Empathic Statements Research Articles

Decades old communication training influences seen in patient-centric communication skills of transplant hematologists.

12099 Background: Competency in communication skills was added as a requirement for residencies in 1999. Numerous strategies have since been incorporated into all phases of medical education and beyond. “Ask-tell-ask” and “NURSE” are commonly taught strategies used to guide conversations between physicians and patients. “Ask-tell-ask” provides a structure for assessing and delivering medical knowledge to a patient. “NURSE” outlines methods for incorporating empathy into the medical provider’s statements. We evaluated for the presence of these communication strategies in a high-stakes discussion between a transplant hematologist and a simulated patient facing a new diagnosis of high-risk myelodysplastic syndrome (MDS). Methods: This is a sub-analysis from a mixed-methods, observational study. Our team recruited hematologists who routinely perform hematopoietic cell transplants and designed a patient scenario of a 67-year-old man with recently diagnosed high-risk MDS referred to hematology. Video-recorded virtual encounters simulated an initial hematology consultation appointment between the hematologist and an actor trained to portray the patient. We analyzed transcripts and coded for themes in the discussion content and structure. We evaluated for the use of known communication strategies “ask-tell-ask”, and “NURSE” empathic responses. Results: Of 37 hematologists from 25 academic centers who participated, 73% reported receiving at least some formal communication training. Hematologists ” when teaching patients about their disease and treatment options. For example, nearly all hematologists opened the encounter by asking the patient a perception question regarding their understanding of their disease; nearly all incorporated at least one "NURSE" empathic statement after telling the patient about their disease and its prognostic implications. Most explored the patient’s goals for treatment and described treatment options utilizing an “ask-tell-ask” approach. Nearly all concluded the encounter with a summary and strategy for next steps. Conclusions: While it is commonly held that teaching communication is difficult, these conversations between hematologists and patient actors show the impact of communication training delivered over the past twenty years through the routine incorporation of well-described strategies of “ask-tell-ask” and "NURSE". This observational study provides a window into how these teachings have permeated into medical practice and hematology/oncology specifically. The incorporation of commonly taught communication strategies into these physician-patient encounters provides evidence that teaching high-quality communication may change physician behavior in a sustained and diffuse way.

Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study.

Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.

Empathy in clinical performance examinations: Medical students’ use of empathic statements in interaction with standardized patients

This paper examines interactional functions of empathic statements in clinical performance examinations by using the method of conversation analysis. In video-recordings of 170 consultations between medical students and standardized patients (individuals trained to play the role of the patient), medical students produce empathic utterances in three sequential positions and accomplish different interactional jobs. First, medial students produce empathic statements before the initiation of history taking. They check whether patients have concerns in addition to those in problem presentation. Second, medical students construct empathic statements during history taking. They treat a particular symptom as problematic, in alignment with patients’ display of a problem. Finally, medical students produce empathic statements before the delivery of diagnosis. They portray the upcoming diagnosis as made in recognition of the troublesome nature of patients’ problems. This suggests that functions of empathic statements can vary according to the specific demands of interaction in different sequential contexts.

Family Responses to Different Types of Clinician Empathy Expression in Pediatric Care Conferences.

Background: Clinician empathy positively impacts patient outcomes. Few studies have assessed the effects of different types of empathic expression. Objective: To describe how families respond when clinicians express empathy in different ways. Design: Prospective, mixed-methods cohort. Setting/Subjects: English and interpreted pediatric inpatient care conferences at a U.S. quaternary hospital between January 1, 2018 and January 1, 2021. Measurements: Directed content analysis of clinician empathic statements and family responses. Results: Of 29 patient-family dyads, 11 (39%) used language interpretation. In response to 80 clinician empathic statements, families expressed agreement or shared more 84% (67/80) of the time. Families shared more about their perspective in response to explore statements 71.4% (10/14) of the time, in response to validate statements 61% (17/28) of the time, and in response to respect/support statements 39% (11/28) of the time. Conclusion: Certain types of empathic statements may be more effective at prompting families to share more about their perspective, a key element of shared decision-making.

