Does GP empathy influence patient enablement and success in lifestyle change among high risk patients?

Caroline Braad Hansen, Kristian Møller Hornbæk Pavlovic, Jens Sondergaard, Trine Thilsing, Caroline Braad Hansen, Kristian Møller Hornbæk Pavlovic, Jens Sondergaard, Trine Thilsing

Abstract

Background: Chronic lifestyle-related-diseases can be prevented by healthy lifestyle. Patients at high risk of disease may benefit from targeted health checks in general practice. However, general-practice-based-studies have shown that patient outcome, enablement, and well-being may be influenced by general practitioner (GP) empathy. The aim of this study is to investigate 1) how high risk patients evaluate their GPs' empathy during a health check consultation, 2) whether the perceived GP empathy is associated with the patient's enablement in immediate continuation of the health check consultation and 3) the patient's subsequent lifestyle changes.

Methods: This study is part of a population based non-randomized feasibility study testing a complex intervention that systematically identifies citizens at high risk of lifestyle-related disease and with health-risk behavior and offers targeted preventive services in the Danish primary care sector. The ultimate aim of the intervention is to improve lifestyle and thereby reduce the risk of lifestyle-related disease. In the feasibility study a random sample of patients aged 30 to 59 years were invited to participate, and to fill in a questionnaire on lifestyle-risk factors. Participants deemed to be at high risk of disease were offered a focused clinical examination and a subsequent health check consultation at the GP. Following each health check consultation GP empathy and patient enablement were assessed using The Care Measure (CARE) and Patient Enablement Instrument (PEI). Patient's perceived healthy-lifestyle change (y/n) was assessed after three months. The study has been approved by the Danish Data Protection Agency (J.nr 2015-57-0008) and registered at ClinicalTrial. Gov on June 13, 2016.

Results: Twenty-six GP's participated in the study. Among 93 patients receiving a health check consultation 60 rated the GPs empathy. The median CARE-score was 40. The PEI median was 5.5 and 44.9% achieved a healthier lifestyle. No association was observed between GP empathy and patient enablement or a perceived healthier lifestyle.

Conclusion: No statistical significant association between the CARE-score and patient enablement or a perceived healthier lifestyle was observed. Our results contrast previous findings and may to some extent be explained by a small sample size and the selected high-risk group.

Trial registration number: NCT02797392 .

Keywords: Empathy; GP empathy; Healthier lifestyle; Lifestyle change.

Conflict of interest statement

The Authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
flowdiagram of the selectionproces
Fig. 2
Fig. 2
Distribution of Patient enablement instrument (PEI) scores among male and female patients
Fig. 3
Fig. 3
linear regression between CARE-measure score and Patient Enablement Instrument (PEI) score
Fig. 4
Fig. 4
Box-plot of CARE-measure score in patients with and without healthy lifestyle changes at 3 months follow up

