

To describe development and pilot testing of a multi-modal frailty-focused education and communication training workshop for health care clinicians. Pilot testing was conducted via two workshops (#1:face-to-face [2019], #2:virtual [2020]). Participants: convenience sample of clinicians and students who volunteered. Workshop #1 included registered nurses working in an acute care and one medical student (N=14); #2: nursing students enrolled in an APRN program. Design: Pre/post observational study. Data analysis: descriptive statistics, paired t-tests and Wilcoxon rank test. Statistically significant increases in frailty knowledge (#1: p=0.02, d=0.44; #2: p=0.006, d=0.55) and self-reported competency with older adult interactions (#1: p<0.001, d=0.62; #2: p=0.001, d=0.63) were reported for both workshops. Post course evaluations of the workshop were positive, with scores ranging from 3.5-3.9 (range: 0-4) for increased understanding of the concept of frailty, communication to support health-related behavior, and best practice empathic communication skills. The FCOM workshop was successful. Participants gained knowledge and skills for use in working with older adults across the aging continuum from non-frail to frail. Our FCOM training workshop expands prior communication training on shared decision-making with frail individuals to a broader population of all older adults.

Indian physicians' attitudes and practice regarding menopause and its management: a focus group discussion.

To explore Indian physicians' attitudes and practice toward menopause and its management. To contribute to the larger project aimed at developing communication skills and decision aids for Indian physicians and women. Using a cross-sectional design, purposive sampling, and a qualitative methodology, 10 Indian physicians (female, 6; male, 4; mean age, 51.5 years) who were practicing either endocrinology or gynecology were recruited to participate in a virtual focus group discussion. Questions explored physicians' attitudes toward menopause and their approach toward addressing menopause and related concerns with their patients. The focus group was analyzed using qualitative content analysis. Three main themes emerged: (1) "The only way to get over it is to accept it": Attitudes toward menopause, (2) "More than menopausal hormone therapy, it is empathy that's required": Physiological and psychological symptom management and (3) Matching the empathic intent with skills: A need for training in the management of menopause. The study findings underscore the need to introduce Indian physicians to empathic communication skills training, involve, and educate physicians about the international and national clinical guidelines regarding menopausal hormone therapy and alternative therapies, and techniques for distress screening and early referrals. http://links.lww.com/MENO/B17 .

Engaging the "Difficult" Patient: Strengthening Empathic Communication Skills.

Engaging the "Difficult" Patient: Strengthening Empathic Communication Skills.

Development and feasibility of a communication training to assist caregivers with advanced care planning.

Caregivers are critical in advanced care planning (ACP) discussions, which are difficult but necessary to carry out patients' goals of care. We developed and evaluated the feasibility and acceptability of a communication training to equip caregivers of patients with malignant brain tumors with skills to navigate ACP conversations. Caregivers completed a 2-h virtual training addressing ACP Discussions with Your Loved One and ACP Discussions with the Medical Team. A pre-training assessment was completed at baseline and a training evaluation was completed one day post-training. A subset of participants completed semi-structured interviews 2 months post-training. Of 15 caregivers recruited, 9 attended the training and 4 completed qualitative interviews. Post-training, 40% felt confident in discussing ACP with loved ones and 67% felt confident doing so with healthcare professionals; 100% reported feeling confident in using skills learned in the training to facilitate these conversations. Data from qualitative interviews highlighted additional benefits of the training in empathic communication skills and fostering social support. Our communication skills training shows promise in supporting caregivers' skills and confidence in engaging in ACP discussions with patients and healthcare providers. A future randomized controlled trial with a larger and more diverse caregiving sample is needed to determine training efficacy.

P2.08-09 Adaptation of Empathic Communication Skills Training for Oncology Care Providers to Reduce Lung Cancer Stigma

Stigma is commonly experienced by individuals diagnosed with lung cancer, particularly in discussions about smoking during clinical encounters with their oncology care providers (OCPs). Building upon prior work developing and pilot testing an Empathic Communication Skills (ECS) training module targeting lung cancer patients, this study sought feedback from key stakeholders about the ECS training module in preparation of launching a virtually-delivered, multi-site clinical trial to test the implementation and effectiveness of the evidence-based ECS training module to reduce lung cancer stigma.

