Empathy in healthcare settings

................................................................................................................ 10 Chapter 1 Introduction ......................................................................................... 12 1.1. Patient satisfaction ................................................................................... 13 1.2. Patient adherence to treatment ................................................................. 14 1.3. Improved health outcomes ....................................................................... 15 1.4. Professional satisfaction ........................................................................... 16 1.5. Sustaining and developing empathy ......................................................... 17 Chapter 2 Literature Review ................................................................................ 20 2.1 Empathy: An Overview ........................................................................... 20 2.2 Defining empathy .................................................................................... 21 2.2.1 An emotional dimension of empathy ................................................. 21 2.2.2 A cognitive dimension of empathy .................................................... 24 2.2.3 A moral dimension of empathy ......................................................... 26 2.2.4 A behavioural dimension of empathy ................................................ 28 2.3 Multidimensional models of empathy in healthcare .................................. 29 2.3.1 The multidimensional model of medical empathy (Squier, 1990) ...... 30 2.3.2 The Multidimensional Model of Empathy (Davis, 1983) ................... 32 2.3.3 Process model of clinical empathy (Larson & Yao, 2005) ................. 38 2.4 Models of empathy: limitations and next steps ......................................... 40 Chapter 3. Measures of empathy ............................................................................ 42 3.1. Reliability and validity ............................................................................. 42 3.2. An overview of empathy scales ................................................................ 44 3.2.1. Empathy Construct Rating Scale (ECRS) .......................................... 45 3.2.2. The Barrett-Lennard Relation Inventory (BLRI) ............................... 47 3.2.3. Jefferson Scale of Physician Empathy (JSPE) ................................... 49 3.2.4. The Reynolds Empathy Scale ........................................................... 51 3.2.5. The CARE Measure .......................................................................... 53 3.2.6. Hogan’s Empathy Scale .................................................................... 55 3.2.7. The Questionnaire Measure of Emotional Empathy .......................... 56 3.2.8. The Interpersonal Reactivity Index ................................................... 57 3.3. Summary of empathy measures ............................................................... 59 3.4. Overview of Thesis and Research Questions ............................................ 64 Chapter 4 – Individual differences and empathy: Personality and the IRI ............... 68 4.1. The Five Factor Model (FFM) of Personality ........................................... 68 4.2. Construct validity .................................................................................... 73 4.3. Method .................................................................................................... 74 4.3.1 Participants and Procedure ................................................................ 74 4.3.2 Measures .......................................................................................... 74 4.3.3 Analysis ............................................................................................ 77 4.4. Results ..................................................................................................... 77 4.4.1 Correlations ...................................................................................... 79 4.4.2 Joint factor analysis .......................................................................... 80 4.5. Discussion ............................................................................................... 86 4.5.1 Perspective Taking and Empathic Concern ....................................... 88 4.5.2 Personal Distress .............................................................................. 90 4.5.3 Fantasy ............................................................................................. 90 4.5.4 Limitations and next steps................................................................. 92 Chapter 5 – Emotional intelligence and empathy .................................................... 93 5.1 Emotional Intelligence ............................................................................. 94 5.2 Empathy and Emotional Intelligence ........................................................ 96 5.3 Method .................................................................................................. 101 5.3.1 Participants ..................................................................................... 101 5.3.2 Procedure and Measures ................................................................. 102 5.4 Results ................................................................................................... 108 5.4.1 Correlations .................................................................................... 109 5.4.2 Joint factor analysis ........................................................................ 111 5.5 Discussion ............................................................................................. 113 5.5.1 Perspective Taking and Empathic Concern ..................................... 113 5.5.2 Personal Distress ............................................................................ 114 5.5.3 Fantasy ........................................................................................... 115 5.5.4 Limitations ..................................................................................... 116 5.5.5 Summary and next steps ................................................................. 116 Chapter 6 – Self-report empathy and other-rated empathic behaviour ................... 118 6.1 Empathy and behaviour ......................................................................... 118 6.2 Criterion-related validation .................................................................... 121 6.3 Method .................................................................................................. 125 6.3.1 Context and participants ................................................................. 125 6.3.2 Measures ........................................................................................ 127 6.4 Results ................................................................................................... 132 6.4.1 Correlations .................................................................................... 134 6.4.2 Cultural differences: comparing groups .......................................... 137 6.4.3 Correlations by group ..................................................................... 141 6.5 Discussion ............................................................................................. 146 6.5.1 Empathy and behaviour .................................................................. 148 6.5.2 Empathy and culture ....................................................................... 149 6.5.3 Limitations ..................................................................................... 151 6.5.4 Summary and next steps ................................................................. 153 Chapter 7 Empathy from the patient perspective ................................................ 154 7.1 The patient perspective: judgements of empathy .................................... 155 7.2 Empathy and behaviour ......................................................................... 157 7.3 Antecedents: situational characteristics .................................................. 158 7.4 Quantitative and qualitative methods ..................................................... 158 7.5 Method .................................................................................................. 161 7.5.1 Participants ..................................................................................... 161 7.5.2 Procedure ....................................................................................... 161 7.5.3 Analysis .......................................................................................... 162 7.6 Findings and Discussion ........................................................................ 169 7.6.1 Interpersonal Processes ................................................................... 170 7.6.2 Antecedents of empathy .................................................................. 175 7.6.3 Other areas of the template ............................................................. 179 7.6.4 Reflections and limitations .............................................................. 182 7.6.5 Summary ........................................................................................ 183 Chapter 8: Concluding discussion ........................................................................ 184 8.1 Summary of the findings ........................................................................ 184 8.2 Implications for theory ........................................................................... 187 8.3 Implications for practice ........................................................................ 189 8.4 Future research ...................................................................................... 191 8.5 Closing points ........................................................................................ 191 References ........................................................................................................... 193 Appendix 1: Development of Research ................................................................ 219 Appendix 2: The Interpersonal Reactivity Index .................................................. 221 Appendix 3: Information Sheet (doctors) ............................................................. 223 Appendix 4: Consent Form (doctors) ................................................................... 224 Appendix 5: Factor loadings for the Bar On EQ-i items ....................................... 225 Appendix 6: Information sheet (patients) ............................................................. 228 Appendix 7: Consent form (patients) .................................................................... 230 Appendix 8: Study four interview schedule .......................................................... 231 Appendix 9: Coded Interview .............................................................................. 232