Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland
Open accessAbstract
BACKGROUND: Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation. METHODS: A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable. RESULTS: Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy. CONCLUSIONS: Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings.
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HCPs working with underserved population may experience more stress.
“Future studies could also include the variable of socioeconomic deprivation, as HCPs working with underserved population may experience more stress.5”
From Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies (2016) · cites this paper as [5]
The Results (Psychological distress; page not provided) discuss distress among patients, not healthcare professionals. The Discussion (Relationship to literature; page not provided) describes pressures on patient enablement in deprived areas, but does not address whether HCPs working with underserved populations experience more stress. Searches for physician stress, burnout, and stressful consultations found no passage on that point. (LLM, conf=0.76)
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PEN-13: A New Generic 13-Item Questionnaire for Measuring Patient Enablement (German Version)
Siegel, A., Ehmann, A., Meyer, I., Groene, O., Niebling, W., Martus, P., & Rieger, M. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16234867 · Cited by 11 · see citing works
Tolvanen, E., Groenewegen, P., Koskela, T., Eide, T. B., Cohidon, C., & Kosunen, E. (2020) · Health Expectations · doi:10.1111/hex.13091 · Cited by 11 · see citing works
Matsuhisa, T., Takahashi, N., Aomatsu, M., Takahashi, K., Nishino, J., Ban, N., & Mercer, S. W. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0826-2 · Cited by 11 · see citing works
Mercer, S. W., Lunan, C. J., MacRae, C., Henderson, D., Fitzpatrick, B., Gillies, J. C. M., Guthrie, B., & Reilly, J. (2022) · Scottish Medical Journal · doi:10.1177/00369330221132156 · Cited by 10 · see citing works
Primary care transformation in Scotland: a qualitative evaluation of the views of patients
Donaghy, E., Sweeney, K., Henderson, D., Angus, C., Cullen, M., Hemphill, M., Wang, H., Guthrie, B., & Mercer, S. W. (2024) · British Journal of General Practice · doi:10.3399/bjgp.2023.0437 · Cited by 10 · see citing works
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Factors affecting patient enablement in an Asian setting: a mixed methods study
Chan, M., Fang, H., & Shah, M. (2019) · Singapore Medical Journal · doi:10.11622/smedj.2019125 · Cited by 9 · see citing works
Croft, R. L., Byrd, C. T., & Kelly, E. M. (2022) · Journal of Communication Disorders · doi:10.1016/j.jcomdis.2022.106274 · Cited by 12 · see citing works
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Empathy During Patient-Provider Interactions for Women With Chronic Pelvic Pain: A Qualitative Study
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Reducing health inequalities through general practice: a realist review and action framework
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- Authors
- Mercer, S. W., Jani, B. D., Maxwell, M., Wong, S. Y., & Watt, G. C.
- Affiliations
- University of Glasgow (GB)
- University of Stirling (GB)
- Corresponding author
- Mercer, Stewart W
- Venue
- BMC Family Practice
- Published
- 2012-02-08
- Volume
- 13
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC3329411
- OpenAlex
- W2138386680
- Cited by
- 154
- References
- 28
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 9 · 2023: 10 · 2022: 22 · 2021: 10 · 2020: 10 · 2019: 15 · 2018: 13 · 2017: 10 · 2016: 11 · 2015: 11 · 2014: 14 · 2013: 7 · 2012: 2
- FWCI
- 7.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by)
- Funders
- Scottish Government
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- patient enablement, patient empowerment, physician empathy, socioeconomic deprivation, general practitioner visits, Patient Enablement Instrument, CARE measure, multimorbidity, emotional distress, patient expectations, consultation outcomes
- MeSH terms
- Adult, Attitude to Health, Cross-Sectional Studies, Empathy, Family Practice, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, Physician-Patient Relations, Surveys and Questionnaires, Referral and Consultation, Scotland, Socioeconomic Factors, Reproducibility of Results, Patient Satisfaction, Outcome Assessment, Health Care
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