Patient Perception of Physician Compassion After a More Optimistic vs a Less Optimistic Message: A Randomized Clinical Trial | Oncology | JAMA Oncology | JAMA Network
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Original Investigation
May 2015

Patient Perception of Physician Compassion After a More Optimistic vs a Less Optimistic Message: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
  • 2Clinique La Chavannerie, Groupe Orpea, Chaponost, France
  • 3Laboratoire EA 4129, Santé-Individu-Société, Université Lyon 1, Lyon, France
  • 4Programa Medicina Paliativa, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
  • 5Palliative Care Unit-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
  • 6Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
  • 7Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
  • 8Research Medical Library, University of Texas MD Anderson Cancer Center, Houston
JAMA Oncol. 2015;1(2):176-183. doi:10.1001/jamaoncol.2014.297
Abstract

Importance  Information regarding treatment options and prognosis is essential for patient decision making. Patient perception of physicians as being less compassionate when they deliver bad news might be a contributor to physicians’ reluctance in delivering these types of communication.

Objective  To compare patients’ perception of physician compassion after watching video vignettes of 2 physicians conveying a more optimistic vs a less optimistic message, determine patients’ physician preference after watching both videos, and establish demographic and clinical predictors of compassion.

Design, Setting, and Participants  Randomized clinical trial at an outpatient supportive care center in a cancer center in Houston, Texas, including English-speaking adult patients with advanced cancer who were able to understand the nature of the study and complete the consent process. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the videos observed by the patient.

Intervention  One hundred patients were randomized to observe 2 standardized, roughly 4-minute videos depicting a physician discussing treatment information (more optimistic message vs less optimistic message) with a patient with advanced cancer. Both physicians made an identical number of empathetic statements (5) and displayed identical posture. After viewing each video, patients completed assessments including the Physician Compassion Questionnaire (0 = best, 50 = worst).

Main Outcomes and Measures  Patients’ perception of physician compassion after being exposed to a more optimistic vs an equally empathetic but less optimistic message.

Results  Patients reported significantly better compassion scores after watching the more optimistic video as compared with the less optimistic video (median [interquartile range], 15 [5-23] vs 23 [10-31]; P < .001). There was a sequence effect favoring the second video on both compassion scores (P < .001) and physician preference (P < .001). Higher perception of compassion was found to be associated with greater trust in the medical profession independent of message type: 63 patients observing the more optimistic message ranked the physician as trustworthy vs 39 after the less optimistic message (P = .03).

Conclusions and Relevance  Patients perceived a higher level of compassion and preferred physicians who provided a more optimistic message. More research is needed in structuring less optimistic message content to support health care professionals in delivering less optimistic news.

Trial Registration  clinicaltrials.gov Identifier: NCT02357108

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