Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study

Abstract

PURPOSE To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. METHODS This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study population included 867 individuals with screen-detected type 2 diabetes who were followed up for an average of 10 years until December 31, 2014 in the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION)-Cambridge trial. Twelve months after diagnosis, patients assessed practitioner empathy and their experiences of diabetes care during the preceding year using the consultation and relational empathy (CARE) measure questionnaire. CARE scores were grouped into tertiles. The main outcome measures were first recorded CVD event (a composite of myocardial infarction, revascularization, nontraumatic amputation, stroke, and fatal CVD event) and all-cause mortality, obtained from electronic searches of the general practitioner record, national registries, and hospital records. Hazard ratios (HRs) were estimated using Cox models adjusted for relevant confounders. The ADDITION-Cambridge trial is registered as ISRCTN86769081. RESULTS Of the 628 participants with a completed CARE score, 120 (19%) experienced a CVD event, and 132 (21%) died during follow up. In the multivariable model, compared with the lowest tertile, higher empathy scores were associated with a lower risk of CVD events (although this did not achieve statistical significance) and a lower risk of all-cause mortality (HRs for the middle and highest tertiles, respectively: 0.49; 95% CI, 0.27-0.88, P = .01 and 0.60; 95% CI, 0.35-1.04, P = .05). CONCLUSIONS Positive patient experiences of practitioner empathy in the year after diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand which aspects of patient perceptions of empathy might influence health outcomes and how to incorporate this understanding into the education and training of practitioners.

Whole-person care in general practice: The doctor–patient relationship

“…[11][12][13] Research also suggests that this relationship increases patient satisfaction and may improve clinical outcomes. [14][15][16] The importance of personal aspects of the doctor-patient relationship featured prominently in these results. Some participants' comparisons of the relationship to friendship and one participant's reference to 'loving' patients reflect previous research.…”

A price tag on clinical empathy? Factors influencing its cost-effectiveness

“…Observational studies report (among other things) that enhanced empathy reduces mortality by 50% among diabetic patients, 3 reduces symptom burden and improves wellbeing, 6 increases patient enablement, 8 increases patient safety, 5 improves self-efficacy and adherence 9 and reduces practitioner burnout. 4 …”

“… 2 These trials suggest that compared with ‘usual care’, empathic positive communication can reduce pain, improve patient satisfaction and increase quality of life. Observational studies suggest that empathic care has benefits ranging from reducing mortality 3 and practitioner burnout 4 to increasing safety. 5 On the other hand, these very same studies reveal that additional time is required to undertake empathy training and to treat patients in the clinic; both of these can be costly.…”

Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices

“…There is evidence that continuity of care, encouraged in general practice and not possible in A&E, is associated with reduced mortality 7 . A study of patients with type-2 diabetes demonstrated that higher levels of empathy from practitioners reduced all-cause mortality 8 . In addition GP empathy has been shown to have psychosocial benefits 9 .…”