Patient Perceptions Of Empathy Research Articles

Patient perceptions of empathy in primary care telephone consultations: A mixed methods study

ObjectiveClinical empathy can enhance patient outcomes. This study examined patients’ perceptions of empathy in primary care consultations delivered by telephone. MethodsA mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. ResultsSurvey respondents (n = 359) rated practitioners as between ‘good’ and ‘very good’ at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. ConclusionPrimary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. Practice implicationsTo ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.

Multi-institutional intervention to improve patient perception of physician empathy in emergency care

BackgroundPhysician empathy has been linked to increased patient satisfaction, improved patient outcomes and reduced provider burnout. Our objective was to test the effectiveness of an educational intervention to improve physician...

244 Effect of Physician Burnout on Perception of Physician Empathy

Physician burnout is an ongoing health crisis effecting up to 50% of the physicians in the United States. Resident physicians are at a particularly high risk for burnout due to the rigorous demands of resident training. It has been assumed provider empathy could be protective against burnout. We aim to determine the strength and direction of correlation between provider burnout and patient perception of empathy as well as self-perception of empathy. We hypothesize that physician burnout is negatively associated with patient perception and self-perception of physician empathy and communication We conducted a correlational study measuring relationship of provider burnout and perception of empathy. Our participants included emergency medicine residents training at an urban, university-affiliated community hospital. Resident burnout rates were measured by responses to a validated survey administrated through an anonymous platform. Burnout was defined using the Maslach Burnout Inventory (MBI), a 22-item rating scale designed to assess three aspects of the burnout syndrome: emotional exhaustion (EE), depersonalization (DP), and lack of personal accomplishment (PA). A score of greater than 27 in EE, greater than 10 in DP, and less than 33 in PA was considered high risk for burnout. Empathy was self-measured by provider as well as reported by patients they cared for in the emergency department via a survey conducted by research assistants at conclusion of interaction with the provider. Self-empathy scores were measured with an Interpersonal Reactivity Index (IRI) focusing on empathic concern (EC). Patient perception of the resident’s empathy was quantified with the Consultation and Relational Empathy (CARE) Measure. Descriptive statistics and percent of respondents with burnout determined by their scores in each of 3 MBI domains are reported. Results for each domain were compared with self-perception and patient perception of empathy scores using linear and logistic regression analysis. Thirty-two of the 39 eligible residents completed the survey and took care of patients who perceived their empathy during the study period. Logistic regression model demonstrated that for every point increase of self-empathy score, the odds for DP burnout were less likely (Odds 0.69, 95% CI 0.49-0.86, p=0.01). For every point increase of patient perception of empathy, the odds for DP burnout were also less likely (Odds 0.71, 95% CI 0.49-0.95, p=0.04). Residents at high risk for burnout using the DP domain (less than 10 in DP) had lower empathy scores by patients (Effect -.3.30, 95% CI -6.60 to -0.55, p =0.03) and lower self-empathy scores (Effect -5.70, 95% CI -9.09 to -2.21, p < 0.01). Burnout remains a concern for resident physicians in the US. Identifying those at risk and investigating protective characteristics are of crucial importance to combat this epidemic. We found a correlation between residents’ empathy and the level of DP. An increase in empathy decreased the level of DP, making them at less risk for burnout. Our evidence also suggests that higher empathy scores can make DP less likely.

Measuring Patients’ Perceived Empathy of Clinical Nurses

Background: Empathy is the perception of patients’ feelings and experiences; in other words, nurses can understand their patients’ feelings by considering themselves in their position. Empathic relationship in patient care can lead to considerable interpersonal communication and as a result, better outcomes for patient health. Thus, the purpose of this study was to assess patients’ perceived empathy of clinical nurses. &#x0D; Methods: This cross-sectional study was carried out at teaching hospitals of Zanjan city in 2018 -2019. A sample including 285 inpatients of teaching hospitals in Zanjan city were selected by systematic sampling. To collect data, the Scale of Patient-Perceived Empathy from Nurses (SPPEN) was used. Descriptive statistics (Mean and frequency) and multivariate analyses were applied to describe empathy relationships with personal characteristics.&#x0D; Results: The factor analysis on 15 items of SPPEN led to three factors with eigenvalue&gt;1 that totally explained 74.5 percent of the variance. Three dimensions of nurses’ expression, patients’ feedbacks and patients’ expectations were identified as effective factors on patients’ perceived empathy. The mean score of overall SPPEN was at upper intermediate level (m=4.98). The mean score of overall SPPEN and its dimensions in young patients were higher than patients aged 45 years and over. Differences in mean scores of overall SPPEN and its dimensions (Except nurses’ expression) were statistically significant on the base of age characteristics (p&lt;0.05). Furthermore, there were significant differences at mean scores of patients’ feedback and patients’ expectations dimensions on the base of inpatients ward variable (p&lt;0.05). The highest mean score of patients’ feedbacks (5.34±1.05) and patients’ expectations (6.05±1.1) were related to gynecology and surgery wards, respectively.&#x0D; Conclusion: The findings of the present study indicate that inpatients’ perception score of nurses’ empathy was at upper intermediate level. According to the findings, nurses’ empathy and communicative skills must be promoted by establishing training workshops for empathy development.

