Department of Neurology, Mayo Clinic, USA.
Program in Professionalism and Values, Mayo Clinic, USA.
J Telemed Telecare. 2021 Oct;27(9):572-581. doi: 10.1177/1357633X19899237. Epub 2020 Jan 27.
We assessed patients' perceptions of physician empathy during telemedicine consultations as compared to in-person consultations during clinical encounters for acute stroke.
This prospective cohort study was undertaken at a comprehensive stroke centre hub in collaboration with a distant community hospital spoke site. Eligible participants presented to hub or spoke emergency departments with suspected acute stroke within three hours of symptom onset. Participants were evaluated at the hub site in person or at the remote site via telemedicine by the same group of neurologists. Following acute care decisions, single-visit data including participant-reported assessments of physician empathy were collected within 24 h. The primary outcome was the Consultation and Relational Empathy score. The secondary outcome for the telemedicine cohort was the Telemedicine Patient Satisfaction Measure score.
Between 31 May 2013-13 March 2019, 70 patients completed the study. Fifty patients were seen by telemedicine and 20 patients were seen in person. Median Consultation and Relational Empathy scores (with a possible score of 10-50) were 49 (range 27-50) for telemedicine and 45 (range 26-50) for in-person consultations (Wilcoxon rank sum = 0.18). Each item of the Consultation and Relational Empathy questionnaire was rated very good or excellent by at least 87% of participants in the telemedicine group. The median Telemedicine Patient Satisfaction Measure score was 54 (range 12-60), with each item rated agree or strongly agree by at least 84% of participants.
We found no difference between telemedicine and in-person visits in patient perception of physician empathy in acute stroke care. Therefore, we conclude that empathy can be conveyed by facial expression, voice and attentiveness in a telemedicine encounter and, in the setting of acute stroke care, does not require physical touch or proximity.
我们评估了患者在远程医疗咨询期间对医生同理心的感知，与急性卒中临床就诊期间的面对面咨询进行了比较。
这项前瞻性队列研究在综合卒中中心枢纽与远程社区医院分中心合作进行。符合条件的参与者在症状发作后 3 小时内到枢纽或分中心急诊室就诊，怀疑患有急性卒中。在急性护理决策之后，在 24 小时内通过远程医疗或在远程站点由同一组神经科医生对参与者进行了单访评估。收集了包括患者报告的医生同理心评估在内的单次就诊数据。主要结局是咨询和关系同理心评分。远程医疗队列的次要结局是远程医疗患者满意度测量评分。
2013 年 5 月 31 日至 2019 年 3 月 13 日期间，70 名患者完成了研究。50 名患者通过远程医疗就诊，20 名患者面对面就诊。远程医疗的中位数咨询和关系同理心评分（可能为 10-50）为 49（范围 27-50），面对面就诊的中位数咨询和关系同理心评分（可能为 10-50）为 45（范围 26-50）（Wilcoxon 秩和检验=0.18）。远程医疗组的每个咨询和关系同理心问卷项目都至少有 87%的参与者评为非常好或极好。远程医疗患者满意度测量评分的中位数为 54（范围 12-60），至少有 84%的参与者对每个项目的评价为同意或强烈同意。
我们发现，在急性卒中护理中，远程医疗和面对面就诊患者对医生同理心的感知没有差异。因此，我们得出结论，同理心可以通过远程医疗中的面部表情、声音和注意力来传达，在急性卒中护理环境中，不需要身体接触或接近。
