Does Addressing Mental Health During a Musculoskeletal Specialty Care Visit Affect Patient-rated Clinician Empathy?

Ngoue, Marielle; Lam, Ryan; Pierson, S Ryan; Smoot, J Brannan; Ring, David; Crijns, Tom J.

doi:10.1097/corr.0000000000002494

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…Sixth, the recorded encounters include initial and follow-up visits. Although one might expect more empathetic opportunities at initial visits, prior research has demonstrated no such association, so in this study, we included both new and return visits [34,36,48,75].…”

Section: Limitationsmentioning

confidence: 99%

When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

Pierson

Ngoue

Lam

et al. 2023

Clin Orthop Relat Res

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Background Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care. Questions/purposes Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities? Methods This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses. Results After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01). Conclusion Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience. Clinical Relevance Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.

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Section: Limitationsmentioning

confidence: 99%

When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

Pierson

Ngoue

Lam

et al. 2023

Clin Orthop Relat Res

Self Cite

View full text Add to dashboard Cite

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“…In this symposium, you will find evidence that shows how communication effectiveness during patient encounters is not correlated with patient ratings [3]. You will see how surgeons can be trained to identify unhelpful thinking and feelings of distress in their patients [2], and how noticing these aspects of illness does not, on average, harm the relationship [6]. Combined, these papers force us to rethink how we incorporate evaluation and treatment of mental health in musculoskeletal specialty care.…”

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confidence: 99%

Editorial Comment: The Second Annual I-MESH Symposium

Ring¹,

Vranceanu

2023

Clin Orthop Relat Res

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Do Surgeons Experience Moral Dissonance When There Is Misalignment Between Evidence and Action? A Survey and Scenario-based Study

Okelana,

Razi,

Ring

et al. 2024

Clin Orthop Relat Res

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Background Moral dissonance is the psychological discomfort associated with a mismatch between our moral values and potentially immoral actions. For instance, to limit moral dissonance, surgeons must develop a rationale that the potential for benefit from performing surgery is meaningfully greater than the inherent harm of surgery. Moral dissonance can also occur when a patient or one’s surgeon peers encourage surgery for a given problem, even when the evidence suggests limited or no benefit over other options. Clinicians may not realize the degree to which moral dissonance can be a source of diminished joy in practice. Uncovering potential sources of moral dissonance can help inform efforts to help clinicians enjoy their work. Questions/purposes In a scenario-based experiment performed in an online survey format, we exposed musculoskeletal specialists to various types of patient and practice stressors to measure their association with moral dissonance and asked: (1) What factors are associated with the level of pressure surgeons feel to act contrary to the best evidence? (2) What factors are associated with the likelihood of offering surgery? Methods We performed a scenario-based experiment by inviting members of the Science of Variation Group (SOVG; an international collaborative of musculoskeletal surgeons that studies variation in care) to complete an online survey with randomized elements. The use of experimental techniques such as randomization to measure factors associated with specific ratings makes participation rate less important than diversity of opinion within the sample. A total of 114 SOVG musculoskeletal surgeons participated, which represents the typical number of participants from a total of about 200 who tend to participate in at least one experiment per year. Among the 114 participants, 94% (107) were men, 49% (56) practiced in the United States, and 82% (94) supervised trainees. Participants viewed 12 scenarios of upper extremity fractures for which surgery is optional (discretionary) based on consensus and current best evidence. In addition to a representative age, the scenario included randomized patient and practice factors that we posit could be sources of moral distress based on author consensus. Patient factors included potential sources of pressure (such as “The patient is convinced they want a specific treatment and will go to a different surgeon if they don’t get it”) or experiences of collaboration (such as “The patient is collaborative and involved in decisions”). Practice factors included circumstances of financial or reputational pressure (such as “The practice is putting pressure on you to generate more revenue”) and factors of limited pressure (such as “Your income is not tied to revenue”). For each scenario, the participant was asked to rate both of the following statements on a scale from 0 to 100 anchored with “I don’t feel it at all” at 0, “I feel it moderately” at 50, and “I feel it strongly” at 100: (1) pressure to act contrary to best evidence and (2) likelihood of offering surgery. Additional explanatory variables included surgeon factors: gender, years in practice, region, subspecialty, supervision of trainees, and practice setting (academic/nonacademic). We sought factors associated with pressure to act contrary to evidence and likelihood of offering surgery, accounting for potential confounding variables in multilevel mixed-effects linear regression models. Results Accounting for potential confounding variables, greater pressure to act contrary to best evidence was moderately associated with greater patient despair (regression coefficient [RC] 6 [95% confidence interval 2 to 9]; p = 0.001) and stronger patient preference (RC 4 [95% CI 0 to 8]; p = 0.03). Lower pressure to act contrary to evidence was moderately associated with surgeon income independent of revenue (RC -6 [95% CI -9 to -4]; p < 0.001) and no financial benefit to operative treatment (RC -6 [95% CI -8 to -3]; p < 0.001). Marketing concerns were the only factor associated with greater likelihood of offering surgery (RC 6 [95% CI 0 to 11]; p = 0.04). Conclusion In this scenario-based survey experiment, patient distress and strong preferences and surgeon financial incentives were associated with greater surgeon feelings of moral dissonance when considering discretionary fracture surgery. Clinical Relevance To support enjoyment of the practice of musculoskeletal surgery, we recommend that surgeons, surgery practices, and surgery professional associations be intentional in both anticipating and developing strategies to ameliorate potential sources of moral dissonance in daily practice.

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Does Addressing Mental Health During a Musculoskeletal Specialty Care Visit Affect Patient-rated Clinician Empathy?

Cited by 3 publications

References 43 publications

When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

Editorial Comment: The Second Annual I-MESH Symposium

Do Surgeons Experience Moral Dissonance When There Is Misalignment Between Evidence and Action? A Survey and Scenario-based Study

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