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Physician Empathy and Chronic Pain Outcomes

In this cohort study that included 1470 adults with chronic low back pain, patients treated by very empathic physicians reported having significantly better and clinically relevant outcomes pertaining to pain, function, and health-related quality of life over 12 months compared with patients treated by slightly empathic physicians.

The patient-physician relationship is fundamental to the practice of medicine. Although there is no agreement on how to define or study empathy, empathic opportunities arising during medical encounters may be missed, thereby posing a threat to the patient-physician relationship. Physician empathy may enhance patient adherence to treatment and improve clinical outcomes. A systematic review of randomized trials involving artificially manipulated practitioner empathy compared with usual care found modest patient benefits for several clinical conditions. Nevertheless, the review was limited by variability of interventions, practitioners, patients, and conditions, thereby yielding high statistical heterogeneity and low-quality evidence. Moreover, empathy outcomes were often assessed immediately after an encounter and never beyond 3 weeks. Studies of physician empathy generally rely on observational research in a more natural setting.

These involve physician self-assessed empathy or patient-perceived empathy. Unlike the latter, the former often measures physician attitudes about empathy rather than empathy itself. Because no correlation between physician and patient ratings of empathy has been observed, patients must be involved in assessing physician empathy. The Consultation and Relational Empathy (CARE) measure is the primary patient rating instrument for physician empathy, owing to its reliability and internal validity and consistency. The CARE measure may capture subtle nuances of patient interactions with physicians, thereby confirming its value in assessing relational components of empathy. The patient-physician relationship is vital among patients with chronic low back pain (CLBP) because patients often feel isolated, misunderstood, or stigmatized when an underlying cause of pain cannot be identified. A large correlation between physician empathy and satisfaction was reported immediately following a pain clinic consultation, and physician empathy was strongly associated with satisfaction among patients with CLBP even after controlling for confounders. A therapeutic alliance between such patients and physical therapists led to better pain and function outcomes over 8 weeks.

Improved physician empathy over 3 months also was associated with better pain and health-related quality-of-life (HRQOL) outcomes among patients attending pain clinics Because it is unclear whether these results would be sustained in general medical settings over time, we aimed to assess the association of patient-reported physician empathy with CLBP outcomes in such settings over 12 months.

Read the whole cohort study here.

Autor: John C. Licciardone, DO, MS, MBA1; Yen Tran, BS2; Khang Ngo, BSA2; et al   Quelle: jamanetwork.com (10.05.2024 - LW)
 
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