Therapeutic Relationships in Applied Behavior Analysis: Current Status and Future Directions.

For behavior analytic practitioners, skills related to building a therapeutic alliance (e.g., empathic statements, reflective listening, affirmations) may be as important as knowledge of and skills in implementation of the science of behavior analysis. We surveyed 277 board certified behavior analysts (BCBAs) to learn more about their training, use of these skills, and their perceptions of how their skills might have changed over years of practicing. The findings suggest that behavior analysts may benefit from explicit training in skills required to establish and maintain therapeutic relationships with parents of children with autism. In this article we review recent research in this area and suggest directions for training of behavior analysts. Further, motivational interviewing is introduced as an evidence-based clinical approach that encompasses many of the skills required to build a therapeutic alliance.

Effect of a Coaching Intervention to Improve Cardiologist Communication

Communication between cardiologists and patients can significantly affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested. To evaluate the effect of a communication coaching intervention to teach evidence-based communication skills to cardiologists. This 2-arm randomized clinical trial was performed at outpatient cardiology clinics at an academic medical center and affiliated community clinics, and from February 2019 through March 2020 recruited 40 cardiologists and audio recorded 161 patients in the preintervention phase and 240 in the postintervention phase. Data analysis was performed from March 2022 to January 2023. Half of the cardiologists were randomized to receive a coaching intervention that involved three 1:1 sessions, 2 of which included feedback on their audio-recorded encounters. Communication coaches taught 5 skills derived from motivational interviewing: (1) sitting down and making eye contact with all in the room, (2) open-ended questions, (3) reflective statements, (4) empathic statements, and (5) "What questions do you have?" Coders unaware of study arm coded these behaviors in the preintervention and postintervention audio-recorded encounters (objective communication). Patients completed a survey after the visit to report perceptions of communication quality (subjective communication). Analysis included 40 cardiologists (mean [SD] age, 47 [9] years; 7 female and 33 male) and 240 patients in the postintervention phase (mean [SD] age, 58 [15] years; 122 female, 118 male). When controlling for preintervention behaviors, cardiologists in the intervention vs control arm were more likely to make empathic statements (intervention: 52 of 117 [44%] vs control: 31 of 113 [27%]; P = .05); to ask, "What questions do you have?" (26 of 117 [22%] vs 6 of 113 [5%]; P = .002); and to respond with empathy when patients expressed negative emotions (mean ratio of empathic responses to empathic opportunities, 0.50 vs 0.20; P = .004). These effects did not vary based on patient or cardiologist race or sex. We found no arm differences for open-ended questions or reflective statements and were unable to assess differences in patient ratings due to ceiling effects. In this randomized clinical trial, a communication coaching intervention improved 2 key communication behaviors: expressing empathy and eliciting questions. Empathic communication is a harder-level skill that may improve the patient experience and information comprehension. Future work should explore how best to assess the effect of communication coaching on patient perceptions of care and clinical outcomes and determine its effectiveness in larger, more diverse samples of cardiologists. ClinicalTrials.gov Identifier: NCT03464110.

Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations.

