Exploring patient views of empathic optimistic communication for osteoarthritis in primary care.

Talk Code: 
R.6
Presenter: 
Emily Lyness
Co-authors: 
Jane Vennik, Felicity L Bishop, Kirsten A Smith, Mary Steele, Stephanie Hughes, Leanne Morrison, Mohana Ratnapalan, Jennifer Bostock, Christian Mallen, Geraldine Leydon, Jeremy Howick, Lucy Yardley, Paul Little, Hazel Everitt.
Author institutions: 
The University of Southampton, The University of Oxford, The University of Keele

Problem

Osteoarthritis (OA), a common primary care presentation, causes pain and can significantly impact quality of life. Clinical research shows that an empathic consultation approach can improve patient quality of life and satisfaction with care. Experimental studies have also demonstrated optimistic communication which conveys a positive message about treatment effects, can reduce patient experience of pain. However, there is limited understanding about patients’ views on these approaches. Empathica is an SPCR project developing a digital intervention to enhance practitioner skills in communicating empathy and realistic optimism. Associated with this, we sought to explore patients’ views on empathy and realistic optimism in primary care consultations.

Approach

Thirty-three purposively sampled patients, aged 45+ with hip or knee OA from primary care practices in Wessex participated in a semi-structured interviews, using stimuli to elicit patients’ perspectives on Empathica-style consultations. Fifteen participants watched two filmed consultations in randomised order, one enacting the ‘Empathica-trained’ approach incorporating evidence-based verbal and non-verbal behaviours, and the other a ‘neutral’ consultation. They rated each one in turn on a modified Consultation and Relational Empathy (CARE) scale and then answered a series of open-ended questions about the films. Eighteen participants read two written vignettes in a randomised order. One used positive messages and phrases whilst the other used neutral messages and phrases. Participants then answered a series of open-ended questions about the vignettes and positive messaging in primary care consultations more broadly. Questionnaire data were analysed descriptively. Interviews were transcribed verbatim and analysed using thematic analysis.

Findings

Participants rated the Empathica-style consultation video more highly (mean CARE 43 vs 17) demonstrating enhance empathy compared to the neutral consultation. Participants felt the following GP behaviours enhanced the interaction; showing care and respect, demonstrating knowledge of the patient, active listening, open body language and good eye contact. Participants identified important components of the positive communication approach, which included providing a clear rationale for management advice using evidence and reinforcement of the message. They felt effective delivery of a positive message in the consultation required the GP to communication with empathy in order to reassure the patient that the positive message was credible and trustworthy. There was, however, some scepticism as to whether this approach is achievable in the time and resource constrained environment of NHS primary care.

Consequences

These findings highlight components of verbal and non-verbal empathic and optimistic communication that are acceptable to patients and could enhance the primary care consultation for OA. It is important to identify key elements that primary care practitioners could include without adding time to the consultation. These results have informed development of the Empathica intervention which aims to enhance practitioner empathic communication, and ultimately improve levels of OA pain and quality of life for patients.

Submitted by: 
Emily Lyness
Funding acknowledgement: 
The EMPATHICA trial is supported by a National Institute for Health Research (NIHR) School for Primary Care Research grant (project number 389). The Primary Care Department is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. HDM is funded through an NIHR Clinical Lectureship. CDM is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and social care.