References

    1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. doi: 10.1016/j.diabres.2009.10.007.
    1. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–2753. doi: 10.1161/hc4601.099487.
    1. Si S, Moss JR, Sullivan TR, Newton SS, Stocks NP. Effectiveness of general practice-based health checks: a systematic review and meta-analysis. Br J Gen Pract. 2014;64(618):e47–e53. doi: 10.3399/bjgp14X676456.
    1. Engelsen C, Koekkoek PS, Godefrooij MB, Spigt MG, Rutten GE. Screening for increased cardiometabolic risk in primary care: a systematic review. Br J Gen Pract. 2014;64(627):e616–e626. doi: 10.3399/bjgp14X681781.
    1. van den Brekel-Dijkstra K, Rengers AH, Niessen MA, de Wit NJ, Kraaijenhagen RA. Personalized prevention approach with use of a web-based cardiovascular risk assessment with tailored lifestyle follow-up in primary care practice--a pilot study. Eur J Prev Cardiol. 2016;23(5):544–551. doi: 10.1177/2047487315591441.
    1. Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sonderlund AL, Christensen JR, et al. Digital recruitment and acceptance of a stepwise model to prevent chronic disease in the Danish primary care sector: cross-sectional study. J Med Internet Res. 2019;21(1):e11658. doi: 10.2196/11658.
    1. Dryden R, Williams B, McCowan C, Themessl-Huber M. What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health. 2012;12:723. doi: 10.1186/1471-2458-12-723.
    1. medicin Dsfa. Den motiverende samtale [Website]. 1999 [Available from: .
    1. MacPherson H, Mercer SW, Scullion T, Thomas KJ. Empathy, enablement, and outcome: an exploratory study on acupuncture patients' perceptions. J Altern Complement Med. 2003;9(6):869–876. doi: 10.1089/107555303771952226.
    1. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(Suppl):S9–12.
    1. Morse GA JM, Bottorf JL, Yonge O, O'Brien B, Solberg SM. Kathleen Hunter McIlveen. Exploring Empathy: a conceptual fit for nursing practice? J Nurs Scholarsh. 1992;24(4).273–80.
    1. Mercer SW, Higgins M, Bikker AM, Fitzpatrick B, McConnachie A, Lloyd SM, et al. General Practitioners' empathy and health outcomes: a prospective observational study of consultations in areas of high and low deprivation. Ann Fam Med. 2016;14(2):117–124. doi: 10.1370/afm.1910.
    1. Mercer SW, Neumann M, Wirtz M, Fitzpatrick B, Vojt G. General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland--a pilot prospective study using structural equation modeling. Patient Educ Couns. 2008;73(2):240–245. doi: 10.1016/j.pec.2008.07.022.
    1. Mohammadreza Hojat DZL, Fred WM, Richard W, Carol R, Joseph SG. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3).
    1. Kardakis T, Weinehall L, Jerdén L, Nyström ME, Johansson H. Lifestyle interventions in primary health care: professional and organizational challenges. Eur J Pub Health. 2014;24(1):79–84. doi: 10.1093/eurpub/ckt052.
    1. Johansson H, Weinehall L, Emmelin M. "it depends on what you mean": a qualitative study of Swedish health professionals' views on health and health promotion. BMC Health Serv Res. 2009;9:191. doi: 10.1186/1472-6963-9-191.
    1. Johansson H, Stenlund H, Lundström L, Weinehall L. Reorientation to more health promotion in health services - a study of barriers and possibilities from the perspective of health professionals. J Multidiscip Healthc. 2010;3:213–224. doi: 10.2147/JMDH.S14900.
    1. Larsen LB, Sonderlund AL, Sondergaard J, Thomsen JL, Halling A, Hvidt NC, et al. Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study. BMC Fam Pract. 2018;19(1):124. doi: 10.1186/s12875-018-0820-8.
    1. Christensen JO, Sandbaek A, Lauritzen T, Borch-Johnsen K. Population-based stepwise screening for unrecognised type 2 diabetes is ineffective in general practice despite reliable algorithms. Diabetologia. 2004;47(9):1566–1573. doi: 10.1007/s00125-004-1496-2.
    1. Martinez FJ, Raczek AE, Seifer FD, Conoscenti CS, Curtice TG, D'Eletto T, et al. Development and initial validation of a self-scored COPD population screener questionnaire (COPD-PS) Copd. 2008;5(2):85–95. doi: 10.1080/15412550801940721.
    1. Cardiology ESo. Heartscore webpage [Available from: .
    1. Howie JG, Heaney DJ, Maxwell M, Walker JJ. A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract. 1998;15(2):165–171. doi: 10.1093/fampra/15.2.165.
    1. Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705. doi: 10.1093/fampra/cmh621.
    1. Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sonderlund AL, Christensen JR, et al. Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up - an assessment of attendance. BMC Public Health. 2019;19(1):1092. doi: 10.1186/s12889-019-7419-4.
    1. Steinhausen S, Ommen O, Thum S, Lefering R, Koehler T, Neugebauer E, et al. Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients. Patient Educ Couns. 2014;95(1):53–60. doi: 10.1016/j.pec.2013.12.007.
    1. Hermans L, Olde Hartman TC, Dielissen PW. Differences between GP perception of delivered empathy and patient-perceived empathy: a cross-sectional study in primary care. Br J Gen Pract. 2018;68(674):e621–e6e6. doi: 10.3399/bjgp18X698381.

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