Empathetic statements from physicians during intensive care conferences with family members are conducive to building the physician-family relationship, though only when “unburied” by medical terminology, according to results published in JAMA Network Open.
A qualitative, cross-sectional study was designed to investigate family responses to empathetic gestures made by physicians. Investigators obtained and analyzed 68 transcripts of audio-recorded care conferences from an urban medical center between 2013 and 2017. The transcripts detailed communication between a total of 30 physicians and 179 associated family members of 68 children in intensive care. Researchers coded statements as empathetic per the NURSE (naming, understanding, respecting, supporting, exploring) pneumonic. Observed empathy was classified as “buried” in medical terminology or closed-ended statements or “unburied,” in which the family was allowed to respond. Family responses were characterized as allied, cognitive, or none, and per these responses, researchers identified missed opportunities for physicians to align with families.
Of the total physician cohort, 43% were men, 80% were white, and 80% had more than 5 years of practice. During the care conferences, physicians recognized emotional cues 74% of the time, making an observed total of 364 empathetic statements. More than 60% (61.5%) of these statements were coded as unburied, and 38.5% were buried. Buried statements were typically (95%) bookended by “medical talk.”
Unburied statements were associated with “alliance responses” from the family more often than buried statements (odds ratio 18; 95% CI, 10.1-32.4; P <.001). Researchers identified missed opportunities for physicians to address emotion in 26% of transcripts, and just 7% of physicians tended to all recorded family concerns during a conference. Missed opportunities included responding to family comments with medical statements, ignoring family comments, attempting to discount certain concerns, changing topics, or deferring to a colleague.
These results highlight the positive impact of physician empathy on family response and conference outcomes. These data encourage providers to address the emotional concerns of patient families as a matter of good practice.
October TW, Dizon ZB, Arnold RM, et al. Characteristics of physician empathetic statements during pediatric intensive care conferences with family members. JAMA Network Open. 2018;1:e180351.