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.

Influence of Socioeconomic Bias on Emergency Medicine Resident Decision Making and Patient Care.

Physician bias impacts clinical decision making, resulting in disparities in patient care. Most existing studies focus on sex and racial bias. This study aimed to investigate disparities in physician decision making among patients of varying socioeconomic status (SES). Emergency medicine residents (n = 31) participated in 3 consecutive scenarios of similar disease acuity but with standardized patients of varying SES. Following the scenarios, residents met with a standardized participant acting as an attending physician for a handoff to recount their decision-making processes and care recommendations. Blinded raters evaluated clinical performance using an objective assessment tool. We assessed associations between patient SES and resident-ordered imaging, ordered medication, patient-perceived empathy, and clinical performance. We used qualitative analyses to study residents' decision-making processes. Quantitative analyses revealed no significant relationship between SES and resident-ordered imaging, ordered medications, patient-perceived empathy, and clinical performance. Qualitative analyses revealed 3 themes regarding clinical decision making: (1) overt diagnostic focus, (2) discharge planning, and (3) risk and exposure. Although quantitative analyses showed that SES did not affect clinical behavior within simulated scenarios, qualitative analyses uncovered 3 themes believed important to physician decision-making processes. Overt diagnostic focus may have resulted from the study environment in addition to organizational factors, policies, and training. Discharge planning, which was not explicitly studied, was often tailored to SES with emphasis placed on risks for patients of low SES. Further research is needed to uncover the nuances of bias, SES, and physician decision making throughout the patient care continuum and within various clinical environments.

Patients' and Clinicians' Perceptions of Clinician-Expressed Empathy in Advanced Cancer Consultations and Associations with Patient Outcomes.

Background: Empathy is a cornerstone of effective communication. However, clinicians' and patients' perceptions of clinician-expressed empathy might differ. The independent perceptions of patients and clinicians on clinician-expressed empathy in advanced cancer consultations and the associations of these perceptions with patient outcomes are unknown.Objective: We assessed (1) patients' and clinicians' independent perceptions of clinician-(self-)expressed empathy in advanced cancer consultations and (2) the associations between these perceptions and affective patient outcomes.Methods: This observational study included data from 41 consultations in the advanced breast cancer setting. Postconsultation, patients' and clinicians' perceptions of clinician-expressed empathy were assessed, as well as patients' (1) pre–post anxiety, (2) post-anxiety, (3) emotional well-being, and (4) satisfaction. Multilevel regression analyses were run to draw conclusions.Results: Patients perceived higher levels of empathy than clinicians, without a significant relationship between the two (mean [M] = 85.47, standard deviation [SD] = 14.00 vs. M = 61.88, SD = 15.30, 0–100 scale; β = 0.14, p < 0.138, 95% confidence interval [CI] = −0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) β = −0.67, p = 0.039, 95% CI = −1.30 to −0.03; (2) β = −0.15, p = 0.042, 95% CI = −0.30 to −0.01], higher satisfaction (β = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (β = −0.32, p < 0.001, 95% CI = −0.48 to −0.16). There were no associations with clinicians' perceptions [(1) β = −0.34, p = 0.307, 95% CI = −1.00 to 0.31; (2) β = −0.02, p = 0.824, 95% CI = −0.17 to 0.14; (3) β < 0.01, p = 0.918, 95% CI = −0.03 to 0.02; (4) β = 0.08, p = 0.335, 95% CI = −0.08 to 0.25].Conclusions: Patients' and clinicians' empathy perceptions differed. In improving patient outcomes, the focus should be on patients' perceptions of clinician-expressed empathy. Future research could focus on ways to elicit patients' perceptions of empathy with the higher aim of improving patient outcomes.

