Clinicians Expressing Empathy Has Positive Influence on Patient Recall

Though the underlying mechanism remains unclear, research from an observational study published in Patient Education and Counseling demonstrated the positive influence of clinician-expressed empathy during consultations with female patients with advanced breast cancer.

More specifically, the study discovered that clinicians can influence a patient’s recall of medical information provided by using empathy.

“Our results revealed that clinician-expressed empathy positively influenced patients’ recall in clinical practice: both the totality of information and the information about treatment aims/positive effects in particular were recalled better after consultations in which more empathy was expressed,” explained the authors. “However, this improved recall was not explained by a decrease in patients’ anxiety level.”

In total, 41 consultations between oncologists and female patients with advanced breast cancer were audio recorded. Using the recordings, researchers assessed patients’ post-consultation information recall and pre- and post-consultation anxiety (0-100); recall was scored according to a self-created questionnaire. In addition, clinician-expressed empathy (0-100) was also evaluated.

Ultimately, the study participants were found to have remembered 61% of the information discussed. Recall was best for information about treatment options (77%), followed by information about treatment aims and positive effects (63%). However, patient recall was least effective for information about side effects (40%).

Clinician-expressed empathy was also found to have led to an overall increase in information recall (P = .041). Specifically, empathy significantly influenced recall of treatment aims and positive effects (P = .028), though it did not significantly impact recall of treatment options (P = .123) or side effects (P = .129).

“This contradicts findings from a previous experimental study, which did find an effect of empathy on recall of treatment options,” the authors noted. “This contradictory result may be explained by the fact that we included follow-up consultations, whereas van Osch et al. used the initial bad consultations. In addition, our study was conducted in clinical care.”

Patient anxiety decreased by 27.48 points from before the consultation to after (pre-consultation: M = 57.41, SD = 28.88, 0-100 range; post-consultation: M = 29.37, SD = 25.80, 0-83 range). This decrease was deemed to be significant (t[40] = -5.77, P < .001; 95% CI, -37.11 to -17.86).

Importantly though, the mediating role of anxiety could not be established by the investigators. The indirect effects of all individual parts and total recall were close to 0 and non-significant.

“It might be that a decrease in anxiety is not the mechanism by which empathy increases recall,” the authors suggested.

Of note, this study had several limitations, including that empathy was assessed by neutral observers, whose perspective might differ from that of a patient. The use of audio-recorded consultations also limited the research in that it excluded non-verbal empathic communication from the analysis. Additionally, the limited sample size used in this study consisted of predominantly highly educated females recruited in a specialized cancer hospital, which limits the generalizability of the results.

Moving forward, future studies should overcome these limitations by including a larger, more diverse population of patients, focusing on the role of different empathic behaviors, making use of video-recorded consultations, and assessing recall with real-life or telephone interviews to obtain more in-depth information.

“Most importantly, more research is needed to discover the underlying mechanism of how empathy can improve patients’ information recall,” the authors wrote.

Reference:

Westendorp J, Stouthard J, Meijers MC, et al. The power of clinician-expressed empathy to increase information recall in advanced breast cancer care: an observation study in clinical care, exploring the mediating role of anxiety. Patient Education and Counseling. doi: 10.1016/j.pec.2020.10.025