AB0626 PHYSICIAN EMPATHY AND PATIENT-REPORTED OUTCOMES IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY
Authors: M. Gopalakrishnan, A. Kumar P H, H. Deg, M. K. Garg
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Empathy is an attribute that involves understanding the patient combined with a capacity to communicate this understanding with an intention to help (1). Empathy in clinical care has been associated with better outcomes for the patients and lower disease activity is associated with a higher degree of trust in physicians in rheumatology (2). Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) is a validated instrument that assesses patient ratings of physician empathy. <h3>Objectives:</h3> We aimed to explore the relationship between patient-reported physician empathy and patient-reported outcomes of disease in the context of rheumatoid arthritis (RA) using the Hindi version of JSPPPE (Hi-JSPPPE). <h3>Methods:</h3> A cross-sectional study after Institute Ethics Committee approval in patients with RA presented to the rheumatology clinic in our tertiary care teaching hospital, at Jodhpur, India, catering to approximately 900+ patients with RA was conducted. After informed written consent, patients were administered a validated Hindi version of JSPPPE. Hi-JSPPPE is a 5-item measure and the items are answered on a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Simultaneously, patients reported outcomes (PROs) namely Patient Health Questionnaire-9 (PHQ-9), Patient Global Assessment (PtGA), Rheumatoid Arthritis Impact of Disease (RAID), and Pittsburgh Sleep Quality Index (PSQI) were calculated. Correlations between Hi-JSPPPE scores and patient-reported outcomes and between individual Hi-JSPPPE items and RAID components were calculated using Spearman's correlation coefficient. Binary logistic regression was done using RAID as the dependent parameter and Hi-JSPPPE score as a predictor. A Receiver Operating Characteristic (ROC) curve was constructed to determine the optimal cut-off for Hi-JSPPPE score for defining RAID remission score in our population (3). <h3>Results:</h3> A total of 239 patients with RA were enrolled in the study, with a median age of 47 years (38-55), 191 (79.9%) were females and the median duration of RA was 5 years (2-5). The median patient global assessment was 3 (2-5) and median RAID scores were 2.69 (1.1-4.07). Depression was present in 111 (46.4%) and impaired sleep was present in 190 (79.5%) patients. Patients reported Hi-JSPPPE scores for 20 clinicians in the rheumatology clinic. Correlations between Hi-JSPPPE and PROs showed significant negative correlation with RAID (r = -0.235 p &lt;0.001), and PHQ-9 (r = -0.025, p = 0.001). Correlations of each item of Hi-JSPPPE with individual components of RAID had significant negative correlations with almost all of them except sleep and coping (Table 1). Hi-JSPPPE had no significant correlations with PSQI, and PtGA. Binary logistic regression analysis showed that the Hi-JSPPPE score could predict the RAID score (cut off &lt;2.32) {OR -0.220; 95% CI 0.69 - 0.93}. Hi-JSPPPE score of 29.5 had 99.1% sensitivity and 86.99% specificity to predict RAID score of 2.32 (AUC 0.596, 95% CI 0.525 - 0.668, P = 0.01) (Figure 1). <h3>Conclusion:</h3> Hi-JSPPPE has been found to correlate well with RAID as a composite score and as well as at individual item levels. Hi-JSPPPE score of 29.5 out of 35 had good sensitivity and specificity in predicting a RAID score of 2.32. To our knowledge, ours is the first study to conclusively show that physician empathy is key to achieving PRO targets in RA. Hence, interventions to improve clinician empathy may emerge as an important strategy in RA management. <h3>REFERENCES:</h3> [1] Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract J R Coll Gen Pract. 2013;63(606):e76-84. doi:10.3399/bjgp13X660814 [2] Georgopoulou S, Prothero L, D'Cruz DP. Physician-patient communication in rheumatology: a systematic review. Rheumatol Int. 2018 May;38(5):763-775. doi: 10.1007/s00296-018-4016-2. Epub 2018 Mar 26. PMID: 29582095; PMCID: PMC5910487. [3] S Kumar P, Kumar P H A, Garg MK, et al. AB0210 CAN RHEUMATOID ARTHRITIS IMPACT OF DISEASE (RAID) SCORE BE USED AS A PATIENT REPORTED OUTCOME BASED TARGET IN A TREAT-TO-TARGET APPROACH: A PROSPECTIVE STUDY FROM INDIA. Annals of the Rheumatic Diseases 2023;82:1289. <h3>Acknowledgements:</h3> Dr Jyoti Jain, Department of Internal Medicine and Thomas Jefferson University (TJU). <h3>Disclosure of Interests:</h3> <b>None declared.</b>