How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys.
How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys.
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您的医疗保健医生的同理心如何？对患者调查的系统回顾和荟萃分析。
DOI：
10.1186/s12909-017-0967-3
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发表时间：
2017-08-21
影响因子：
3.6
通讯作者：
Meissner K
中科院分区：
文献类型：
--
作者：
Howick J;Steinkopf L;Ulyte A;Roberts N;Meissner K
越来越多的证据表明，加强表达同理心的医疗从业人员可以改善患者的健康状况，并降低医疗法律风险。然而，我们不知道医疗从业者如何始终如一地表达足够的同理心。在这项研究中，我们通过调查医生共情的患者排名来解决这一差距。我们对一些研究进行了系统回顾和荟萃分析，这些研究要求患者使用咨询和关系共情（CARE）测量对医生的共情进行评分。CARE正在成为医生共情的最常见和最有效的患者评级。我们检索了MEDLINE， Embase, PsycINFO, Cinahl， Science & Social Science引文索引，Cochrane Library和PubMed从数据库建立到2016年3月。我们排除了未使用CARE测量的研究。两名审稿人独立筛选标题并提取有关平均CARE评分、患者和从业人员的人口统计数据以及医疗从业人员类型的数据。51份出版物中的64项独立研究有足够的数据可供汇总。平均CARE评分为40.48 （95% CI, 39.24 ~ 41.72）。与CARE开发人员收集的分数相比，这排在最后的5个百分位数。较长的咨询（n = 13）比较短的咨询（n = 9） （34.93, 95% CI 32.63至37.24）得分高15% （42.60,95% CI 40.66至44.54）。以女性从业者为主（n = 6）的研究共情得分（42.77,95% CI 38.98 ~ 46.56）比以男性从业者为主（n = 6）的研究共情得分（34.84,95% CI 30.98 ~ 38.71）高16%。不同提供者类型（专职卫生专业人员、医学生、内科医生和中医）之间的差异有统计学意义（P = 0.032）。专职卫生专业人员（n = 6）得分最高（45.29,95% CI 41.38 ~ 49.20），内科医生（n = 39）得分最低（39.68,95% CI 38.29 ~ 41.08）。澳大利亚、美国和英国的患者共情评分最高（平均CARE评分为bbbb43），香港的得分最低（平均CARE评分<35）。患者对医生共情的排名变化很大，女性医生比男性医生更有效地表达对患者的共情。患者对医生共情评价的高变异性可能与患者健康结果的变化有关。局限性包括经常未能报告反应率，从而导致反应偏差的风险。未来的工作需要研究如何减少从业者共情的可变性。本文的在线版本（doi:10.1186/s12909-017-0967-3）包含补充材料，可供授权用户使用。
A growing body of evidence suggests that healthcare practitioners who enhance how they express empathy can improve patient health, and reduce medico-legal risk. However we do not know how consistently healthcare practitioners express adequate empathy. In this study, we addressed this gap by investigating patient rankings of practitioner empathy. We conducted a systematic review and meta-analysis of studies that asked patients to rate their practitioners’ empathy using the Consultation and Relational Empathy (CARE) measure. CARE is emerging as the most common and best-validated patient rating of practitioner empathy. We searched: MEDLINE, Embase, PsycINFO, Cinahl, Science & Social Science Citation Indexes, the Cochrane Library and PubMed from database inception to March 2016. We excluded studies that did not use the CARE measure. Two reviewers independently screened titles and extracted data on average CARE scores, demographic data for patients and practitioners, and type of healthcare practitioners. Sixty-four independent studies within 51 publications had sufficient data to pool. The average CARE score was 40.48 (95% CI, 39.24 to 41.72). This rank s in the bottom 5th percentile in comparison with scores collected by CARE developers. Longer consultations (n = 13) scored 15% higher (42.60, 95% CI 40.66 to 44.54) than shorter (n = 9) consultations (34.93, 95% CI 32.63 to 37.24). Studies with mostly (>50%) female practitioners (n = 6) showed 16% higher empathy scores (42.77, 95% CI 38.98 to 46.56) than those with mostly (>50%) male (n = 6) practitioners (34.84, 95% CI 30.98 to 38.71). There were statistically significant (P = 0.032) differences between types of providers (allied health professionals, medical students, physicians, and traditional Chinese doctors). Allied Health Professionals (n = 6) scored the highest (45.29, 95% CI 41.38 to 49.20), and physicians (n = 39) scored the lowest (39.68, 95% CI 38.29 to 41.08). Patients in Australia, the USA, and the UK reported highest empathy ratings (>43 average CARE), with lowest scores (<35 average CARE scores) in Hong Kong. Patient rankings of practitioner empathy are highly variable, with female practitioners expressing empathy to patients more effectively than male practitioners. The high variability of patient rating of practitioner empathy is likely to be associated with variable patient health outcomes. Limitations included frequent failure to report response rates introducing a risk of response bias. Future work is warranted to investigate ways to reduce the variability in practitioner empathy. The online version of this article (doi:10.1186/s12909-017-0967-3) contains supplementary material, which is available to authorized users.
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DOI：
10.1001/jama.1958.02990210034008
发表时间：
1958-01-01
影响因子：
120.7
作者：
ARING, CD
通讯作者：
ARING, CD
影响因子：
3.6
作者：
Hemmerdinger, Joanne M;Stoddart, Samuel D R;Lilford, Richard J
通讯作者：
Lilford, Richard J
影响因子：
2.2
作者：
Mercer, SW;McConnachie, A;Watt, GCM
通讯作者：
Watt, GCM
影响因子：
1.7
作者：
Attar HS;Chandramani S
通讯作者：
Chandramani S
影响因子：
5.9
作者：
Derksen, Frans;Bensing, Jozien;Lagro-Janssen, Antoine
通讯作者：
Lagro-Janssen, Antoine