Empatia clínica e satisfação por compaixão em médicos/as: Análise de mediadores potenciais

• Rosa, Francisca ^[1] ; Alves-Nogueira, Ana ^[1] ; Melo, Cláudia ^[1] ; Canavarro, Maria Cristina ^[1] ; Carona, Carlos ^[1]
  1. [1] Universidade de Coimbra

     Universidade de Coimbra

     Coimbra (Sé Nova), Portugal

     
• Localización: Revista Portuguesa de Investigação Comportamental e Social: RPICS, ISSN-e 2183-4938, Vol. 11, Nº. 1, 2025 (Ejemplar dedicado a: May; 1–20)
• Idioma: portugués
• DOI: 10.31211/rpics.2025.11.1.346
• Títulos paralelos:
  • Clinical empathy and physicians’ compassion satisfaction: Analysis of potential mediators
• Enlaces
  • Texto completo (pdf)
• Resumen
  • English

    Background: Clinical empathy is an intrinsic attribute of the medical profession and is associated with greater physicians’ compassion satisfaction levels. However, little is known about the potentially modifiable mechanisms underlying this relationship. Aim: This study aimed to analyze the direct and indirect effects of clinical empathy on physicians’ compassion satisfaction via the quality of therapeutic relationships and barriers to compassion. Method: A sample of 222 physicians, collected exclusively online, completed a set of self-report instruments. Direct and indirect effects were analyzed using structural equation modeling. Results: Clinical empathy was moderately and positively correlated with the quality of therapeutic relationships and compassion satisfaction, and negatively correlated with barriers to compassion. An indirect effect of clinical empathy on compassion satisfaction was observed through the quality of therapeutic relationships (b = .05, 95% IC [.02; .10]) and barriers to compassion (b = .02, 95% IC [.01; .05]). The model explained around 31% of the variability in compassion satisfaction levels. Conclusions: Higher levels of empathy among physicians may lead to greater compassion satisfaction through better quality of therapeutic relationships and lower perceived barriers to compassion. Intervention programs targeting these mechanisms might increase positive mental health in these professionals.

  • português

    Contexto: A empatia clínica é um atributo intrínseco à profissão médica, estando associada a níveis mais elevados de satisfação por compaixão em médicos/as. Contudo, pouco se sabe acerca dos mecanismos mediadores e potencialmente modificáveis subjacentes a essa relação. Objetivo: Este estudo visou analisar os efeitos diretos e indiretos da empatia clínica nos níveis de satisfação por compaixão em médicos/as, considerando como mediadores a qualidade das relações terapêuticas e as barreiras à compaixão. Métodos: Uma amostra de 222 médicos/as, recolhida exclusivamente online, preencheu um conjunto de instrumentos de autorresposta. Os efeitos diretos e indiretos foram explorados utilizando modelos de equações estruturais. Resultados: A empatia clínica relacionou-se moderada e positivamente com a qualidade das relações terapêuticas e com a satisfação por compaixão, e negativamente com as barreiras à compaixão. Observou-se um efeito indireto da empatia sobre a satisfação por compaixão, tanto através da qualidade das relações terapêuticas (b = 0,05, 95%IC [0,02; 0,10]), como das barreiras à compaixão (b = 0,02, 95% IC [0,01; 0,05]). O modelo explicou 31% da variabilidade nos níveis de satisfação por compaixão. Conclusões: Níveis mais elevados de empatia em médicos/as poderão favorecer satisfação por compaixão, mediada por relações terapêuticas de melhor qualidade e da perceção de menos barreiras à compaixão. Intervenções focadas nesses fatores poderão melhorar a saúde mental positiva destes/as profissionais.