Improving Patient Experience by Teaching Empathic Touch and Eye Gaze: A Randomized Controlled Trial of Medical Students

Background:Empathy is critical for optimal patient experience with health-care providers. Verbal empathy is routinely taught to medical students, but nonverbal empathy, including touch, less so. Our objective was to determine whether instruction encouraging empathic touch and eye gaze at exit can impact behaviors and change patient-perceived empathy.Materials:A randomized, controlled, double-blinded trial of 34 first-year medical students was conducted during standardized patient (SP) interviews. A video either encouraging empathic touch and eye gaze at exit or demonstrating proper hand hygiene (control) was shown. Encounter videos were analyzed for touch and eye gaze at exit. The Jefferson Scale of Patient Perceptions of Physician Empathy was used to measure correlations. Intervention students were surveyed regarding patient touch.Results:Of this, 23.5% of intervention students touched the SP versus zero controls; 88.2% of intervention students demonstrated eye gaze at exit. Eye gaze at exit positively impacted patient-perceived empathy (correlation = 0.48, P > .001). Survey responses revealed specific barriers to touch.Conclusion:Medical students may increase perceived empathy using eye gaze at exit. Instruction on empathic touch and sustained eye gaze at exit at the medical school level may be useful in promoting empathic nonverbal communication. Medical educators should consider providing specific instructions on how to appropriately touch patients during history-taking. This is one of the few studies to explore touch with patients and the first ever to report the positive correlation of a health provider’s sustained eye gaze at exit with the patient’s perceived empathy. Further studies are needed to explore barriers to empathic touch.

Patient Perception of Empathy from Emergency Medicine Residents

Background and Hypothesis: This project analyzes the effect of years of training and gender of ED providers on patients’ perception of empathy from them. The project will also explore how patient characteristics may impact the patients’ perception of empathy from the ED providers. &#x0D; It is expected that women providers in their third year of training will exhibit higher scores of empathy. It has been previously demonstrated that white women with a college education have the worst perceptions of empathy from their ED providers. &#x0D; Experimental Design or Project Methods: Eligible patients from Eskenazi/Methodist Hospital, who have had a CT scan ordered, will be enrolled via convenience sample. Patient perceptions of physician empathy will be assessed via the “Empathy Behavior Survey for Patients” (EBS) and “Jefferson Scale of Patient Perceptions of Physician Empathy” (JSPPPE). Patient demographic data and information about the provider ordering the CT scan will be recorded as well. &#x0D; Results: On the EBS/JSPPE, 1st, 2nd, and 3rd year residents were given scores of 51/31.5, 51/31, and 51.5/33 respectively. Male residents were given a median score of 51 on the EBS and 32 on the JSPPPE. Female residents were given a median score of 50.5 and 31 on the JSPPPE. White female patients with a college education gave a score of 50.5 on the EBS and a 32.5 on the JSPPPE. &#x0D; Conclusion and Potential Impact: Years of training or gender do not seem to have an impact on patient perception of empathy nor do White female patients with a college education.

Differences between GP perception of delivered empathy and patient-perceived empathy: a cross-sectional study in primary care.

Empathy has positive effects on a range of healthcare outcomes. It is therefore an important skill for a GP. However, the correlation between GP perception of delivered empathy and patient perception of GP empathic communication during consultations is still unclear. To investigate the correlation between GP perception of delivered empathy and patient-perceived empathy. Cross-sectional study in primary care in the Netherlands, between December 2016 and February 2017. GPs and their patients were asked to fill in an empathy questionnaire directly after a consultation. Patient perception of received empathy during the consultation was measured through the Dutch version of the Consultation and Relational Empathy (CARE) questionnaire. GP perception of delivered empathy during the consultation was measured with an adapted version of the CARE questionnaire. The authors obtained questionnaires from 147 consultations by 34 different GPs in 16 primary care practices. A total of 143 consultations were eligible for inclusion in the analysis. Mean patient-perceived empathy score was significantly higher than mean GPs' empathy score (42.1, range 20.0 to 50.0 and 31.6, range 24.0 to 41.0, respectively, P<0.0001). Furthermore, a low correlation (r = 0.06) was found between GP empathy score and patient-perceived empathy score. GPs rate the delivered empathy during consultations consistently and significantly lower than their patients experience empathy during consultations. Moreover, GPs' impressions of the empathy delivered during the consultation do not predict the actual amount of empathy perceived by their patients. Patients experience a great deal of empathy during their clinical encounter. GPs' self-reports on empathy delivered gives an inaccurate reflection, and underestimates patient-perceived empathy.

