Khairat Al Habbal

ABSTRACT

Empathy levels of emergency physicians: perceptions of patients and their physicians, a qualitative study

Khairat Al Habbal

Khalifa University

Background and Purpose:
Empathy is the ability to understand an individual’s subjective experience yet still remain as an observer. It plays a major role in establishing a good physician–patient relationship crucial for successful medical care. In spite of its importance, physicians face barriers to expressing empathy.
The purpose of this study is to evaluate if there is any difference between the perspectives of patients and their corresponding emergency physicians regarding physicians’ empathy levels and to identify the themes they considered important for an empathetic encounter.
Methods:
This is a qualitative study conducted at a Middle Eastern tertiary care center Emergency Department (ED) using in-depth semi-structured interviews administered to each participating patient and his/her corresponding ED physician in order to assess their perspectives on the physician’s empathy levels during that medical encounter. Inductive thematic analysis was used to identify empathy-related themes.
Results:
Both patients and physicians believe in the importance of empathy in the ED setting based on four major themes: emotions, interpersonal and communication skills, time, and chief complaint. Nevertheless, a gap lies in the expressive communication phase between the two groups. Time and the chief complaint were perceived as barriers to empathy by the physicians but by their patients.
Conclusions:
This study reveals the difference between the perspectives of patients and their respective physicians regarding the communicative and interpersonal aspects of empathy. Efforts are needed from both sides in order to improve the quality of the empathetic encounter which would lead to better patient-centered care. The identified themes are similar to those of the Consultation and Relational Empathy (CARE) measure. The next step will be validating this measure in Arabic for use in future research on empathy with Arabic speaking patients. 

ABSTRACT

Reliability and validity of the Arabic version of the Consultation and Relational Empathy (CARE) Measure

Alicia Djoundourian

Elma Nassar

Ziad Tayara

Stewart Mercer

Rudy Abi Habib

Purpose. Empathy is the ability to communicate an understanding of an individual’s subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring empathy and studying it in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-items questionnaire that measures patient assessment of physician’s empathy in the primary health care setting. It has been validated in English, Chinese, Dutch and Japanese. To our knowledge, there are no validated tools to assess empathy in the clinical setting in the Arabic language. This study aims at validating the CARE measure in Arabic. 
Methods. The CARE measure was translated and back translated by certified translators. Data collection took place between October 2019 and February 2020 at a general practice clinic at one of the main university hospitals in Lebanon and two other primary care clinics affiliated with it. A total of 202 patients completed the questionnaire which consisted of the 10 CARE items, participants’ opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation. 
 Results. Our findings showed significant positive correlations between CARE measure score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients’ satisfaction with consultation length and whether they recommend the doctor to family and friends. These were similar findings to the original English, Chinese and Dutch versions. High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version.
Conclusion. The Arabic version of the CARE measure appears to be valid and reliable. It is available for use for research, education, and assessment of physicians’ empathy across Arabic speaking countries as well as countries all over the globe having access to Arabic speaking patients.

BIO

Dr Khairat Al Habbal is an Assistant Professor of Family Medicine at Khalifa University (KU), College of Medicine and Health Sciences. She is the Strand Leader of the Medicine and Society course and the Director of the KU-BALSAM program, the university’s community health outreach program that aims at increasing the learners’ awareness about the social determinants of health. She had previously introduced narrative medicine as part of the curriculum through her role as a medical educator at a medical school in Beirut. Her research interests include empathy and its effects on the patient-physician relationship along with other topics. Dr Al Habbal also holds an MSc in Global Health Policy form the London School of Hygiene and Tropical Medicine and is a global health consultant working on strengthening primary care through building the capacity of the primary healthcare workforce.