Empathic communication, defined as both responding to emotions and actively appreciating another's world view, is associated with better outcomes for patients and families, including decreased anxiety and depression, and improved coping 1 Kelley JM Kraft-Todd G Schapira L Kossowsky J Riess H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014; 9: e94207https://doi.org/10.1371/journal.pone.0094207 Crossref PubMed Scopus (420) Google Scholar , 2 Hoffstädt H Stouthard J Meijers MC et al. Patients’ and Clinicians’ Perceptions of Clinician-Expressed Empathy in Advanced Cancer Consultations and Associations with Patient Outcomes. Palliative Medicine Reports. 2020; 1: 76-83https://doi.org/10.1089/pmr.2020.0052 Crossref Google Scholar , 3 Neumann M Wirtz M Bollschweiler E et al. Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ. Couns. 2007; 69: 63-75https://doi.org/10.1016/j.pec.2007.07.003 Crossref PubMed Scopus (186) Google Scholar , 4 Flickinger TE Saha S Roter D et al. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. Patient Educ. Couns. 2016; 99: 220-226https://doi.org/10.1016/j.pec.2015.09.001 Crossref PubMed Scopus (68) Google Scholar , 5 Hojat M Louis DZ Markham FW Wender R Rabinowitz C Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad. Med. 2011; 86: 359-364https://doi.org/10.1097/ACM.0b013e3182086fe1 Crossref PubMed Scopus (678) Google Scholar . Despite this, clinicians who have not undergone formal communication training typically focus on information exchange and miss patients’ emotional and social cues. To address this gap, we use the acronym NURSE (Name, Understand, Respect, Support, Explore) 6 Fortin AH Dwamena FC Frankel RM Smith RC Smith's Patient-Centered Interviewing : An Evidence-Based Method. 4th ed. McGraw-Hill Education, New York2019 Google Scholar ,7 Back AL Arnold RM Baile WF Tulsky JA Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005; 55: 164-177https://doi.org/10.3322/canjclin.55.3.164 Crossref PubMed Scopus (430) Google Scholar to teach trainees how to respond to patient emotions. When used effectively, these skills communicate caring and help patients and families navigate their emotions and cope with their circumstances, both of which ultimately help with decision-making. However, we worry that some learners may not progress beyond this model, and may even see these empathic statements as a tool to get emotions to settle down and let the patient can make the “right” decision. This suggests that we - the teachers - need to do a better job explaining the way that emotions and empathy function in the clinician-patient/family interaction. Emotion and decision-making theory 8 Lerner JS Li Y Valdesolo P Kassam KS. Emotion and decision making. Annu. Rev. Psychol. 2015; 66: 799-823https://doi.org/10.1146/annurev-psych-010213-115043 Crossref PubMed Scopus (1081) Google Scholar ,9 Conte B Hahnel UJJ Brosch T. From values to emotions: Cognitive appraisal mediates the impact of core values on emotional experience. Emotion. 2022; https://doi.org/10.1037/emo0001083 Crossref Scopus (1) Google Scholar , as well as our clinical experiences, lead us to conclude that skilled empathy, beyond resolving emotion so the conversation can move forward, helps us in these discussions in at least four additional ways. Empathy helps us uncover and understand patient values, to appropriately pace the conversation, to facilitate healthy grieving, and, ultimately, transforms how we approach our work. Below we describe these four functions of empathy in an encounter in which we meet with a patient with serious illness or their family to discuss medical decisions. . We focus on the hospital setting, where we meet families in crisis and must build a connection quickly. However, these skills may apply to a wide variety of clinical encounters.

Empathy Expression in Interpreted and Noninterpreted Care Conferences of Seriously Ill Children.

Clinician empathy is associated with improved communication and clinical outcomes. We hypothesized that, when clinicians express empathy, families are more likely to deepen discussions, and that clinicians express less empathy in care conferences with language interpretation. Prospective, mixed methods cohort study of English and interpreted audio-recorded transcripts of care conferences for pediatric patients with serious illness hospitalized at a single urban, quaternary medical institution between January 2018 and January 2021. Directed content analysis identified empathic opportunities, clinician empathetic statements or missed opportunities, and family responses. Clinician empathic statements were "buried" if immediately followed by more clinician medical talk. Descriptive analyses summarized demographics and codes. χ2 analyses summarized differences among language interpretation and family responses. Twenty-nine patient-family dyads participated. Twenty-two (81%) family members were female. Eleven (39%) used language interpretation (8 Spanish, 2 Vietnamese, 1 Somali). Families created 210 empathic opportunities. Clinicians responded with unburied empathy 80 times (38%, no differences for English versus interpreted care conferences, P = .88). When clinicians buried empathy or missed empathic opportunities, families responded with alliance (agreement, gratitude, or emotional deepening) 14% and 15% of the time, respectively. When clinicians responded with unburied empathy, families responded with alliance 83% of the time (P < .01). Our study suggests that clinician empathic expression does not differ when language interpretation is used in pediatric care conferences. Clinicians often miss opportunities to express empathy, or they bury it by medical talk. Although unburied empathy created opportunities for relationship-building and family-sharing, buried empathy negatively impacted these domains similarly to no empathic expression.

