Patient perspectives of empathic and positive communication for osteoarthritis in Primary Care: an analogue study

Problem

Research has shown that empathic and positive communication can reduce pain, increase quality of life, and improve satisfaction with care for patients with osteoarthritis. However, there is limited understanding about patient’s views and insights into empathic and optimistic communication in a primary care consultation. This analogue study is part of Empathica; a SPCR-funded programme of work developing brief training for primary care practitioners in empathic and optimistic communication.

Approach

We developed and filmed two primary care consultations for osteoarthritis (OA); one enacting the Empathica-trained approach which incorporated examples of evidence-based verbal and non-verbal behaviours, and the other enacting a ‘neutral’ or normal-styled consultation. A purposively-varied sample of 15 OA patients watched the two filmed consultations in random order. After each consultation, patients rated the GP’s clinical empathy using a modified Consultation and Relational Empathy (CARE) measure and took part in a semi-structured interview. Descriptive statistics were used to present the questionnaire data. Interviews were transcribed verbatim and were analysed using thematic analysis. NVIVO was used to manage the data.

Findings

Participants rated the Empathica-style consultation generally more positively than the neutral consultation (mean CARE measure 42.93 vs 16.67). With the Empathica-style consultation, patients identified key elements considered to enhance the interaction including the GP showing care and respect; demonstrating knowledge of the patient; active listening; being encouraging and positive; open body language and good eye contact. Key elements of the neutral consultation that patients thought impaired the consultation included the GP not showing she was listening; being dismissive of patient’s concerns; lack of clarity about likely outcomes. Participants reported that the patient appeared more satisfied with the Empathica-style consultation and considered them more likely to engage in the management plan. However, participants could perceive little difference in GP satisfaction between the two consultations.

Consequences

These findings highlight elements of 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 can 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.