There is Little or No Association Between Independently Assessed Communication Strategies and Patient Ratings of Clinician Empathy

Abstract

BackgroundQuality of care is increasingly assessed and incentivized using measures of patient-reported outcomes and experience. Little is known about the association between measurement of clinician communication strategies by trained observers and patient-rated clinician empathy (a patient-reported experience measure). An effective independent measure could help identify and promote clinician behaviors associated with good patient experience of care.Questions/purposes(1) What is the association between independently assessed clinician communication effectiveness and patient-rated clinician empathy? (2) Which factors are associated with independently assessed communication effectiveness?MethodsOne hundred twenty adult (age > 17 years) new or returning patients seeking musculoskeletal specialty care between September 2019 and January 2020 consented to video recording of their visit followed by completion of questionnaires rating their perceptions of providers’ empathy levels in this prospective study. Patients who had operative treatment and those who had nonoperative treatment were included in our sample. We pooled new and returning patients because our prior studies of patient experience found no influence of visit type and because we were interested in the potential influences of familiarity with the clinician on empathy ratings. We did not record the number of patients or baseline data of patients who were approached, but most patients (> 80%) were willing to participate. For 7% (eight of 120 patients), there was a malfunction with the video equipment or files were misplaced, leaving 112 records available for analysis. Patients were seen by one provider among four attending physicians, four residents, or four physician assistants or nurse practitioners. The primary study question addressed the correlation between patient-rated clinician empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and clinician communication effectiveness, independently rated by two communication scholars using the Liverpool Communication Skills Assessment Scale. Based on a subset of 68 videos (61%), the interrater reliability was considered good for individual items on the Liverpool Communication Skills Assessment Scale (intraclass correlation coefficient [ICC] 0.78 [95% confidence interval (CI) 0.75 to 0.81]) and excellent for the sum of the items (that is, the total score) (ICC = 0.92 [95% CI 0.87 to 0.95]). To account for the potential association of personal factors with empathy ratings, patients completed measures of symptoms of depression (the Patient-Reported Outcome Measurement Information System depression computerized adaptive test), self-efficacy in response to pain (the two-item Pain Self-Efficacy Questionnaire), health anxiety (the five-item Short Health Anxiety Inventory), and basic demographics.ResultsAccounting for potentially confounding variables, including specific clinicians, marital status, and work status in the multivariable analysis, we found higher independent ratings of communi...

CORR Insights®: There is Little or No Association Between Independently Assessed Communication Strategies and Patient Ratings of Clinician Empathy

“…The study by Brown et al [2] in this month’s Clinical Orthopaedics and Related Research ® is important because it challenges assumptions about the correlation between communication effectiveness and perceived empathy. Clinic visits between musculoskeletal providers and patients were video-recorded, patients completed post-visit questionnaires, and trained communication scholars observed the videos.…”

“…Clinic visits between musculoskeletal providers and patients were video-recorded, patients completed post-visit questionnaires, and trained communication scholars observed the videos. The authors found little or no association of observed communication behaviors with patient-rated empathy of the clinician and concluded that either effective communication alone is insufficient for high levels of empathy or that existing measures of effective communication or empathy are inadequate or inappropriate [2]. Based on this evidence, clinicians, organizations, and systems should not spend a lot of time or money on “perfecting” communication strategies for all clinicians using our existing measures.…”

“…Musculoskeletal specialists may therefore use communication and relationship-building strategies to achieve these aims, and independent observations and measurement of effective strategies would be helpful in order to learn and improve most effectively and efficiently.The study by Brown et al [2] in this month's Clinical Orthopaedics and Related Research ® is important because it challenges assumptions about the correlation between communication effectiveness and perceived empathy.Clinic visits between musculoskeletal providers and patients were video-recorded, patients completed post-visit questionnaires, and trained communication scholars observed the videos. The authors found little or no association of observed communication behaviors with patient-rated empathy of the clinician and concluded that either effective communication alone is insufficient for high levels of empathy or that existing measures of effective communication or empathy are inadequate or inappropriate [2]. Based on this evidence, clinicians, organizations, and systems should not spend a lot of time or money on "perfecting" communication strategies for all clinicians using…”

Editorial: Introducing CORR®’s Newest Column: What I Wish My Surgeon Knew

“…It’s a small wonder that one survey found that while 75% of orthopaedic surgeons believed they were communicating effectively with patients, only 21% of those patients agreed [4]. Diving deeper, it appears that even objective ratings of communication effectiveness made by trained communication scholars have little or no association with patient-rated clinician empathy [1].…”

“…The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons ® . S. S. Leopold ✉, Clinical Orthopaedics and Related Research ® , 300 S. Northwest Highway, Suite 203, Park Ridge, IL 60068, USA, Email: sleopold@clinorthop.org trained communication scholars have little or no association with patient-rated clinician empathy [1].…”