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

Patient Educ Couns. 2007 Dec;69(1-3):63-75. doi: 10.1016/j.pec.2007.07.003. Epub 2007 Sep 11.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Attitude of Health Personnel
  • Attitude to Health*
  • Communication
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Depression / etiology
  • Depression / psychology
  • Empathy*
  • Factor Analysis, Statistical
  • Female
  • Germany
  • Hospitals, University
  • Humans
  • Male
  • Medical Oncology / organization & administration*
  • Middle Aged
  • Models, Statistical*
  • Neoplasms / complications
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Outcome Assessment, Health Care
  • Patient-Centered Care
  • Physician-Patient Relations*
  • Quality of Life / psychology
  • Retrospective Studies
  • Social Support
  • Surveys and Questionnaires