Examining the relationship between clinician communication and patient participatory behaviors in cardiology encounters

ObjectivesExamine the association of coder ratings of cardiologist behaviors and global scores of cardiologist communication style with patient participation in clinic encounters. MethodsWe coded transcripts of clinic encounters for patient participatory behaviors: asking questions, assertive statements, and expressing negative emotions; clinician behavior counts: reflective statements, open-ended questions, empathic statements, and eliciting questions. We used general linear regression models to examine associations of mean number of patient participatory behaviors with clinician behaviors. ResultsOur sample included 161 patients of 40 cardiologists. Patient female gender was associated with on average 2.1 (CI: 0.06, 4.1; p = 0.04) more patient participatory behaviors. In an adjusted model, clinician reflective statements were associated with on average 0.3 (CI: 0.04, 0.4; p = 0.02) more patient participatory behaviors. A clinician making at least one empathic statement was associated with on average 3.7 (CI: 0.2, 7.1; p = 0.04) more patient participatory behaviors. ConclusionsThese results demonstrate that some individual clinician behaviors are associated with higher patient participation in cardiology encounters. Practice implicationsClinician reflective and empathic statements may be important targets in communication training to increase patient participation. SectionCommunication Studies.

Racial/ethnic disparities in serious illness communication for patients with cancer.

6540 Background: Racial/ethnic disparities in serious illness communication exist between patients with cancer and their oncologists. Our prior work has shown that goals of care discussions are three minutes shorter with racial/ethnic minority patients. In this study, we sought to compare oncologist's use of serious illness communication skills, patient participatory behavior, and overall communication quality during encounters with patients with advanced cancer of different self-reported races/ethnicities. Methods: We analyzed baseline recordings from a two-arm multisite randomized controlled trial to test a coaching model of communication skills training for solid tumor oncologists and their newly diagnosed advanced cancer patients. We audio recorded post-imaging patient-oncologist encounters for patients receiving systemic cancer treatment and coded transcripts for oncologist's use of serious illness communication skills (coded as count/encounter): open-ended questions, reflections, empathic responses to patient empathic opportunities, empathic statements, “sorry” statements, and elicitation of questions. We also assessed global codes of oncologist communication (assessed on 5-point Likert scales): flow, concerns addressed, attention, warmth, and respect. Finally, we coded patient participatory behavior (coded as count/encounter): asking questions and assertive responses. We compared the skills and behaviors by race/ethnicity of the patient using the non-parametric Kruskal-Wallis test. Results: We included the 56 (38%) recordings with oncologists who did not receive the intervention. The patients in these encounters were 25 (45%) female; 32 (57%) over the age of 65; 23 (41%) White Non-Hispanic, 20 (36%) Black Non-Hispanic, and 11 (20%) Hispanic. Overall, oncologists responded empathically to patients’ emotions only 19% of the time. Oncologists used fewer reflective statements with Black Non-Hispanic patients (mean 0.3 statements/encounter) as compared to White Non-Hispanic patients (1.1) and Hispanic patients (1.1), p = 0.02. Furthermore, coders rated oncologists as being less likely to address concerns of Black Non-Hispanic patients (mean Likert scale 3.1) as compared to White Non-Hispanic (3.8) and Hispanic (3.4) patients, p = 0.04. Finally, coders rated oncologists as having less warmth with Black Non-Hispanic patients (mean Likert scale 2.9) as compared to White Non-Hispanic (3.8) and Hispanic (3.3) patients, p = 0.04. Conclusions: In this diverse sample of patients with advanced cancer, oncologists used fewer reflective statements, were less attentive to concerns, and expressed less warmth with Black Non-Hispanic patients. Interventions are needed to overcome these striking racial/ethnic disparities in serious illness communication for patients with cancer.