• Referencias bibliográficas
  • Alves-Nogueira, A. C., Pereira, M., Melo, C., Canavarro, M. C., & Carona, C. (2021). A versão portuguesa da “Medida CARE - Autorrelato”...
  • Alves-Nogueira, A. C., Pereira, M., Melo, C., Canavarro, M. C., & Carona, C. (2022a). A versão portuguesa da "Escala de Avaliação...
  • Alves-Nogueira, A. C., Pereira, M., Melo, C., Canavarro, M. C., & Carona, C. (2022b). A versão portuguesa do “Questionário de Barreiras...
  • Alves-Nogueira, A. C., Góis, A. C., Pereira, M., Canavarro, M. C., Melo, C., & Carona, C. (2024). The associations between physician-patient...
  • Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family...
  • Bonvicini, K. A., Perlin, M. J., Bylund, C. L., Carroll, G., Rouse, R. A., & Goldstein, M. G. (2009). Impact of communication training...
  • Carvalho, P., & Sá, L. (2011). Estudo da fadiga por compaixão nos cuidados paliativos: Tradução e adaptação cultural da escala “Professional...
  • Chan, K., Lee, J., Yu, E., Chan, A., Leung, A., Cheung, R., Li, C., Kong, R., Chen, J., Wan, S., Tang, C., Yum, Y., Jiang, D., Wang, L., &...
  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2.ª ed.). Lawrence Erlbaum.
  • Coulter, A., & Oldham, J. (2016). Person-centred care: What is it and how do we get there? Future Hospital Journal, 3(2), 114–116. https://doi.org/kj8x
  • Dev, V., Fernando, A., Kirby, J. N., & Consedine, N. S. (2019). Variation in the barriers to compassion across healthcare training and...
  • Fallowfield, L., Jenkins, V., Farewell, V., Saul, J., Duffy, A., & Eves, R. (2002). Efficacy of a Cancer Research UK communication skills...
  • Fernando, A., & Consedine, N. S. (2014a). Beyond compassion fatigue: The transactional model of physician compassion. Journal of Pain...
  • Fernando, A., & Consedine, N. S. (2014b). Development and initial psychometric properties of the Barriers to Physician Compassion Questionnaire....
  • Fernando, A., & Consedine, N. S. (2017). Barriers to medical compassion as a function of experience and specialization: Psychiatry, pediatrics,...
  • Galiana, L., Oliver, A., Arena, F., De Simone, G., Tomás, J. M., Vidal-Blanco, G., Muñoz-Martínez, I., & Sansó, N. (2020). Development...
  • Gaskin, J., & Lim, J. (2018). Indirect Effects [AMOS Plugin]. https://bit.ly/4bVQbw0
  • Gilbert, P. (2009). The compassionate mind: A new approach to life’s challenges. Constable.
  • Gleichgerrcht, E., & Decety, J. (2013). Empathy in clinical practice: How individual dispositions, gender, and experience moderate empathic...
  • Golda, N., Beeson, S. C., Kohli, N., & Merrill, B. (2018). Recommendations for improving the patient experience in specialty encounters....
  • Hair, J., Babin, B., Anderson, R., & Black, W. (2019). Multivariate data analysis (8.ª ed.). Pearson Prentice.
  • Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: A review. The Ochsner Journal, 10(1), 38–43. https://bit.ly/3PCvN9Y
  • Hojat, M., Maio, V., Pohl, C. A., & Gonnella, J. S. (2023). Clinical empathy: Definition, measurement, correlates, group differences,...
  • Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N., Dieninytė, E., Hu, X., Aveyard,...
  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives....
  • Hunt, P. A., Denieffe, S., & Gooney, M. (2019). Running on empathy: Relationship of empathy to compassion satisfaction and compassion...
  • Jahan, F., & Siddiqui, H. (2019). Good communication between doctor-patient improves health outcome. European Journal of Medical and Health...
  • Kelm, Z., Womer, J., Walter, J. K., & Feudtner, C. (2014). Interventions to cultivate physician empathy: A systematic review. BMC Medical...
  • Kerasidou, A., & Horn, R. (2016). Making space for empathy: Supporting doctors in the emotional labour of clinical care. BMC Medical Ethics,...
  • Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting...
  • Kline, R. B. (2011). Principles and practice of structural equation modeling (3.ª ed.). Guilford Press.
  • Lee, E. E., Govind, T., Ramsey, M., Wu, T. C., Daly, R., Liu, J., Tu, X., Paulus, M. P., Thomas, M. L., & Jeste, D. V. (2021). Compassion...
  • Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the...
  • Loerbroks, A., Glaser, J., Vu-Eickmann, P., & Angerer, P. (2017). Physician burnout, work engagement and the quality of patient care....
  • Marôco, J. (2014). Análise de equações estruturais: Fundamentos teóricos, software & aplicações (2ª ed.). ReportNumber.
