Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial
Abstract
:1. Introduction
2. Experimental Section
2.1. Participants
2.2. Design and Procedure
2.3. Measures
2.4. Statistical Analyses
3. Results
3.1. Descriptive Statistics
3.2. Prediction of Survival with the General Score of Empathy
3.3. Prediction of Survival by Distinguishing the Two Types of Empathy
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Characteristics | Follow-Up Consultations | Bad-News Consultations | p Value | ||||
---|---|---|---|---|---|---|---|
Number of Patients | % | Mean (Standard Deviation, SD) | Number of Patients | % | Mean (SD) | ||
Patients (n = 179) | |||||||
Sociodemographic data | |||||||
Age | 63.4 (11.9) | 63.4 (10.5) | 0.99 | ||||
Men | 67 | 66.3 | 54 | 69.2 | 0.68 | ||
Married or in a relationship (Yes) | 82 | 81.2 | 53 | 69.7 | 0.08 | ||
Patient-reported education | 0.67 | ||||||
No diploma | 22 | 21.8 | 17 | 21.8 | |||
High school | 49 | 48.5 | 41 | 52.6 | |||
Bachelor degree | 18 | 17.8 | 15 | 19.2 | |||
More than bachelor degree | 12 | 11.9 | 5 | 6.4 | |||
Patient-reported financial situation | 0.86 | ||||||
Not at all or not very comfortable | 17 | 16.8 | 11 | 14.1 | |||
Moderately comfortable | 55 | 54.5 | 45 | 57.7 | |||
Rather or very comfortable | 29 | 28.7 | 22 | 28.2 | |||
Medical data | |||||||
Type and severity of cancer | <0.0001 | ||||||
Stage I, II or III (NSCL or SCL) | 62 | 61.4 | 22 | 28.2 | |||
Stage IV (NSCL or SCL) | 22 | 21.8 | 34 | 43.6 | |||
Mesothelioma (no stage assigned) | 8 | 7.9 | 13 | 16.7 | |||
Missing data | 9 | 8.9 | 9 | 11.5 | |||
Smoker | 0.12 | ||||||
Never | 12 | 11.9 | 12 | 15.4 | |||
Ever | 71 | 70.3 | 85 | 44.8 | |||
Missing data | 18 | 17.8 | 31 | 39.7 | |||
Time since diagnosis and inclusion in the study (years) | 2.5 (2.4) | 2.4 (1.9) | 0.64 | ||||
Karnofsky index | 0.76 | ||||||
60–70 | 5 | 4.9 | 3 | 3.9 | |||
>70 | 54 | 93.1 | 71 | 91.0 | |||
Missing data | 2 | 2.0 | 4 | 5.1 | |||
Metastasis | 17 | 16.8 | 34 | 43.6 | <0.0001 | ||
Treatment before inclusion | |||||||
Chemotherapy | 57 | 56.4 | 62 | 79.5 | 0.0012 | ||
Surgery | 60 | 59.4 | 22 | 28.2 | <0.0001 | ||
Radiotherapy | 47 | 46.5 | 24 | 30.8 | 0.0325 | ||
Targeted therapies | 5 | 5.1 | 9 | 11.7 | 0.10 | ||
Treatment after inclusion | |||||||
Surgery | 6 | 5.9 | 2 | 2.6 | 0.28 | ||
Chemotherapy | 31 | 30.7 | 49 | 62.8 | <0.0001 | ||
Radiotherapy | 16 | 15.9 | 22 | 28.2 | 0.04 | ||
Targeted therapies | 12 | 11.9 | 19 | 24.4 | 0.03 | ||
Immunotherapy | 11 | 10.9 | 25 | 32.1 | 0.0005 | ||
No further treatment | 49 | 48.5 | 11 | 14.1 | <0.0001 | ||
Charlson index of comorbidities | 7.6 (2.7) | 8.5 (2.2) | 0.03 | ||||
Genetic mutation: EGFR or ALK or ROS (%) | 8 | 7.9 | 12 | 15.4 | 0.12 | ||
Deceased at censoring | 36 | 35.6 | 52 | 66.7 | <0.0001 | ||
Psychological data | |||||||
Cancer-related emotional distress | 7.7 (5.5) | 9.6 (4.7) | 0.02 | ||||
Patient emotional skills | 3.3 (0.6) | 3.3 (0.5) | 0.66 | ||||
Patient-reported physician empathy | 43.7 (6.7) | 42.5 (7.1) | 0.23 |
Characteristics | Low Patient-Reported Physician Empathy (≤45) | High Patient-Reported Physician Empathy (>45) | p Value | ||||
