Empathy: An NP/MD comparison

Nurse Practitioner, Apr 2003 by Hojat, Mohammadreza, Fields, Sylvia K, Gonnella, Joseph S

Empathy in the context of health care delivery is defined as a cognitive (as opposed to affective) attribute that involves understanding the experiences and perspective of the patient, combined with the ability to communicate this understanding to the patient.1,2 This definition is based on descriptions in literature applicable to interpersonal exchanges between a clinician and her/his patient in the health care setting.3

Research has indicated that empathy can have a positive role in patient outcomes.4-6 Despite the importance of empathy as an essential component of patient-clinician relationships,4 empirical research is scarce among health professionals in general, and among NPs in particular. One reason is the lack of a psychometrically sound tool to operationally measure empathy in health care delivery situations. In response to this need, our research team has recently developed the Jefferson Scale of Physician Empathy (JSPE) for physicians and health care professionals.1,2,7-9

In previous studies using the JSPE, gender differences were observed on the mean empathy scores in favor of female medical students7,10 and female physicians.1,2 Also, significant differences on the mean empathy scores have been found among physicians in different specialty areas.1,2,11 In a previous study comparing physicians (42 female and 56 male physicians in general internal medicine) and registered nurses (n=56), we didn't find any significant difference in total empathy scores between the groups, but significant differences were observed among the groups on 7 (of 20) items of the JSPE.9

* Study Comparisons

This study compared the empathy scores of NPs with physicians, and is the first to compare the scores of physicians and NPs on an empathy scale developed specifically for health care professionals. Differences in empathy scores for female participants were examined to remove the confounding gender effect, based on findings in which gender differences on empathy scores were noticed.1,2,10

Study samples consisted of three groups: female NPs (n=32), female physicians practicing in pediatrics (n=37), and female physicians in hospital-base specialties (n=33) such as anesthesiology (n=16), radiology (n=14) and pathology (n=3).

The NPs were advanced practice nurse members and nonmembers of the Nurse Practitioner Council of Coastal Georgia attending the 6th Annual Nurse Practitioner Conference held March 2002 in Savannah. Ages ranged from 24 to 62 (mean= 47 years, SD = 7.7).

The participating physicians were in the Jefferson Health System affiliated with Thomas Jefferson University Hospital and Jefferson Medical College in the greater Philadelphia area. They were chosen from a larger sample of physicians who participated in a study on physician empathy.1,2,11 Only pediatricians and physicians in the hospitalbased specialties were chosen because these were the only specialties for which data on empathy scores for more than 30 female physicians were available (comparable to the sample size of NPs). Pediatricians' ages ranged from 30 to 62 (mean= 42 years, SD =8.1), and the hospital-based physicians' ages ranged from 32 to 58 (mean=46 years, SD =7.6).

Research Instrument

Psychometric data in support of the construct and criterion-related validities (convergent and discriminant) and reliability (coefficient alpha and test-retest) for medical students (n=193), internal medicine residents (n=41), and physicians (n=704) have been reported.1,2,7

Convergent validity was confirmed by significant correlations (p

The coefficient alpha, an indicator of the internal consistency reliability aspect of the scale was over 0.80 for samples of medical students, medical residents, and practicing physicians.1,7 Coefficient alpha for the NP sample in this study is 0.85. An alpha coefficient of this magnitude indicates that the JSPE is a reliable measure for NPs.

A sample item of the JSPE with the highest item total score correlation (r=0.60)^sup 2^ is : "I try to imagine myself in my patients' shoes when providing care to them:' A sample item with the lowest item-total score correlation (r=.30)^sup 2^ is: "My understanding of how my patients and their families feel is an irrelevant factor in medical treatment (reverse scored item)."

The JSPE scores have been proven to be significantly correlated with clinical competence ratings (high scorers rated more clinically competent).10 Physicians in people-oriented specialties (e.g., family medicine, internal medicine, pediatrics) scored higher than those in technology-oriented specialties (anesthesiology, radiology, surgery) specialties on the JSPE,1,2,11 and psychiatrists scored higher than surgeons.1

* Study Results

Results of analysis of variance indicate significant differences among the three groups (F^sub (2,99)^ =2.98, p=.05)(see Table: "Statistical Analysis Results of JSPE"). The Duncan post hoc mean comparison test showed that the NPs and pediatricians obtained a significantly higher mean empathy score than the hospital-based physicians. The pattern of findings remained unchanged when the effect of age was controlled by using the analysis of covariance approach (age as a covariate, adjusted F^sub (3,91)^ = 2.94).