Neumann Melanie, Wirtz Markus, Bollschweiler Elfriede, Mercer Stewart W, Warm Mathias, Wolf Jürgen, Pfaff Holger
Centre for Health Services Research Cologne, Medical Department of the University of Cologne, Germany.
Patient Educ Couns. 2007 Dec;69(1-3):63-75. doi: 10.1016/j.pec.2007.07.003. Epub 2007 Sep 11.
The aim of the present cross-sectional study was to explore patient- and physician-specific determinants of physician empathy (PE) and to analyse the influence of PE on patient-reported long-term outcomes in German cancer patients.
A postal survey was administered to 710 cancer patients, who had been inpatients at the University Hospital Cologne (response rate 49.5%). PE was measured with the German translation of the consultation and relational empathy (CARE) measure, and patient-reported long-term outcomes were assessed using the major (ICD-10) depression inventory (MDI) and the EORTC quality of life (Qol) questionnaire QLQ-C30. Hypotheses were tested by structural equation modelling.
PE had (a) a moderate indirect effect on "depression" and a smaller indirect effect on "socio-emotional-cognitive Qol" by affecting "desire for more information from the physician regarding findings and treatment options" and (b) a moderate indirect effect on "socio-emotional-cognitive Qol" and a smaller effect on "depression" via "desire for more information about health promotion". The determinant with the greatest importance was "patient-perceived general busyness of hospital staff": it had a strong negative influence on PE, indirectly influencing "desire for more information from the physician regarding findings and treatment options" and also patients' "depression".
PE seems to be an important pre-requisite for information giving by physicians and through this pathway having a preventive effect on depression and improving Qol. Conversely, physicians' stress negatively influences these relationships.
The research findings suggest that reducing physicians' stress at the organizational and individual may be required to enhance patient-physician communication. Empathy, as an outcome-relevant professional competence needs to be assessed and developed more intensively in medical students and physicians.
本横断面研究旨在探讨医生同理心（PE）中患者及医生特定的决定因素，并分析PE对德国癌症患者报告的长期结局的影响。
对710名曾在科隆大学医院住院的癌症患者进行了邮寄调查（回复率49.5%）。采用咨询与关系同理心（CARE）量表的德文译本测量PE，使用主要（ICD-10）抑郁量表（MDI）和欧洲癌症研究与治疗组织生活质量（Qol）问卷QLQ-C30评估患者报告的长期结局。通过结构方程模型检验假设。
PE通过影响“希望医生提供更多关于检查结果和治疗方案的信息”，对“抑郁”有中度间接影响，对“社会情感认知生活质量”有较小间接影响；并且通过“希望获得更多关于健康促进的信息”，对“社会情感认知生活质量”有中度间接影响，对“抑郁”有较小影响。最重要的决定因素是“患者感知到的医院工作人员总体忙碌程度”：它对PE有强烈负面影响，间接影响“希望医生提供更多关于检查结果和治疗方案的信息”以及患者的“抑郁”。
PE似乎是医生提供信息的重要前提条件，并通过此途径对抑郁起到预防作用并改善生活质量。相反，医生的压力对这些关系有负面影响。
研究结果表明，可能需要在组织和个人层面减轻医生的压力，以加强医患沟通。同理心作为一种与结局相关的专业能力，需要在医学生和医生中更深入地评估和培养。