---|---|---|---|---|---|---|---|
Number of Patients | % | Mean (Standard Deviation, SD) | Number of Patients | % | Mean (SD) | ||
Patients (n = 179) | |||||||
Sociodemographic data | |||||||
Age | 64.1 (12.4) | 62.9 (10.3) | 0.50 | ||||
Men | 67 | 74.4 | 53 | 60.2 | 0.04 | ||
Married or in a relationship (Yes) | 64 | 72.7 | 70 | 79.6 | 0.29 | ||
Education | 0.43 | ||||||
No diploma | 24 | 26.7 | 15 | 17.1 | |||
High school | 44 | 48.9 | 46 | 52.3 | |||
Bachelor degree | 15 | 16.7 | 17 | 19.3 | |||
More than bachelor degree | 7 | 7.8 | 10 | 11.4 | |||
Financial ease | 0.09 | ||||||
Not at all or not very comfortable | 13 | 14.4 | 15 | 17.1 | |||
Moderately comfortable | 57 | 63.3 | 42 | 47.7 | |||
Rather or very comfortable | 20 | 22.2 | 31 | 35.2 | |||
Medical data | |||||||
Type and severity of cancer | 0.71 | ||||||
Stage I, II or III (NSCL or SCL) | 44 | 48.9 | 40 | 45.5 | |||
Stage IV (NSCL or SCL) | 26 | 28.9 | 29 | 33.0 | |||
Mesothelioma (no stage assigned) | 12 | 13.3 | 9 | 10.2 | |||
Missing data | 8 | 8.9 | 10 | 11.4 | |||
Smoker | 0.83 | ||||||
Never | 12 | 13.3 | 12 | 13.6 | |||
Ever | 50 | 55.6 | 55 | 62.5 | |||
Missing data | 28 | 31.1 | 21 | 23.4 | |||
Time since diagnosis and inclusion in the study (years) | 2.3 (1.9) | 2.5 (2.3) | 0.57 | ||||
Karnofsky index | 0.18 | ||||||
60–70 | 6 | 6.7 | 2 | 2.3 | |||
>70 | 83 | 92.2 | 81 | 92.1 | |||
Missing data | 1 | 1.1 | 5 | 5.7 | |||
Metastasis | 23 | 26.7 | 27 | 31.0 | 0.53 | ||
Treatment before inclusion | |||||||
Chemotherapy | 57 | 63.3 | 61 | 69.3 | 0.40 | ||
Surgery | 39 | 43.3 | 43 | 48.9 | 0.46 | ||
Radiotherapy | 36 | 40.0 | 34 | 38.6 | 0.85 | ||
Targeted therapies | 7 | 7.8 | 7 | 8.1 | 0.95 | ||
Treatment after inclusion | |||||||
Surgery | 4 | 4.4 | 4 | 4.5 | 0.97 | ||
Chemotherapy | 44 | 48.9 | 35 | 39.8 | 0.22 | ||
Radiotherapy | 23 | 25.6 | 15 | 17.5 | 0.17 | ||
Targeted therapies | 15 | 16.7 | 16 | 18.2 | 0.79 | ||
Immunotherapy | 19 | 21.1 | 17 | 19.3 | 0.77 | ||
No further treatment | 27 | 30.0 | 33 | 37.5 | 0.29 | ||
Charlson index of comorbidities | 8.2 (2.5) | 7.7 (2.6) | 0.29 | ||||
Genetic mutation: EGFR or ALK or ROS (%) | 10 | 11.1 | 10 | 11.4 | 0.12 | ||
Deceased at censoring | 45 | 50.6 | 42 | 51.9 | 0.87 | ||
Psychological data | |||||||
Cancer-related emotional distress | 9.7 (5.1) | 7.5 (5.1) | 0.006 | ||||
Patient emotional skills | 3.2 (0.4) | 3.5 (0.6) | 0.005 | ||||
Patient-reported physician empathy | 37.1 (5.0) | 48.6 (1.7) | 0.001 |
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Characteristics | Number of Patients | % | Mean (Standard Deviation) (Range) |
---|---|---|---|
Patients (n = 179) | |||
Sociodemographic data | |||
Age | 63.4 (11.3) (24–85) | ||
Men | 121 | 67.6 | |
In a relationship or married (Yes) | 135 | 76.2 | |
Patient-reported education | |||
No diploma | 39 | 21.8 | |
High school | 90 | 50.3 | |
Bachelor degree | 33 | 18.4 | |
More than bachelor degree | 17 | 9.5 | |
Patient-reported financial situation | |||
Not at all or not very comfortable | 28 | 15.6 | |
Moderately comfortable | 100 | 55.9 | |
Rather or very comfortable | 51 | 28.5 | |
Medical data | |||
Type of cancer | |||
Non-small cell lung cancer (NSCL) | 135 | 75.4 | |
