University of Lille Nord de France, Department of Psychology, Lille, France; UDL3, URECA, Villeneuve d'Ascq, France.
Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057 - IUPDP, Boulogne-Billancourt, France.
Patient Educ Couns. 2014 Mar;94(3):322-7. doi: 10.1016/j.pec.2013.10.029. Epub 2013 Nov 8.
To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression.
Twenty-eight physicians assessed their patients' distress level on the distress thermometer, while patients (N=201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out.
Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA.
This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA.
Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns.
考察影响医生评估转移性癌症患者痛苦（也称为共情准确性，empathic accuracy，EA）准确性的决定因素。假设的决定因素包括医生的共情态度、共情技能的自我效能感、医生对与患者关系的感知、患者的痛苦程度和患者的表达抑制。
28 名医生使用痛苦温度计评估患者的痛苦程度，而患者（N=201）则独立使用同一工具评估自己的痛苦程度。EA 是两个分数之间的绝对值差异。使用自我报告的问卷评估假设的决定因素。进行了多层次分析。
EA 的变化很小，由医生变量解释。EA 随着患者痛苦程度的增加而增加。医生感知到的关系质量与 EA 呈正相关。然而，对于高度痛苦的患者，良好的关系与较低的 EA 相关。患者的表达抑制也与较低的 EA 相关。
本研究增加了对肿瘤学环境中 EA 的理解，特别是挑战了 EA 主要取决于医生特征或更好的关系总是有利于更高的 EA 的常见假设。
医生应该向患者询问有关他们情绪的反馈。同时，应提示患者表达他们的担忧。
