Impact of a narrative medicine programme on healthcare providers' empathy scores over time

Po-Jui Chen, Chien-Da Huang, San-Jou Yeh, Po-Jui Chen, Chien-Da Huang, San-Jou Yeh

Abstract

Background: The cultivation of empathy for healthcare providers is an important issue in medical education. Narrative medicine (NM) has been shown to foster empathy. To our knowledge, there has been no research that examines whether a NM programme affects multi-professional healthcare providers' empathy. Our study aims to fill this gap by investigating whether a NM programme effects multi-professional healthcare providers' empathy.

Methods: A pre-post questionnaire method was used.142 participants (n = 122 females) who attended the NM programme were divided into single (n = 58) and team groups (n = 84) on the basis of inter-professional education during a period of 2 months. Perceptions of the NM programme were collected using our developed questionnaire. Empathy levels were measured using the Chinese version of Jefferson Scale of Empathy - Healthcare Providers Version (JSE-HP) - at three time points: prior to (Time 1), immediately after (T2), and 1.5 years (T3) after the programme.

Results: Participants' perceptions about the NM programme (n = 116; n = 96 females) suggested an in enhancement of empathy (90.5%). Empathy scores via the JSE-HP increased after the NM programme (T1 mean 111.05, T2 mean 116.19) and were sustainable for 1.5 years (T3 mean 116.04) for all participants (F(2297) = 3.74, p < .025). A main effect of gender on empathy scores was found (F(1298) = 5.33, p < .022). No significant effect of gender over time was found but there was a trend that showed females increasing empathy scores at T2, sustaining at T3, but males demonstrating a slow rise in empathy scores over time.

Conclusions: NM programme as an educational tool for empathy is feasible. However, further research is needed to examine gender difference as it might be that males and females respond differently to a NM programme intervention.

Keywords: Educational programme; Empathy; Gender; Narrative medicine.

Conflict of interest statement

Ethics approval and consent to participate

The participants completed the 10-item questionnaire for narrative medicine programme and JSE questionnaire anonymously. A waiver of the requirement to obtain the written informed consent was approved by the Chang Gung Memorial Hospital and Chang Gung University Institutional Review Board. Ethical approval for this study was obtained from the Chang Gung Memorial Hospital and Chang Gung University Institutional Review Board (IRB No. 102-4138B, 103-1755B, 105-2716C).