The Art of Saying Nothing.

The Art of Saying Nothing.

Physician self-reported use of empathy during clinical practice

Objectives The use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. This study sought to determine how and when physicians self-report the use of empathy when interacting with their patients. Methods A cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as asked to respond to open-ended questions. Results All physicians self-report that they always (69%) or usually (29.3%) use empathic statements when engaging with patients. 93.1% of physicians believe that their colleagues always (20.7%) or usually (69%) use empathic statements when communicating with patients. Nearly one-third of physicians (33%) indicated that using the words “I understand” denotes an empathic statement. Although 36% of physicians reported that they would like to receive more training or assistance about how and when to use empathy during clinical practice. Significance of Results Despite the self-reported prevalent use of empathic statements, one-third of physicians indicate a desire for more training in what empathy means and when it should be used in a clinical setting. Additionally, nearly one-third of physicians in this study reported using responses that patients may not perceive as being empathic, even when intended to be empathic. This suggests that many physicians feel uncertain about a clinical skill they believe should be used in most, if not all, encounters.

Immersive virtual reality simulated learning environment versus role-play for empathic clinical communication training.

IntroductionThe use of immersive virtual reality simulated learning environments (VR SLEs) for improving clinical communication can offer desirable qualities including repetition and determinism in a safe environment. The aim of this study was to establish whether the mode of delivery, VR SLE versus clinical role‐play, could have a measurable effect on clinical empathic communication skills for MRI scenarios.MethodsA split‐cohort study was performed with trainee practitioners (n = 70) and qualified practitioners (n = 9). Participants were randomly assigned to four groups: clinician VR (CVR), clinician role‐play (CRP), trainee VR (TVR), and trainee RP (TRP). Clinical communication skills were assessed using two methods: firstly, a self‐reported measure – the SE‐12 communication questionnaire and, secondly, a training and assessment tool developed by a panel of experts.ResultsParticipants in the VR trainee (TVR) and clinician (CVR) groups reported 11% (P < 0.05) and 7.2% (P < 0.05) improvements in communication confidence post training, whereas trainees assigned to the role‐play (TRP) intervention reported a 4.3% (P < 0.05) improvement. Empirical assessment of communication training scores assessing a participant’s ability to select empathic statements showed the TVR group performed 5% better on average than their role‐play counterparts (P < 0.05).ConclusionThe accuracy of participant's selection of appropriate empathic responses was shown to differ significantly following the training intervention designed to improve interactions with patients that present for an MRI scan. The results may demonstrate the capacity for immersion into an emotional narrative in a VR environment to increase the user’s susceptibility for recalling and selecting empathic terminology.

Косвенные формы выражения речевого акта пожелания (здоровья) в негативной ситуации

The research objectives are as follows: to identify implicit forms of expressing the speech act “Well-Wishing”, to reveal specificity of this speech act, to determine the level of empathy of such illocutives in interpersonal communication. The authors for the first time examine the functioning of the speech act “Well-Wishing” in a negative situation (the addressee’s illness) as a manifestation of verbal empathy and a form of psychological support, reveal specificity of implicit well-wishes functioning in empathic interpersonal communication, which constitutes scientific originality of the study. The research findings are as follows: the authors identify implicit forms of expressing the speech act “Well-Wishing” in empathic interpersonal communication. The speaker’s communicative intention is realized through directive speech acts “request”, “advice”, “prohibition”, “assurance”, expressive speech acts “blessing”, representative speech acts “claim”. Speech acts of implicit well-wishing are analysed taking into account the basic characteristics of empathic statements (emotional-evaluative connotation, emotional filling, congruence of empathic reaction).

Assessing Interpersonal and Communication Skills.

Assessing Interpersonal and Communication Skills.

