Empathy and life support decisions in intensive care units.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
Multi-center, prospective study of audiotaped physician-family conferences in intensive care units of four hospitals in 2000-2002.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
The Wright Institute, Berkeley, CA, USA.
R Brac
RB
Selph
Julia
J
Shiang
Ruth
R
Engelberg
J Randall
JR
Curtis
Douglas B
DB
White
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D004645:Empathy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011368:Professional-Family Relations; D013637:Tape Recording; D013727:Terminal Care / Q000523:psychology