Small cell lung cancer (SCL) | 10 | 5.6 | |
Mesothelioma | 21 | 11.7 | |
Missing data | 13 | 7.3 | |
Cancer stage | |||
Stage I, II or III (NSCL or SCL) | 84 | 46.9 | |
Stage IV (NSCL or SCL) | 56 | 31.3 | |
Mesothelioma (no stage assigned) | 21 | 11.7 | |
Missing data | 18 | 10.1 | |
Smoker | |||
Never | 24 | 13.4 | |
Ever | 106 | 59.2 | |
Missing data | 49 | 27.4 | |
Time since diagnosis and inclusion in the study (years) | 2.5 (2.2) (0.1–14.4) | ||
Karnofsky index | |||
60–70 | 8 | 4.5 | |
80 | 20 | 11.2 | |
90 | 56 | 31.2 | |
100 | 89 | 19.7 | |
Missing data | 6 | 3.3 | |
Metastasis | 51 | 28.5 | |
Treatment before inclusion | |||
Surgery | 82 | 45.9 | |
Chemotherapy | 119 | 66.5 | |
Radiotherapy | 71 | 39.7 | |
Targeted therapies | 14 | 7.8 | |
Treatment after inclusion | |||
Surgery | 8 | 4.5 | |
Chemotherapy | 80 | 44.7 | |
Radiotherapy | 38 | 21.2 | |
Targeted therapies | 31 | 17.3 | |
Immunotherapy | 36 | 20.1 | |
No further treatment | 60 | 33.5 | |
Charlson index of comorbidities | 8.0 (2.6) (0–16) | ||
Genetic mutation: EGFR or ALK or ROS (%) | 20 | 11.2 | |
Type of consultation | |||
Routine follow-up | 100 | 55.9 | |
Bad news | 79 | 43.0 | |
Change of treatment because of treatment failure % | 69 | 38.6 | |
Relapse or end of active treatment | 8 | 4.5 | |
Missing data | 2 | 1.1 | |
Deceased at censorship | |||
Yes | 88 | 49.2 | |
No | 83 | 46.4 | |
Missing data | 8 | 4.4 | |
Psychological data | |||
Cancer-related emotional distress | 8.5 (5.2) (0–24) | ||
Patient emotional skills | 3.4 (0.5) (1.9–4.8) | ||
Patient-reported physician empathy | 43.2 (6.8) (22–50) | ||
Physicians (n = 5) | |||
Age | 35.8 (5.85) (33–48) | ||
Men | 50 |
Variable | HR | 95% CI | p Value |
---|---|---|---|
Sociodemographic data | |||
Age | 1.02 | 1.01–1.04 | 0.015 |
Woman | 0.51 | 0.30–0.84 | 0.009 |
In a relationship or married (Yes) | 0.88 | 0.52–1.47 | 0.62 |
Patient-reported Education | |||
Overall | 0.49 | ||
No diploma | 1.97 | 0.79–4.92 | 0.15 |
High school | 1.47 | 0.63–3.46 | 0.37 |
Bachelor degree | 1.58 | 0.62–4.00 | 0.34 |
More than bachelor degree (reference category) | |||
Patient-reported financial situation % | |||
Overall | 0.25 | ||
Not at all or not very comfortable | 0.55 | 0.27–1.12 | 0.10 |
Moderately comfortable | 0.84 | 0.53–1.32 | 0.44 |
Rather or very comfortable (reference category) | |||
Medical data | |||
Type and severity of cancer | <0.0001 | ||
Stage I, II or III (NSCL or SCL) (reference category) | |||
Stage IV (NSCL or SCL) | 2.48 | 1.51–4.05 | 0.0003 |
Mesothelioma (no stage assigned) | 3.36 | 1.81–6.23 | 0.0001 |
Smoker (ever) | 0.89 | 0.45–1.78 | 0.75 |
Time since diagnosis and inclusion in the study (years) | 0.96 | 0.87–1.07 | 0.46 |
Karnofsky index (60–70 compared to higher) | 2.11 | 0.92–4.85 | 0.08 |
Metastasis % | 1.63 | 1.04–2.56 | 0.03 |
Treatment before inclusion % | |||
Chemotherapy | 1.78 | 1.06–2.90 | 0.02 |
Surgery | 0.34 | 0.21–0.54 | <0.0001 |
Radiotherapy | 0.95 | 0.62–1.45 | 0.80 |
Targeted therapies | 1.83 | 0.92–3.64 | 0.09 |
Treatment after inclusion % | |||
Surgery | 0.17 | 0.02–1.25 | 0.08 |
Chemotherapy | 2.18 | 1.41–3.37 | 0.0005 |
