Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study

Intensive Care Med. 2019 Jun;45(6):815-822. doi: 10.1007/s00134-019-05601-5. Epub 2019 Mar 25.


Purpose: We tested the hypothesis that, during a life-threatening medical emergency, patient perception of healthcare provider (HCP) compassion is associated with the subsequent development of post-traumatic stress disorder (PTSD) symptoms.

Methods: Prospective cohort study in the emergency department (ED) of an urban academic medical center. We included adult patients presenting with a life-threatening medical emergency, defined as respiratory or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. We measured patient perception of HCP compassion in the ED using the Consultation and Relational Empathy (CARE) measure, a validated 40-point scale. Blinded to clinical outcomes (including the CARE measure), we assessed PTSD symptoms 1 month post-discharge using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5.

Results: Of the 99/113 (88%) patients who completed follow-up, 25% (95% CI 17-35%) had PTSD symptoms at 1 month. In a multivariable model adjusting for potential confounders (e.g. severity of illness score in ED, need for intensive care unit admission, ED overcrowding, and family member emotional support in the ED), patient perception of greater HCP compassion in the ED was independently associated with lower PTSD symptoms at 1 month [odds ratio 0.93 (95% CI 0.89-0.98)]. A one-point increase in the CARE measure was associated with a 7% decrease in the odds of developing PTSD symptoms.

Conclusions: PTSD symptoms are common among ED patients with life-threatening medical emergencies. Patient perception of greater HCP compassion during the emergency is independently associated with lower risk of developing PTSD symptoms.

Keywords: Compassion; Empathy; PTSD; Post-traumatic stress disorder.

MeSH terms

  • Academic Medical Centers / organization & administration
  • Academic Medical Centers / statistics & numerical data
  • Adult
  • Aged
  • Cohort Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Empathy*
  • Female
  • Health Personnel / psychology*
  • Health Personnel / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • Psychometrics / instrumentation
  • Psychometrics / methods
  • Risk Factors
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / classification*
  • Stress Disorders, Post-Traumatic / psychology