Empathy and Life Support Decisions in Intensive Care Units
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Although experts advocate that physicians should express empathy to support family members faced with difficult end-of-life decisions for incapacitated patients, it is unknown whether and how this occurs in practice.
To determine whether clinicians express empathy during deliberations with families about limiting life support, to develop a framework to understand these expressions of empathy, and to determine whether there is an association between more empathic statements by clinicians and family satisfaction with communication.
Multi-center, prospective study of audiotaped physician-family conferences in intensive care units of four hospitals in 2000–2002.
We audiotaped 51 clinician-family conferences that addressed end-of-life decisions. We coded the transcripts to identify empathic statements and used constant comparative methods to categorize the types of empathic statements. We used generalized estimating equations to determine the association between empathic statements and family satisfaction with communication.
There was at least one empathic statement in 66% (34/51) of conferences with a mean of 1.6 ± 1.6 empathic statements per conference (range 0–8). We identified three main types of empathic statements: statements about the difficulty of having a critically ill loved one (31% of conferences), statements about the difficulty of surrogate decision-making (43% of conferences), and statements about the difficulty of confronting death (27% of conferences). Only 30% of empathic statements were in response to an explicit expression of emotion by family members. There was a significant association between more empathic statements and higher family satisfaction with communication (p = 0.04).
Physicians vary considerably in the extent to which they express empathy to surrogates during deliberations about life support, with no empathic statements in one-third of conferences. There is an association between more empathic statements and higher family satisfaction with communication.
- Prendergast TJ, Luce JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med. 1997;155(1):15–20, Jan.
- Braun UK, Beyth RJ, Ford ME, McCullough LB. Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making. J Gen Intern Med. 2008;23(3):267–274, Mar. CrossRef
- Tilden VP, Tolle SW, Garland MJ, Nelson CA. Decisions about life-sustaining treatment. Impact of physicians’ behaviors on the family. Arch Intern Med. 1995;155(6):633–638, Mar 27. CrossRef
- Tilden VP, Tolle SW, Nelson CA, Fields J. Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nurs Res. 2001;50(2):105–115, Mar-Apr. CrossRef
- Vig EK, Starks H, Taylor JS, Hopley EK, Fryer-Edwards K. Surviving surrogate decision-making: what helps and hampers the experience of making medical decisions for others. J Gen Intern Med. 2007;22(9):1274–1279, Sep. CrossRef
- Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171(9):987–994, May 1. CrossRef
- Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005;55(3):164–177, May-Jun. CrossRef
- Elliot R, Watson JC, Goldman RN, Greenberg LS. Learning emotion-focused therapy: the process experiential approach to change: APA Press; 2003.
- Halpern J. From Detached Concern to Empathy: Humanizing Medicine. New York, NY: Oxford Unversity Press; 2001.
- Larson EB, Yao X. Clinical emapthy as emotional empathy. JAMA. 2005;293(9):1100–1106. CrossRef
- Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced emapthy amoung internal medicine residents. J Gen Int Med. 2005;20(7):559–564. CrossRef
- Mercer SW, Reilly D, Watt GCM. The importance of empathy in the enablement of patients attending the Glasgow Homeopathic Hospital. Br J Gen Pract. 2002;52(484):901–905.
- Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159(9):1563–1569, Sep. CrossRef
- Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116(10):843–846, May 15.
- Zinn W. The empathic physician. Arch Intern Med. 1993;153(3):306–312, Feb 8. CrossRef
- Bellet PS, Maloney MJ. The importance of empathy as an interviewing skill in medicine. J Am Med Assoc. 1991;266:1831–1832. CrossRef
- Bylund CL, Makoul G. Empathic communication and gender in the physician-patient encounter. Patient Educ Couns. 2002;46:207–216. CrossRef
- Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277(8):678–682, Feb 26. CrossRef
- Bohart A, Greenberg L. Empathy and Psychotherapy: An Introductory Overview. In: Bohart A, Greenberg L, eds. Empathy Reconsidered: New Directions in Psychotherapy. 2Washington, DC: American Psychological Association; 1999:3–25.
- Torke AM, Alexander GC, Lantos J, Siegler M. The physician-surrogate relationship. Arch Intern Med. 2007;167(11):1117–1121, Jun 11. CrossRef
- Curtis JR, Engelberg RA, Wenrich MD, et al. Studying communication about end-of-life care during the ICU family conference: development of a framework. J Crit Care. 2002;17(3):147–160, Sep. CrossRef
- McDonagh JR, Elliott TB, Engelberg RA, et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med. 2004;32(7):1484–1488, Jul. CrossRef
- West HF, Engelberg RA, Wenrich MD, Curtis JR. Expressions of nonabandonment during the intensive care unit family conference. J Palliat Med. 2005;8(4):797–807, Aug. CrossRef
- Glaser BG, Strauss AL. Discovery of Grounded Theory. Chicago: Adline Publishing Company; 1967.
- Strauss AL, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications; 1998.
- Glaser BG. The Constant Comparative Method of Qualitative Analysis. In: McCall GJ, Simmons JL, eds. Issues in Participant Observation. Reading, MA: Addison-Wesley; 1969.
- Sackett DL, Haynes RBH, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2Boston: Little, Brown and Company; 1991.
- Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;345(Pt 2):1189–1208, Dec.
- Prendergast TJ, Puntillo K. Withdrawal of life support: intensive caring at the end of life. JAMA. 2002;288(21):2732–2740, Dec 4. CrossRef
- Mercer SW, Reynolds W. Empathy and quality of care. Br J Gen Pract. 2002;52 (Supplement):S9–S12.
- Heyland DK, Rocker GM, Dodek PM, et al. Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med. 2002;30(7):1413–1418, Jul. CrossRef
- Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56(12):1004–1010, Dec.
- Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005;80(2):164–167, Feb. CrossRef
- Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. Jama. 2002;287(23):3143–3146, Jun 19. CrossRef
- Stepien KA, Baernstein A. Educating for empathy. A review. J Gen Intern Med. 2006;21(5):524–530, May. CrossRef
- Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients. An ethical and empirical analysis. JAMA. 1992;267(15):2067–2071, Apr 15. CrossRef
- Krouse RS, Rosenfeld KE, Grant M, et al. Palliative care research: issues and opportunities. Cancer Epidemiol Biomarkers Prev. 2004;13(3):337–339, Mar.
- Mercer SW, McConnachie A, Maxwell M, Heaney DH, Watt GCM. The development and preliminary validation of the Consultation and Relational Empathy (CARE) Measure in general practice. Fam Pract. 2005;21(6):699–703. CrossRef
- Barkham M, Shapiro DA. Counselor Verbal Response Modes and Experienced Empathy. J Couns Psychol. 1986;33(1):3–10. CrossRef
- Halpern J. What is clinical empathy. J Gen Intern Med. 2003;18:670–676. CrossRef
- Branch WT, Malik TK. Using windows of opportunities in brief interviews to understand patients’ concerns. JAMA 1993;(169):1667–1668.
- Roter D, Stewart S, Putnam N, Lipkin M. Communication patterns of primary care physicians. J Am Med Assoc. 1997;277:350–356. CrossRef
- Empathy and Life Support Decisions in Intensive Care Units
Journal of General Internal Medicine
Volume 23, Issue 9 , pp 1311-1317
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- surrogate decision-making
- life support
- Industry Sectors
- Author Affiliations
- 1. The Wright Institute, Berkeley, CA, USA
- 2. Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA, USA
- 3. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- 4. Program in Medical Ethics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA