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Original research
Multi-institutional intervention to improve patient perception of physician empathy in emergency care
  1. Katie Pettit1,
  2. Anne Messman2,
  3. Nathaniel Scott3,
  4. Michael Puskarich3,
  5. Hao Wang4,
  6. Naomi Alanis5,6,
  7. Erin Dehon7,
  8. Sara Konrath8,
  9. Robert D Welch2,
  10. Jeffrey Kline2
  1. 1 Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  2. 2 Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
  3. 3 Hennepin County Medical Center, Minneapolis, Minnesota, USA
  4. 4 Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
  5. 5 Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA
  6. 6 Department of Emergency Medicine, Integrative and Computational Neurosciences Research Unit, Dallas, Texas, USA
  7. 7 University of Mississippi Medical Center, Jackson, Mississippi, USA
  8. 8 Indiana University, Purdue University at Indianapolis Lilly Family School of Philanthropy, Indianapolis, Indiana, USA
  1. Correspondence to Dr Jeffrey Kline, Emergency Medicine, Wayne State University School of Medicine 4201 St. Antoine Boulevard, Detroit 48201, MI, USA; jkline{at}wayne.edu

Abstract

Background Physician 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 empathy and trust in the ED setting.

Methods Physician participants from six emergency medicine residencies in the US were studied from 2018 to 2019 using a pre–post, quasi-experimental non-equivalent control group design with randomisation at the site level. Intervention participants at three hospitals received an educational intervention, guided by acognitivemap (the ‘empathy circle’). This intervention was further emphasised by the use of motivational texts delivered to participants throughout the course of the study. The primary outcome was change in E patient perception of resident empathy (Jefferson scale of patient perception of physician empathy (JSPPPE) and Trust in Physicians Scale (Tips)) before (T1) and 3–6 months later (T2).

Results Data were collected for 221 residents (postgraduate year 1–4.) In controls, the mean (SD) JSPPPE scores at T1 and T2 were 29 (3.8) and 29 (4.0), respectively (mean difference 0.8, 95% CI: −0.7 to 2.4, p=0.20, paired t-test). In the intervention group, the JSPPPE scores at T1 and T2 were 28 (4.4) and 30 (4.0), respectively (mean difference 1.4, 95% CI: 0.0 to 2.8, p=0.08). In controls, the TIPS at T1 was 65 (6.3) and T2 was 66 (5.8) (mean difference −0.1, 95% CI: −3.8 to 3.6, p=0.35). In the intervention group, the TIPS at T1 was 63 (6.9) and T2 was 66 (6.3) (mean difference 2.4, 95% CI: 0.2 to 4.5, p=0.007). Hierarchical regression revealed no effect of time×group interaction for JSPPPE (p=0.71) nor TIPS (p=0.16).

Conclusion An educational intervention with the addition of text reminders designed to increase empathic behaviour was not associated with a change in patient-perceived empathy, but was associated with a modest improvement in trust in physicians.

  • emergency department
  • education
  • teaching
  • interpersonal

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Deidentified participant data available upon reasonable request.

https://doi.org/10.1136/emermed-2020-210757

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Deidentified participant data available upon reasonable request.

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    Footnotes

    • Handling editor Richard Body

    • Twitter @KatiePettitMD, @klinelab

    • Contributors KP—study concept and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. AM—study concept and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. NS—acquisition of data and critical revision of the manuscript for important intellectual content. MP—acquisition of data and critical revision of the manuscript for important intellectual content. HW—acquisition of data and critical revision of the manuscript for important intellectual content. NA—acquisition of data and critical revision of the manuscript for important intellectual content. ED—acquisition of data and critical revision of the manuscript for important intellectual content. SK—study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. RDW—analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. JK—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and acquisition of funding.

    • Funding Work was funded by the Physician Scientist Initiative from the Lilly Endowment Foundation to JK.

    • Disclaimer The Lilly Endowment Foundation had no role in the conception, design, conduct or production of this work.

    • Competing interests Author JK reports grant money to Indiana University School of Medicine to conduct research conceived and written by JK from Bristol Meyer Squibb and Janssen Pharmaceuticals.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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