Radiotherapy | 0.65 | 0.38–1.13 | 0.13 |
Targeted therapies | 1.56 | 0.95–2.54 | 0.08 |
Immunotherapy | 1.59 | 0.99–2.55 | 0.06 |
No further treatment | 0.48 | 0.29–0.81 | 0.006 |
Charlson index of comorbidities | 1.19 | 1.09–1.31 | <0.0001 |
Genetic mutation: EGFR or ALK or ROS (%) | 1.22 | 0.67–2.25 | 0.52 |
Psychological data | |||
Cancer-related emotional distress | 1.05 | 1.01–1.09 | 0.01 |
Patient emotional skills | 0.87 | 0.59–1.29 | 0.48 |
Patient-reported physician empathy | 0.99 | 0.97–1.03 | 0.87 |
Variable | Hazard Ratio | 95% CI | p Value |
---|---|---|---|
Age | 1.04 | 1.00–1.07 | 0.029 |
Woman | 0.48 | 0.26–0.89 | 0.019 |
Patient-reported education | |||
No diploma (reference) | |||
High school | 0.42 | 0.22–0.81 | 0.009 |
Bachelor degree | 0.41 | 0.16–1.06 | 0.07 |
>Bachelor | 0.50 | 0.14–1.70 | 0.26 |
Patient-reported financial situation | |||
Not at all or not very comfortable (reference) | |||
Moderately comfortable | 1.42 | 0.58–3.45 | 0.44 |
Rather or very comfortable | 1.27 | 0.46–3.57 | 0.65 |
Type and severity of cancer | |||
Stage I, II or III (NSCL or SCL) (reference category) | |||
Stage IV (NSCL or SCL) | 3.14 | 1.22–8.09 | 0.018 |
Mesothelioma (no stage assigned) | 3.30 | 1.22–8.91 | 0.018 |
Karnofsky index 60–70 (compared to >70) | 2.53 | 0.84–7.59 | 0.10 |
Time since diagnosis and inclusion in the study | 0.98 | 0.84–1.14 | 0.75 |
Charlson index of comorbidities | 1.02 | 0.88–1.17 | 0.80 |
Mutation (ALK, EGFR, ROS vs. none of them) | 1.40 | 0.64–3.06 | 0.40 |
Metastases | 0.92 | 0.38–2.25 | 0.85 |
Cancer-related emotional distress | 1.06 | 1.01–1.12 | 0.03 |
Emotional skills | 1.57 | 0.87–2.85 | 0.14 |
Patient-reported physician empathy | - | - | - |
Type of consultation (bad news vs. follow-up) | - | - | - |
Empathy * type-of-consultation (interaction) | 0.022 | ||
Empathy in bad news consultations | 1.06 | 1.01–1.12 | 0.024 |
Empathy in follow-up consultations | 0.96 | 0.90–1.03 | 0.24 |
Variable | Hazard Ratio | 95% CI | p Value |
---|---|---|---|
Model A | |||
Compassion/listening empathy * type-of-consultation (interaction) | - | - | 0.016 |
Compassion/listening in bad news consultations | 1.13 | 1.03–1.23 | 0.008 |
Compassion/listening in follow-up consultations | 0.94 | 0.85–1.05 | 0.300 |
Model B | |||
Active/positive empathy * type-of-consultation (interaction) | - | - | 0.07 |
Active/positive in bad news consultations | 1.10 | 0.96–1.26 | 0.16 |
Active/positive in follow-up consultations | 0.92 | 0.79–1.06 | 0.25 |
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Lelorain, S.; Cortot, A.; Christophe, V.; Pinçon, C.; Gidron, Y. Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial. J. Clin. Med. 2018, 7, 364. https://doi.org/10.3390/jcm7100364
Lelorain S, Cortot A, Christophe V, Pinçon C, Gidron Y. Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial. Journal of Clinical Medicine. 2018; 7(10):364. https://doi.org/10.3390/jcm7100364
Chicago/Turabian StyleLelorain, Sophie, Alexis Cortot, Véronique Christophe, Claire Pinçon, and Yori Gidron. 2018. "Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial" Journal of Clinical Medicine 7, no. 10: 364. https://doi.org/10.3390/jcm7100364