Provider Empathy Linked to Cardiovascular and Mortality Risk in Diabetes

This data supports previous research that linked provider empathy with clinical outcomes in patients with diabetes.

Better patient experiences of provider empathy may lead to improved diabetic outcomes. Evidence suggests that empathy also improves patient satisfaction, which is independently associated with improved clinical outcomes. This research examined the association between provider empathy in the first year of type 2 diabetes diagnosis and incidence of CVD events and all-cause-mortality in patients with type 2 diabetes over ten years.

This study is a pragmatic, cluster-randomized, controlled trial that evaluated traditional diabetes treatment and an intensive multifactorial diabetes treatment. The study population included 867 patients with type 2 diabetes, and their outcomes were documented for over ten years. 

Patients were given a provider empathy assessment one year after type 2 diabetes diagnosis. The empathy questionnaire included ten items assessing how good the provider was at: making you feel at ease, letting you tell your story, listening, showing interest in you as a person, validating concerns, showing care and compassion, positive attitude, clear explanations, helping the patient be independent, and planning of action with the patient. Study outcomes were first cardiovascular event and all-cause-mortality. Adjustments were made for confounders and hazard ratios were measured using Cox models.

Patient characteristics were as follows: mean standard age was 61 years old, 60% male, 97% white, 35% were employed full time, mean HbA1c was 6.51%, mean total cholesterol was 4.49 mmol/L, and mean systolic blood pressure was 135.4 mmHg.  After exclusions, 621 patients were used for the case analysis.

In univariable and multivariable models, higher scores on the empathy assessment were associated with lower rates of cardiovascular events, although this was not statistically significant. In the multivariable model, moderate and high empathy scores were significantly associated with lower rates of all-cause-mortality. In the ten year follow up of this study, data showed patients who received more provider empathy during the first 12 months after a type 2 diabetes diagnosis had significantly lower all-cause-mortality.

Many clinicians focus on guidelines and technology-based assessments, but these findings reveal the impact provider empathy can have on clinical outcomes. This is especially true in the first year following a diabetes diagnosis. The benefits of greater empathy are comparable to risk reductions seen in pharmacological treatments but without any negative side effects.

This data supports previous research that linked provider empathy with clinical outcomes in patients with diabetes. These other studies focused on outcomes such as blood pressure and glucose levels instead of CVD events and mortality. The limitation to most of these previous studies were short follow up periods, so this study evaluated patients for 10 years. Future research should include measures of patient quality of life and optimism, because recent systematic reviews suggest a link between positivity and cause-specific mortality. 

The validity of this study strength can be seen in the use of actual CVD events and mortality in models as well as the ten year follow up. Although this study was diverse in social class it was not culturally diverse as most patients were white males. This is a major limitation of this study and makes it not generalizable to the public. Another limitation is that this study used an assessment to determine empathy scores, and relying on a single point could skew data.

More research is required to show causality between empathy, all-cause-mortality, and CVD events in type 2 diabetes patients. Nonetheless, healthcare programs and companies should consider incorporating empathy training, as this may improve clinical outcomes. As we move toward more precise treatment plans, we should not forget the human element of care and that empathy may directly affect diabetic outcomes.

Practice Pearls:

• Patients who received more provider empathy during the first 12 months after a type 2 diabetes diagnosis had significantly lower all-cause-mortality.
• Higher scores on the empathy assessment were associated with lower rates of cardiovascular events, although this was not statistically significant.
• To confirm causation between empathy, CVD events, and all-cause-mortality, more research is required and should include a diverse population, more than one empathy assessment point, and patient quality of life and optimism

Dambha-Miller, et al. “Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study.” Apollo Home, HighWire, 1 July 2019, www.repository.cam.ac.uk/handle/1810/291546.

Kassey James, Pharm.D. Candidate, LECOM School of Pharmacy