Just Say NO to Certain Patient Requests—And Here’s How

Back to table of contents Previous article Next article Government & LegalFull AccessJust Say NO to Certain Patient Requests—And Here’s HowAnne Huben-Kearney, R.N., B.S.N., M.P.A.Anne Huben-KearneySearch for more papers by this author, R.N., B.S.N., M.P.A.Published Online:4 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.35AbstractNot all patients’ requests can or should be fulfilled. Here are factors to consider when your response is “no.”Despite the fact that psychiatrists want to help and accommodate patients’ wishes, not all patients’ requests can or should be fulfilled. There are situations in which patients may request a particular medication or treatment that is not in their best interest, request a letter for a nonclinical reason, or ask for a “favor,” assuming the psychiatrist will agree. If the psychiatrist denies a request, many patients threaten to call the Board of Medicine or post a bad review.Provide an Explanation: Psychiatrists can defuse patient anger by knowing when and how to say “no.” Rather than following your immediate instinct to “just say no” to a request for a medication or service that would not be helpful to the patient, take a minute to contemplate the request and then provide an explanation of why the request would not be in the patient’s best interests. Explicitly state your rationale without lengthy explanations (for example, it would not be appropriate medical care, against policy, or even violate professional ethics).Gather Information: Another option is gathering information from the patient regarding the particular request. Identify the underlying factors of the request and whether additional information is necessary before you respond with an explanation of why you cannot agree to grant the “favor.”Consider Compelling Principles: Compelling principles to consider when responding to patient requests are integrity and protecting the doctor-patient relationship. While denying a patient’s request may feel like it harms the alliance in the moment, allowing the patient to manipulate the psychiatrist into a false position is also harmful to the relationship, according to Opinions of the Ethics Committee on the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, 2020 Edition.Avoid Feelings of Guilt: Feelings of guilt should never be part of saying no. No one should agree to a request out of guilt or obligation; doing so will likely lead to additional stress and resentment, which would affect the doctor-patient relationship.Be Empathetic: Making empathic statements such as “I know this is not what you wanted” or “I can see you are frustrated” acknowledges the patient’s feelings of frustration or powerlessness. Accepting a patient’s negative emotions, rather than minimizing them or trying to fix them, is important. Knowing when and how to say no while preserving the doctor-patient relationship is not always easy, but it is a best practice to reduce risk and well worth the effort. ■This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2020 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.Opinions of the Ethics Committee on the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, 2020 Edition, is posted here.Anne Huben-Kearney, R.N., B.S.N., M.P.A., is a risk management consultant in the Risk Management Group of AWAC Services Company, a member company of Allied World. ISSUES NewArchived

How medical school alters empathy: Student love and break up letters to empathy for patients.

Medical education is committed to promoting empathic communication. Despite this, much research indicates that empathy actually decreases as students progress through medical school. In qualitative terms, relatively little is known about this changing student relationship with the concept of empathy for patients and how teaching affects it. This study explores that knowledge gap. Adopting a constructivist paradigm, we utilised a research approach new to medical education: Love and Breakup Letter Methodology. A purposive sample of 20 medical students were asked to write love and break up letters to 'empathy for patients'. The letters were prompts for the focus group discussions that followed. Forty letters and three focus group discussions were thematically analysed. The three major themes were: art and artifice; empathic burden; and empathy as a virtue. Students were uncomfortable with the common practice of faking empathic statements, a problem exacerbated by the need to 'tick the empathy box' during examinations. Students evolved their own empathic style, progressing from rote empathic statements towards phrases which suited their individual communication practice. They also learned non-verbal empathy from positive clinician role-modelling. Students reported considerable empathic burden. Significant barriers to empathy were reported within the hidden curriculum, including negative role-modelling that socialises students into having less compassion for difficult patients. Students strongly associated empathy with virtue. Medical education should address the problem of inauthentic empathy, including faking empathic s in assessments. Educators should remember the value of non-verbal compassionate communication. The problems of empathic burden, negative role modelling and of finding empathy difficult for challenging patients may account for some of the empathy decline reported in quantitative research. Framing empathy as a virtue may help students utilise empathy more readily when faced with patients they perceive as challenging and may promote a more authentic empathic practice.