  • Matsuzaki, P. G.-I., Mariya, F. A., Ueno, L. I., & Gimenes, M. J. F. (2021). Physician burnout: Prevention strategies. Revista Brasileira...
  • McGuire-Snieckus, R., McCabe, R., Catty, J., Hansson, L., & Priebe, S. (2007). A new scale to assess the therapeutic relationship in community...
  • Mercer, S., Maxwell, M., Heaney, D., & Watt, G. (2004). The consultation and relational empathy (CARE) measure: Development and preliminary...
  • Morgan, D. J., Scherer, L. D., & Korenstein, D. (2020). Improving physician communication about treatment decisions. JAMA, 324(10), 937–938....
  • Moudatsou, M., Stavropoulou, A., Philalithis, Α., & Koukouli, S. (2020). The role of empathy in health and social care professionals....
  • Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., Haramati, A., & Scheffer, C. (2011). Empathy decline...
  • Newnham, E. A., Hooke, G. R., & Page, A. C. (2010). Progress monitoring and feedback in psychiatric care reduces depressive symptoms....
  • Nunnally, J., & Bernstein, I. J. (1994). Psychometric theory (3.ª ed.). McGraw-Hill.
  • Olaisen, R. H., Schluchter, M. D., Flocke, S. A., Smyth, K. A., Koroukian, S. M., & Stange, K. C. (2020). Assessing the longitudinal impact...
  • Ordem dos Psicólogos Portugueses. (2021). Regulamento n.º 637/2021: Código Deontológico da Ordem dos Psicólogos Portugueses. Diário da República,...
  • Patel, S., Pelletier-Bui, A., Smith, S., Roberts, M. B., Kilgannon, H., Trzeciak, S., & Roberts, B. W. (2019). Curricula for empathy and...
  • Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects....
  • Rotenstein, L., Torre, M., Ramos, M. A., Rosales, R., Guille, C., Sen, S., & Mata, D. A. (2018). Prevalence of burnout among physicians:...
  • Schoemann, A. M., Boulton, A. J., & Short, S. D. (2017). Determining power and sample size for simple and complex mediation models. Social...
  • Shanafelt, T. D., West, C. P., Zhao, X., Novotny, P. J., Kolars, J. C., Habermann, T. M., & Sloan, J. A. (2005). Relationship between...
  • Sinclair, S., Norris, J. M., McConnell, S., Chochinov, H. M., Hack, T. F., Hagen, N. A., McClement, S., & Bouchal, S. R. (2016). Compassion:...
  • Smyth, J. D. (2006). Comparing Check-all and forced-choice question formats in web surveys. Public Opinion Quarterly, 70(1), 66–77. https://doi.org/d97dpw
  • Stamm, B. H. (2005). The Professional Quality of Life Scale: Compassion satisfaction, burnout, and compassion fatigue/secondary trauma scales....
  • Storozuk, A., Ashley, M., Delage, V., & Maloney, E. A. (2020). Got bots? Practical recommendations to protect online survey data from...
  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5.ª ed.). Allyn and Bacon.
  • Trompetter, H. R., Lamers, S. M. A., Westerhof, G. J., Fledderus, M., & Bohlmeijer, E. T. (2017). Both positive mental health and psychopathology...
  • Violato, C., & Hecker, K. (2007). How to use structural equation modeling in medical education research: A brief guide. Teaching and Learning...
  • Wang, H., Kline, J. A., Jackson, B. E., Laureano-Phillips, J., Robinson, R. D., Cowden, C. D., d’Etienne, J. P., Arze, S. E., & Zenarosa,...
  • Wang, Y., Wu, Q., Wang, Y., & Wang, P. (2022). The effects of physicians’ communication and empathy ability on physician–patient relationship...
  • Weilenmann, S., Schnyder, U., Parkinson, B., Corda, C., Von Känel, R., & Pfaltz, M. C. (2018). Emotion transfer, emotion regulation, and...
  • Weiss, R., Vittinghoff, E., Fang, M. C., Cimino, J. E., Chasteen, K., Arnold, R. M., Auerbach, A. D., & Anderson, W. G. (2017). Associations...
  • West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal...
  • Wolfshohl, J. A., Bradley, K., Bell, C., Bell, S., Hodges, C., Knowles, H., Chaudhari, B. R., Kirby, R., Kline, J. A., & Wang, H. (2019)....
  • World Medical Association. (2013). World medical association Declaration of Helsinki –Ethical principles for medical research involving human...
  • Wu, Q., Bachelor, Z. J., & Wang, P. (2021). The relationship between the physician-patient relationship, physician empathy, and patient...
  • Zhang, X., Li, L., Zhang, Q., Le, L. H., & Wu, Y. (2023). Physician empathy in doctor-patient communication: A systematic review. Health...
  • Zolnierek, K. B. H., & DiMatteo, M. R. (2009). Physician communication and patient adherence to treatment. Medical Care, 47(8), 826–834....