Effects of 1-day e-learning education on perinatal psychological support skills among midwives and perinatal healthcare workers in Japan: a randomised controlled study

BackgroundAlthough midwives are expected to play a key role for psychological support throughout perinatal periods, their educational chances are limited. Versatile teaching strategies such as e-learning may be promising in expanding education. The objective of our study was to clarify the effects of an e-learning educational programme on midwives’ empathic communication skills.MethodsFrom April 2019 to September 2019, a randomised controlled trial of a 1-day e-learning educational programme on perinatal psychological issues (both perinatal mental health assessment and empathic communication) was conducted to improve empathic communication skills of midwives and perinatal healthcare workers. Two types of measurements (paper-and-pencil multiple-choice test and video-viewing tests of simulated patient) were used to measure the competency of empathic communication skills.ResultsParticipants (N = 115) were randomly allocated to two groups (Intervention: n = 58, Control: n = 57). The intervention group was at a significantly higher level for both post-tests of empathic communication skills compared with the control group. Both intervention and control groups showed improvements in acquiring knowledge about perinatal mental health assessments.ConclusionsThe results of our study show that a 1-day e-learning programme helped improve the midwives' empathic communications skills. Therefore, an effective 1-day e-learning educational programme of perinatal mental health will expand opportunity to learn about empathic communication skills for midwives and perinatal healthcare workers.Trial registrations: UMIN000036052.

Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery.

Background:Empathic communication skills have a growing presence in graduate medical education to empower trainees in serious illness communication.Objective:Evaluate the impact, feasibility, and acceptability of a shared communication training intervention for residents of different specialties.Design:A randomized controlled study of standard education v. our empathic communication skills-building intervention: VitalTalk-powered workshop and formative bedside feedback using a validated observable behavioral checklist.Setting/Subjects:During the 2018–2019 academic year, our intervention was implemented at a large single-academic medical center in the United States involving 149 internal medicine and general surgery residents.Measurements:Impact outcomes included observable communication skills measured in standardized patient encounters (SPEs), and self-reported communication confidence and burnout collected by surveys. Analyses included descriptive and inferential statistics, including independent and paired t tests and multiple regression model to predict post-SPE performance.Results:Of residents randomized to the intervention, 96% (n = 71/74) completed the VitalTalk-powered workshop and 42% (n = 30/71) of those residents completed the formative bedside feedback. The intervention demonstrated a 33% increase of observable behaviors (p < 0.001) with improvement in all eight skill categories, compared with the control who only showed improvement in five. Intervention residents demonstrated improved confidence in performing all elicited communication skills such as express empathy, elicit values, and manage uncertainty (p < 0.001).Conclusions:Our educational intervention increased residents' confidence and use of essential communication skills. Facilitating a VitalTalk-powered workshop for medical and surgical specialties was feasible and offered a shared learning experience for trainees to benefit from expert palliative care learning outside their field.

Stigma May Exacerbate Disproportionately Low Guideline-Concordant Treatment Rates for Patients With Advanced-Stage Lung Cancer in the United States

Stigma May Exacerbate Disproportionately Low Guideline-Concordant Treatment Rates for Patients With Advanced-Stage Lung Cancer in the United States

Phubbing as a Millennials' New Addiction and Relating Factors Among Nursing Students.

Objective This study investigated phubbing (the act of ignoring one’s companion or companions to pay attention to one’s smartphone) and examined the factors affecting phubbing among nursing students in South Korea. Methods A cross-sectional survey design was adopted, and a self-reported questionnaire was used. Data were collected from 200 nursing students in two cities. Self-administered questionnaires included demographic data, smartphone addiction, media multitasking motivation, interpersonal competency, and phubbing. Results Phubbing was positively correlated with smartphone addiction (r=0.41, p<0.001) and media multitasking motivation (r=0.16, p<0.05), and negatively correlated with interpersonal competence (r=-0.51, p<0.001). Factors influencing nursing students’ phubbing were interpersonal competency (β=-0.59, p<0.001), media multitasking motivation (β=0.24, p<0.001), smartphone addiction (β=0.19, p<0.01) and interpersonal relationships (β=0.14, p<0.05). The model including these variables accounted for 43% of variance in phubbing. Conclusion Nursing students showed a moderate level of phubbing, and interpersonal competency was an important factor for reducing their phubbing of nursing students. Since phubbing occurs frequently among nursing students, educators in nursing are required to develop and implement active interventional measures to help nursing students avoid phubbing and improve their interpersonal relationships by increasing their empathic ability and communication skills.