Licciardone John C, Middleton Claire N, Aboutaj Amin, Allouche Tal, Siddiqui Imran
University of North Texas Health Science Center, Fort Worth, TX, USA.
J Osteopath Med. 2024 Oct 3;125(2):79-86. doi: 10.1515/jom-2024-0112. eCollection 2025 Feb 1.
Chronic pain may affect the relationship between patients and their treating physicians.
This study was designed to compare four aspects of physician communication and physician empathy reported by patients with chronic pain and in chronic pain-free controls.
A cross-sectional study was conducted within a national pain research registry from July 2020 through January 2024. Patients with chronic low back pain of greater than 3 months duration were matched to chronic pain-free controls utilizing propensity scores derived from a logistic regression model based on 11 variables that included sociodemographic characteristics, cigarette smoking status, history of comorbid medical conditions, and duration of the current patient-physician relationship. Patients reported on the primary outcomes of physician communication utilizing the Communication Behavior Questionnaire (CBQ) and physician empathy utilizing the Consultation and Relational Empathy (CARE) measure. Group means were compared for each aspect of physician communication (patient participation and patient orientation, effective and open communication, emotionally supportive communication, and communication about personal circumstances) and physician empathy, and Cohen's d statistic was utilized to assess the clinical relevance of between-group differences. Secondary exploratory analyses were also performed to compare patients treated by osteopathic physicians vs. allopathic physicians and to determine whether study group X physician type interaction effects were present.
The 387 patients in each study group were matched within a caliper width of 0.001 on the propensity score. Overall, patients ranged from 21 to 79 years of age (mean, 50.7 years; standard deviation [SD], 15.1 years), and 617 (79.7 %) of them were female. Patients in the chronic pain group reported poorer scores for all aspects of physician communication and physician empathy than the chronic pain-free controls. All between-group differences were clinically relevant. There were no differences in physician communication or physician empathy according to physician type in the exploratory analyses, and study group X physician type interaction effects were not observed.
In this cross-sectional study, patients with chronic pain reported having physicians with poorer communication and less empathy than chronic pain-free controls. Longitudinal research is needed to more clearly determine the temporal relationship between patients' chronic pain and physician communication and physician empathy during medical encounters.
慢性疼痛可能会影响患者与其治疗医生之间的关系。
本研究旨在比较慢性疼痛患者和无慢性疼痛对照组报告的医生沟通和医生同理心的四个方面。
2020年7月至2024年1月在一个国家疼痛研究登记处进行了一项横断面研究。将持续时间超过3个月的慢性下腰痛患者与无慢性疼痛对照组进行匹配，匹配采用基于11个变量的逻辑回归模型得出的倾向得分，这些变量包括社会人口学特征、吸烟状况、合并症病史以及当前医患关系的持续时间。患者使用沟通行为问卷（CBQ）报告医生沟通的主要结果，并使用咨询与关系同理心（CARE）量表报告医生同理心。比较了医生沟通（患者参与和患者导向、有效和开放沟通、情感支持性沟通以及个人情况沟通）和医生同理心各方面的组均值，并使用科恩d统计量评估组间差异的临床相关性。还进行了二次探索性分析，以比较整骨疗法医生与全科医生治疗的患者，并确定是否存在研究组×医生类型的交互作用。
每个研究组的387名患者在倾向得分上的匹配宽度为0.001。总体而言，患者年龄在21至79岁之间（平均50.7岁；标准差[SD]为15.1岁），其中617名（79.7%）为女性。慢性疼痛组患者报告的医生沟通和医生同理心各方面得分均低于无慢性疼痛对照组。所有组间差异均具有临床相关性。在探索性分析中，根据医生类型，医生沟通或医生同理心没有差异，也未观察到研究组×医生类型的交互作用。
在这项横断面研究中，慢性疼痛患者报告称其医生的沟通能力较差，同理心也不如无慢性疼痛对照组。需要进行纵向研究，以更清楚地确定患者慢性疼痛与医疗过程中医生沟通和医生同理心之间的时间关系。