Consent for publication

No individual’s data is included in this study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Glass RM. The patient-physician relationship: JAMA focuses on the center of medicine (editorial) JAMA. 1996;275:147–148. doi: 10.1001/jama.1996.03530260061033.
    1. Crutcher JE, Bass MJ. The difficult patient and the troubled physician. J Fam Pract. 1980;11:933–938.
    1. Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883–887. doi: 10.1056/NEJM197804202981605.
    1. Murray E, Lo B, Pollack L, Donelan K, Catania J, Lee K, Zapert K, Turner R. The impact of health information on the internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians. J Med Internet Res. 2003;5(3):e17. doi: 10.2196/jmir.5.3.e17.
    1. Hojat M, Gonnella JS, Nasca TJ. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–1569. doi: 10.1176/appi.ajp.159.9.1563.
    1. Davis MH. Empathy: a social psychological approach. Madison: Wis, Brown and Benchmark; 1994.
    1. Hojat M, Louis DZ, Markham FW. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86:359–364. doi: 10.1097/ACM.0b013e3182086fe1.
    1. Kenny DJ. Determinants of patient satisfaction with the medical consultation. Psychol Health. 1995;10:427–437. doi: 10.1080/08870449508401961.
    1. Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the "nature" and "specific effectiveness" of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns. 2009;74(3):339–346. doi: 10.1016/j.pec.2008.11.013.
    1. Neumann M, Edelhäuser F, Tauschel D. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86:996–1009. doi: 10.1097/ACM.0b013e318221e615.
    1. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–356. doi: 10.1097/00001888-200404000-00013.
    1. Hatem D, Ferrara E. Becoming a doctor: fostering humane caregivers through creative writing. Patient Educ Couns. 2001;45:13–22. doi: 10.1016/S0738-3991(01)00135-5.
    1. Deen SR, Mangurian C, Cabaniss DL. Points of contact: using first-person narratives to help foster empathy in psychiatric residents. Acad Psychiatry. 2010;34:438–441. doi: 10.1176/appi.ap.34.6.438.
    1. Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897–1902. doi: 10.1001/jama.286.15.1897.
    1. Charon R. Narrative medicine: form, function, and ethics. Ann Intern Med. 2001;134:83–87. doi: 10.7326/0003-4819-134-1-200101020-00024.
    1. Brady DW, Corbie-Smith G, Branch WT. What's important to you? the use of narratives to promote self-reflection and to understand the experiences of medical residents. Ann Intern Med. 2002;137:220–223. doi: 10.7326/0003-4819-137-3-200208060-00025.
    1. Gaver A, Borkan JM, Weingarten MA. Illness in context and families as teachers: a year-long project for medical students. Acad Med. 2005;80:448–451. doi: 10.1097/00001888-200505000-00007.
    1. Bell RA. Unmet expectations for care and the patient-physician relationship. J Gen Intern Med. 2002;17:817–824. doi: 10.1046/j.1525-1497.2002.10319.x.
    1. Misra-Hebert AD, Issacson JH, Kohn M. Improving empathy of physicians through guided reflective writing. Int J Med Educ. 2012;3:71–77. doi: 10.5116/ijme.4f7e.e332.
    1. Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME guide no. 9. Med Teach. 2007;29(8):735–751. doi: 10.1080/01421590701682576.
    1. Hojat M, Bianco JA, Mann D, Massello D, Calabrese LH. Overlap between empathy, teamwork and integrative approach to patient care. Med Teach. 2014:1–4.
    1. Hojat M, Mangione S, Gonnella JS, Nasca T, Veloski JJ, Kane G. Empathy in medical education and patient care. Acad Med. 2001;76(7):669. doi: 10.1097/00001888-200107000-00001.
    1. Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, Callahan CA, Magee M. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36(6):522–527. doi: 10.1046/j.1365-2923.2002.01234.x.
    1. Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, Veloski J, Gonnella JS. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–1191. doi: 10.1097/ACM.0b013e3181b17e55.
    1. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009;31(4):412–450.
    1. Cheng JF, Lai YM, Livneh H. Establishing reliability and validity of the Chinese version of the Jefferson scale of empathy (healthcare providers version) J ET Nurs. 2011;58:41–48.
    1. Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ. 2014;14(1):219. doi: 10.1186/1472-6920-14-219.
    1. Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88(8):1171–1177. doi: 10.1097/ACM.0b013e318299f3e3.
    1. Roff S. Reconsidering the "decline" of medical student empathy as reported in studies using the Jefferson scale of physician empathy-student version (JSPE-S). Med Teach. 2015:1–4.
    1. Costa P, Magalhaes E, Costa MJ. A latent growth model suggests that empathy of medical students does not decline over time. Adv Health Sci Educ Theory Pract. 2013;18(3):509–522. doi: 10.1007/s10459-012-9390-z.
    1. Shapiro J, Rucker L, Boker J, Lie D. Point-of-view writing: a method for increasing medical students' empathy, identification and expression of emotion, and insight. Educ Health (Abingdon, England) 2006;19(1):96–105. doi: 10.1080/13576280500534776.
    1. Mehrabian A, Epstein N. A measure of emotional empathy1. J Pers. 1972;40(4):525–543. doi: 10.1111/j.1467-6494.1972.tb00078.x.
    1. Monica ELL. Construct validity of an empathy instrument. Res Nurs Health. 1981;4(4):389–400. doi: 10.1002/nur.4770040406.
    1. Charon R. Literature and medicine: origins and destinies. Acad Med. 2000;75(1):23–27. doi: 10.1097/00001888-200001000-00008.
    1. Stolorow R, Brandchaft B. G a. Psychoanalytic treatment: an Intersubjective approach. Hillsdale: Analytic Press; 1987.
    1. Eisenberg N, Lennon R. Sex differences in empathy and related capacities. Psychol Bull. 1983;94:100–131. doi: 10.1037/0033-2909.94.1.100.
    1. Williams B, Brown T, McKenna L, Palermo C, Morgan P, Nestel D, Brightwell R, Gilbert-Hunt S, Stagnitti K, Olaussen A, et al. Student empathy levels across 12 medical and health professions: an interventional study. J Compass Health Care. 2015;2(1):4. doi: 10.1186/s40639-015-0013-4.
    1. Kret ME, De Gelder B. A review on sex differences in processing emotional signals. Neuropsychologia. 2012;50(7):1211–1221. doi: 10.1016/j.neuropsychologia.2011.12.022.
    1. Baron-Cohen S. Zero degrees of empathy. A new theory of human cruelty. UK, Allen Lane; 2011.
    1. Winefield H, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34(2):90–94. doi: 10.1046/j.1365-2923.2000.00463.x.
    1. Dwamena F, Holmes-Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A, Lewin S, Smith RC, Coffey J, Olomu A. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267.
    1. Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research. Acad Med. 2010;85(4):588–593. doi: 10.1097/ACM.0b013e3181d281dc.
    1. Hojat M. Empathy in patient care: antecedents, development, measurement, and outcomes. New York: Springer; 2007.
    1. Monrouxe LV, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ Open. 2015;5(5):e007518. doi: 10.1136/bmjopen-2014-007518.

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