Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach

Objective The aim of the present cross-sectional study was to explore patient- and physician-specific determinants of physician empathy (PE) and to analyse the influence of PE on patient-reported long-term outcomes in German cancer patients. Methods A postal survey was administered to 710 cancer patients, who had been inpatients at the University Hospital Cologne (response rate 49.5%). PE was measured with the German translation of the consultation and relational empathy (CARE) measure, and patient-reported long-term outcomes were assessed using the major (ICD-10) depression inventory (MDI) and the EORTC quality of life (Qol) questionnaire QLQ-C30. Hypotheses were tested by structural equation modelling. Results PE had (a) a moderate indirect effect on “depression” and a smaller indirect effect on “socio-emotional-cognitive Qol” by affecting “desire for more information from the physician regarding findings and treatment options” and (b) a moderate indirect effect on “socio-emotional-cognitive Qol” and a smaller effect on “depression” via “desire for more information about health promotion”. The determinant with the greatest importance was “patient-perceived general busyness of hospital staff”: it had a strong negative influence on PE, indirectly influencing “desire for more information from the physician regarding findings and treatment options” and also patients’ “depression”. Conclusion PE seems to be an important pre-requisite for information giving by physicians and through this pathway having a preventive effect on depression and improving Qol. Conversely, physicians’ stress negatively influences these relationships. Practice implications The research findings suggest that reducing physicians’ stress at the organizational and individual may be required to enhance patient–physician communication. Empathy, as an outcome-relevant professional competence needs to be assessed and developed more intensively in medical students and physicians.