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Empathy is an important part of healthcare, especially when treatment plans and decisions are being discussed. A recent study looked at how well pediatric physicians delivered empathetic statements during these care conferences and its influence on family-physician communication.
It is critical for physicians to respond appropriately with empathy to support families during a difficult time. Care conferences are discussions held between physicians and families to discuss medical treatment plans and decisions, and often involve high-stake decision-making, which can be emotionally stressing for the family. Past studies have found that physicians in the adult ICU setting do not commonly show empathy, and are often missing the opportunities to connect with families of the patient. However, this has not been well studied in the paediatric ICU setting.
To address this gap in literature, researchers in the United States performed a single-centre, cross-sectional qualitative study examining the characteristics of physician empathetic statements during care conferences in the paediatric ICU setting. Their results were published in JAMA Network Open.
Care conference meetings were eligible if they included discussion of medical decisions that involved initiation, escalation or discontinuation of medical treatments or interventions. Further, the care conferences included were between English-speaking families of a paediatric child and their attending physician. These care conferences were audio recorded and transcribed for analysis.
The primary outcome was the qualitative analysis of the physician’s empathetic statements and the corresponding responses by the families during these meetings. As a side, the study also analyzed the empathetic statements made by other health care team members during the care conferences.
Empathetic statements from physicians
An empathetic statement was defined in the study as a statement that attempted to demonstrate the physician’s understanding of the family’s emotions, such as sadness, anger or frustration. These empathetic statements were categorized into five types: naming the emotion, understanding the emotional response, respecting the family’s role in care, supporting the needs or decisions, and exploring the family’s feelings, concerns or hopes.
Empathetic statements were further classified as buried or unburied. Buried statements were followed by more medical talk or a closed-ended question by the physician. Unburied empathetic statements were followed by a pause to give the family time to respond.
Family responses to physicians
Family responses to empathetic statements were also classified into three types: an alliance response, cognitive response or no response. An alliance response was one that furthered the emotional discussion or expressed gratitude or mourning. A cognitive response meant the family followed up with a medical question or spoke about medical information, and no response occurred when the conversation ended after the empathetic statement, without any response from the family.
The study analyzed 68 audio-recorded care conferences. They found that physicians recognized emotional cues given by families 78% of the time, where an empathetic statement was then given. Of the empathetic statements delivered by physicians, 61.5% were unburied statements compared to 38.5% that were buried, which were almost always followed by continued medical talk.
On average, other health care team members spoke about 5% of the time during care conferences. Of the empathetic statements made by other healthcare team members though, 87% of the time they were unburied statements. The study found that an alliance response was received from the family only 12.1% of the time when physicians gave a buried empathetic statement, versus an alliance response of 71.4% when physicians gave an unburied empathetic statement. Lastly, the study identified missed opportunities for empathy from the physician 25% of the time, and at least one missed opportunity was found in 78% of the analyzed conference calls.
Empathetic listening allows physicians to make better treatment recommendations
Overall, the study found that paediatric physicians frequently respond with empathy, and in almost 50% of the time, this led to the progression of the conversation where physicians were able to learn of a family’s motivations, fears and/or hopes. The use of unburied empathetic statements by physicians helped uncover more information from families, which then helps physicians make treatment recommendations.
Further, studies have suggested that the perceptions of physician empathy translate to the perception of the physician’s ability. It is important for physicians to use unburied empathetic statements to address emotional responses from families, and to avoid missing opportunities for empathy. This can lead to a deeper conversation between the physician and the family, which ultimately results in patient satisfaction and better health outcomes.
Written by Maggie Leung, PharmD
Reference: October, T. W., Dizon, Z. B., Arnold, R. M., & Rosenberg, A. R. (2018). Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members. JAMA Network Open,1(3). doi:10.1001/jamanetworkopen.2018.0351