Evaluation of Patient-perceived Empathy of Health and Social Care Professionals in an Acute Hospital Setting

Evaluation of Patient-perceived Empathy of Health and Social Care Professionals in an Acute Hospital Setting

Teaching empathy to undergraduate medical students: Translation to practice

Introduction: Clinical empathy is the cornerstone of a good patient–clinician relationship. Th is study aims to examine the impact of an empathy teaching innovation (ETI) on empathic communication in medical students, which was introduced in a new medical curriculum and incorporates clinical skills and patient contacts from students’ fi rst-year study. Method: A cluster randomised controlled trial (RCT) collected data on medical students’ self-reported empathy using the Je ff erson Scale of Physician Empathy (JSPE), simulated patients’ ratings of each student using the Je ff erson Scale of Patient Perception of Physician Empathy (JSPPPE) and students’ performance in an objective structured clinical examination (OSCE). Half of the medical students (n = 39) received the ETI and the other half (n = 40) acted as the control group. Th e ETI is a 1-hour actor-led empathy workshop focusing on “being-in-role” and how to “walk a mile in the patient’s shoes”, previously shown to improve medical students’ empathy scores. Results: Th e medical students who received the ETI were rated as more empathetic by the simulated patients, with statistically signi fi cant correlations between patients’ perception of empathy and the consultation performance for the intervention group, but not for the control group. However, the ETI did not signi fi cantly enhance student self-reported empathy. Conclusions: Th is study presents the ETI as a short intervention tool for improving medical students’ portrayal of clinical empathy, as perceived by simulated patients. Findings raise interesting questions for medical educationalists regarding the use of simulated (or actual) patients’ reports on empathy.

Capsule Commentary on Lafreniere et al., Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic.

L afreniere et al. 1 found that physicians with higher reported rates of depersonalization were perceived as more empathic and enabling by their patients. Also, higher physician emotional exhaustion scores did not significantly correlate with patient perceptions of empathy or enablement. Internal medicine resident physician burnout is common, and has been the focus of many interventions over the past several years. The revamping of resident duty hour restrictions in 2011, among other goals, was implemented with the intention of limiting physician burnout and therefore improving quality of care provided to patients. Subsequent studies have shown that burnout did not significantly change after the 2011 duty hour restrictions were implemented, which makes this study by Lafreniere et al. all the more meaningful. As we continue to tweak duty hours and empower residency leadership to actively focus on reducing resident physician burnout rates, the intended outcomes may be years in the making, and it is important to consider whether resident perceptions of burnout are affecting their delivery of patient care. This study suggests that patients do not consider their burnt-out resident physicians to be providing them with inadequate care. While minimizing burnout is important for residents’ wellbeing, it is reassuring that patients’ rating of empathy does not appear to be suffering, regardless of the degree of emotional exhaustion reported by resident physicians. Given the nature of the study, it is difficult to ascertain whether resident depersonalization is what is being perceived as empathic or enabling by the patient, or whether the strongly empathic residents are those that rate their own emotional exhaustion more critically. It would be useful to establish whether a causal relationship exists between residents reporting higher levels of depersonalization and being perceived as more enabling because they are, in fact, not as emotionally involved in the shared decision-making process, resulting in patient perceptions of increased enablement. Future research could help to establish causality, although this would be difficult given the inherent lability in perceptions of emotional delivery.

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic.

Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy. To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents. Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland. Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244). Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis. Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p < 0.001) and enablement (B = 0.11, SE = 0.11, p = 0.02). Emotional exhaustion scores on the MBI were not significantly related to either patient outcome. Patients perceived residents who reported higher levels of depersonalization as more empathic and enabling during their patient care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.

A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients?

BackgroundThere is a lack of research examining patient-perceived empathy and its effect on low-literacy patients’ understanding of health information. This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information.MethodsDuring a 2-month period, a total of 144 patients took a survey that included the Chinese-edition Rapid Estimate of Adult Literacy in Medicine, the Barrett-Lennard Relationship Inventory and the Preoperative Information Understanding Scale. Hierarchical multiple regression analysis provided a test of moderator effects.ResultsAll Cronbach’s alphas exceeded 0.6, with REALM at 0.91, BLRI at 0.67, and PIUS at 0.77.The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians.ConclusionOur study demonstrates that a focus on improving physician–patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients.