\u2018I\u2019m sorry to hear that\u2019\u2014Empathy and Empathic Dissonance: the Perspectives of PA Students

ContextOur understanding of clinical empathy could be enhanced through qualitative research—research currently under-represented in the field. Physician associates within the UK undergo an intensive 2-year postgraduate medical education. As a new group of health professionals, they represent a fresh pair of eyes through which to examine clinical empathy, its nature and teaching.MethodsWorking with a constructivist paradigm, utilising grounded theory methodology, researchers studied 19 purposively sampled physician associate students in two UK medical schools. One-to-one semi-structured interviews were transcribed verbatim. Data were analysed using a grounded theory approach.ResultsThe global themes were the pathways to empathy, empathy modifiers and empathic dissonance a novel term to describe the discomfort students experience when pressurised into making empathic statements they don’t sincerely feel. Students preferred using non-verbal over verbal expressions of empathy. A conceptual model is proposed. The more substantial empathic pathway, affective empathy, involves input from the heart. An alternative empathy, more constrained, comes from the head: cognitive empathy was considered a solution to time pressure and emotional burden. Formal teaching establishes empathic dissonance, a problem which stems from over-reliance on the empathic statement as the means to deliver clinical empathy.ConclusionsThis study furthers our understanding of the construct and teaching of empathy. It identifies empathic barriers, especially time pressure. It proposes a novel concept—empathic dissonance—a concept that challenges medical educationalists to reframe future empathy teaching.

Identifying the Types and Impact of Service Provider’s Responses to Online Negative Reviews in the Sharing Economy: Evidence from B&amp;Bs in China

Online consumer complaints are closely related to business reputation and elicit managers’ persistent efforts. However, service providers in the sharing economy (SE) lack the skills to communicate with consumers because most are informal or nonprofessional property owners. This research aims to examine the relationship between service providers’ responses and prospective consumers’ perceived helpfulness in the SE by using bed and breakfasts (B&amp;B) as the sample. Response length and voice are adopted to measure the content quality of B&amp;B’s response to an online complaint. Three types of voices (defensive, formalistic, and accommodative) are identified by analyzing service providers’ responses to negative reviews, among which the accommodative voice with empathic statements is the most effective. An inverted-U curve relationship between response length and helpfulness votes is verified based on cognitive load theory. Moreover, interactive effects between response length, review length, and images are also examined. This study suggests the investigation of online reviews from comprehensive perspectives, as well as the adoption of personalized strategies by SE practitioners to respond to consumer complaints.

Physician Use of Empathy During Clinical Practice (S813)

1.Discuss mixed methods research outcomes of how and when physicians use empathy when interacting with their patients during clinical practice.2.Demonstrate the importance of empathy and its use during clinical practice. The use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. Physician use of empathy is associated with better patient and family experiences, higher patient satisfaction, increased patient compliance, and trust. Conversely a lack of empathy may adversely impact a patient’s treatment course or impede communication about prognosis. To determine how and when physicians use empathy when interacting with their patients. A cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as asked to respond to open-ended questions. All physicians self-report that they always (42.1%) or usually (57.9%) use empathic statements when engaging with patients. 98.6% of physicians believe that their colleagues always (19.2%) or usually (79.5%) use empathic statements when communicating with patients. Almost half of physicians indicated that using the words “I understand” denotes an empathic statement. 68% of physicians report that they would not like to receive more training or assistance about how and when to use empathy in the health care setting. Although almost all physicians report that they and their colleagues use empathic statements while engaging with patients, almost half of physicians surveyed identified that telling a patient “I understand” is an expression of empathy; however, using the words “I understand” is traditionally not considered to be an expression of empathy. Although almost half of all physicians could not correctly iterate words of empathy, the majority of physicians report that they are not interested in receiving more training about how and when to use empathy.