Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial

Our plain-English summary of Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial, by S. Lelorain, A. Cortot, V. Christophe, et al (Journal of Clinical Medicine, 2018).

The study

• Authors: S. Lelorain, A. Cortot, V. Christophe, C. Pinçon, Y. Gidron
• Journal: Journal of Clinical Medicine
• Published: 2018;7(10)
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and a Karnofsky performance status ≥60 assessed their oncologist's empathy using the CARE questionnaire, which provides a general score and two sub-dimensions: listening/compassion and active/positive empathy. Survival was recorded until April 2018. Usual medical, social and psychological confounders were included in the Cox regression. The median follow-up time was 3.1 years. There was a statistical interaction between listening/compassion empathy and TC (p = 0.016) such that in bad news consultations, higher listening/compassion predicted a higher risk of death (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.03⁻1.23; p = 0.008). In follow-up consultations, listening/compassion did not predict survival (HR = 0.94; 95% CI: 0.85⁻1.05; p = 0.30). The same results were found with the general score of empathy, but not with active/positive empathy. In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death. Further studies are warranted to confirm these results and find out the determinants of patient perception of physician empathy.

In plain English

This French study asked whether patients' views of their doctor's empathy were linked to survival. It reused data from an earlier study of 179 outpatients with thoracic cancer at the University of Lille: 135 with non-small cell lung cancer, 10 with small cell lung cancer, 21 with mesothelioma, and 13 whose cancer type was not recorded. After a consultation, patients rated their oncologist's empathy on a questionnaire. Physicians recorded whether the visit was a bad news consultation or a routine follow-up. Survival was recorded until 1 April 2018. The study did not look at asbestos exposure. Results were adjusted for medical, social and psychological factors. Among patients receiving bad news, each one-point rise in the empathy score was linked to a 6% higher risk of death (hazard ratio 1.06, 95% confidence interval 1.01 to 1.12). In follow-up visits, perceived empathy was not linked to survival. The listening and compassion part of empathy showed the same pattern, but the active and positive part did not. Mesothelioma patients had a higher risk of death than patients with stage I to III lung cancer. The authors called the analyses exploratory and said further studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective, exploratory (post-hoc) survival analysis of data from an earlier questionnaire study, with patients followed for survival afterwards. Cox regression was used.
• Who was studied: 179 adult outpatients with thoracic cancer of any stage and a Karnofsky performance status of 60 or more, seen by five physicians in the thoracic cancer department of the University of Lille, France. They included 135 with non-small cell lung cancer, 10 with small cell lung cancer, 21 with mesothelioma and 13 with missing cancer type. Patients were enrolled from January 2015 and followed until 1 April 2018, with a median follow-up of 3.1 years. 79 had a bad news consultation and 100 a routine follow-up.
• Exposure: Not asbestos. The factor studied was patient-perceived physician empathy, measured with the 10-item CARE questionnaire. It was given as a general score and two sub-scores, listening/compassion and active/positive empathy, and compared across bad news versus follow-up consultations.
• Main results:
  • At censoring, 83 of the 179 patients (46.4%) were still alive. 88 (49.2%) had died and 8 had missing data.
  • In the adjusted model (n = 143), in bad news consultations each one-point increase in the general empathy score was associated with a 6% higher risk of death (hazard ratio 1.06, 95% CI 1.01–1.12, p = 0.024). The interaction between empathy and type of consultation was significant (p = 0.022).
  • In follow-up consultations, general empathy was not related to survival (hazard ratio 0.96 per point, 95% CI 0.90–1.03, p = 0.24).
  • Listening/compassion empathy in bad news consultations was associated with a higher risk of death (hazard ratio 1.13 per point, 95% CI 1.03–1.23, p = 0.008). The interaction with consultation type had p = 0.016.
  • In follow-up consultations, listening/compassion empathy was not associated with survival (hazard ratio 0.94 per point, p = 0.30).
  • Active/positive empathy did not interact with the type of consultation (p = 0.07). It was not associated with survival in either type of consultation.
  • Perceived empathy did not differ between bad news and follow-up consultations.
  • In the adjusted model, mesothelioma (no stage assigned) was associated with a higher risk of death than stage I, II or III lung cancer (hazard ratio 3.30, 95% CI 1.22–8.91, p = 0.018).
• The authors' conclusion: The authors concluded that, in bad news consultations, higher patient perception of physician listening and compassion empathy was associated with a higher risk of death in lung cancer patients. They suggested that high compassion might convey a loss of hope. They said further evidence is needed before firmer conclusions can be drawn.
• Limitations the authors state:
  • Mean perceived empathy in the sample was high, so the results need to be repeated in samples with lower empathy.
  • The sample was mostly male, and results may differ for female patients with other cancers.
  • Most patients had a low level of education.
  • Results could be the opposite for cancers with a better prognosis.
  • The analyses were exploratory and post-hoc, and physician empathy was measured only by patient report.
  • No sample size calculation was done for this analysis.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleural Mesothelioma, Performance Status, Hazard Ratio, confidence interval.

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