Patient-perceived empathy from nurses in Taiwan acute care settings

Purpose: The aim of this study was to understand patient-perceived empathy from nurse among different units of Taiwan acute care settings. Design: A crosssectional study was used with a questionnaire survey in acute care units and intensive care units of a medical center in northern Taiwan. Participants were selected by convenient sampling. A total of 548 patients at 14 acute care units and 4 intensive care units in a large Medical Center participated in this questionnaire survey. Methods: Scale of patient-perceived empathy from nurse including 15 item Likert scale was used in this study. The statistical software SPSS 15.0 for Windows was applied and Cronbach’s α, factor analysis, Pearson’s correlation, t-test and one way ANOVA were conducted to analyze the data. Findings: Patients who were first-time hospitalization had higher scores of patient-perceived empathy from nurse than patients who have had hospitalizing experiences. The patient in surgical unit had the highest score of patient-perceived empathy from nurse. The empathy scale score of patient without ICU experience was significantly higher than patient with ICU experience. Also, patients without depressive history had higher score than patients with depression history. Conclusion: Patients with multiple admissions of hospitalization, ICU experience, and depressive history had lower score than other patients. It is suggested that the perception of patients with complicated disease or condition might be different. Thus, an in-depth caring knowledge of both emotions and disease was needed to support patients’ perception of empathy. Clinical Relevance: The care of complicated patients especially with ICU experience needs strong knowledge based both on emotion and disease.

Nurse-perceived time pressure and patient-perceived care quality

To examine how time pressure among nurses influences patient-perceived care quality. Although nurses worldwide face increased time pressure in the workplace, no studies have addressed how workplace time pressure influences patient-perceived care quality. Patient-perceived care quality predicts patient intent to revisit the hospital if care is required, warranting investigation as to whether nurse-perceived time pressure decreases patient-perceived care quality. A cross-sectional design and survey method were adopted. The data analysis was based on 229 nurse-patient sets drawn from a medical centre in northern Taiwan. Each set comprised one nurse and three patients. The study results demonstrate that time pressure among nurses reduces patient-perceived reliability/accountability, responsiveness and assurance. The test results, however, did not indicate a significant negative association between time pressure and patient-perceived empathy and tangibles. Time pressure among nurses may reduce patient perception of care quality in terms of reliability/accountability, responsiveness and assurance. To enhance patient perception of care quality, nursing managers need to devise means to reduce nurse-perceived time pressure.

Do patient attributes predict oncologist empathic responses and patient perceptions of empathy?

Most patients with advanced cancer experience negative emotion. When patients express emotions, oncologists rarely respond empathically. Oncologists may respond more empathically to some patients, and patients may perceive different levels of empathy and trust given past documentation of disparities in cancer care. We audio-recorded 264 outpatient encounters between oncologists and patients with advanced cancer at three sites. We examined whether patient gender, age, race, marital status, education, economic security, and length of relationship with oncologist were related to oncologist empathic responses to patient's negative emotion and patient's perceptions of oncologist empathy and trust. Half (51%) of the patients expressed a negative emotion. Oncologists sometimes responded with empathy (29%). Oncologists were equally empathic with all patients, except they were more empathic with patients with low economic security compared with those reporting high economic security (p = .002). Patients with low economic security viewed oncologists as more empathic (p = .06) compared with those with moderate security. Married patients also viewed oncologists as more empathic (p = .04). Patients who knew their oncologist for more than a year had more trust than patients who knew their oncologists for less time (p = .02). Oncologists, in general, did not respond empathically to patient's negative emotion, and did this equally for most patients. Oncologists responded more empathically to patients who were less economically advantaged. In turn, patients with lower economic security perceived more empathy. Although oncologists need more education in responding empathically, they may not need to correct many biases in care.

Nurse-expressed empathy, patient outcomes, and development of a middle-range theory.

To demonstrate how a middle-range theory was developed and tested through research that examined relationships between nurse-expressed empathy and two patient outcomes: patient-perceived empathy and patient distress. Nurse-patient relationships are the basis for all nursing care and empathy is an important aspect of these relationships. Research is needed, however, to determine the patient outcomes that are related to the empathy of nurses. Orlando's (1961, 1972) nursing model. 140 subjects, 70 staff RNs and 70 patients from hospital medical-surgical acute care units. Each nurse-subject completed two measures of nurse-expressed empathy and each patient-subject completed a measure of perceived empathy and two measures of distress. Negative relationships were found between nurse-expressed empathy and patient distress (r = -.71, p < .001), and between patient-perceived empathy and patient distress (r = -.71, p < .001). A moderate positive relationship was found between nurse-expressed empathy and patient-perceived empathy (r = .35 to .47, p < .05). A model can be tested when propositions theoretically linked to the model are empirically tested. This study's findings demonstrated support for relationships proposed in Orlando's model.