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Patients’ and clinicians’ perceptions of clinician-expressed empathy in advanced cancer consultations and associations with patient outcomes.

Hoffstadt, H., Stouthard, J., Meijers, M.C., Westendorp, J., Henselmans, I., Spreeuwenberg, P., Jong, P. de, Dulmen, S. van, Vliet, L.M. van. Patients’ and clinicians’ perceptions of clinician-expressed empathy in advanced cancer consultations and associations with patient outcomes. Palliative Medicine Reports: 2020, 1(1), p. 76-83
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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
(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,
(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; b = 0.14, p < 0.138, 95% confidence interval [CI] = 0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) b = 0.67, p = 0.039, 95% CI = 1.30 to 0.03; (2) b = 0.15, p = 0.042, 95% CI = 0.30 to 0.01], higher satisfaction (b = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (b = 0.32, p < 0.001, 95% CI = 0.48 to 0.16). There were no associations with clinicians’ perceptions [(1) b = 0.34, p = 0.307, 95% CI = 1.00 to 0.31; (2) b = 0.02, p = 0.824, 95% CI = 0.17 to 0.14; (3) b < 0.01, p = 0.918, 95% CI = 0.03 to 0.02; (4) b = 0.08, p = 0.335, 95% CI = 0.08 to 0.25].

Conclusions
Patients’ and clinicians’ empathy perceptions differed. In improving patient utcomes, 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.