Empathy and Perspective Taking in Understanding Burnout
Empathy and Perspective Taking in Understanding Burnout
French general practitioners were approached in two ways. The majority (80%) were recruited through the e-mail registry of the French national professional society 'Société de Formation Thérapeutique du Généraliste' (professional society for the continuing education of general practitioners). All members of this society were prompted by e-mail to invite physicians to participate in an Internet based survey (with a maximum of two prompts). Physicians were also approached during the yearly national congress for general practice (20%). The inclusion criterion was that the participant needed to be a working general practitioner. There were no criteria regarding age, gender or seniority. Each participant gave written informed consent before the beginning of the study. The study received ethical approval from the institutional ethics committee at the University Paris Descartes. A full description of participant recruitment procedures is available in a previous report.
The widely used Maslach Burnout Inventory (MBI) consists of 22 items that are scored on 7-point Likert scales (0 = never, 6 = everyday). The MBI comprises 3 subscales: emotional exhaustion (score range 0 to 54), depersonalization (score range 0 to 30) and personal accomplishment (score range 0 to 49). High scores on the emotional exhaustion and depersonalization subscales paired with low scores on the personal accomplishment subscale were indicative of high levels of burnout. An example of a positively worded item is, "I feel emotionally drained from my work". The MBI has been previously validated in samples of health care professionals, including general practitioners, and has been shown to have strong content, internal structure and criterion validity. As previously suggested, we recoded the personal accomplishment items and summed the 22 items of the MBI to form a single global measure of burnout. This procedure resulted in a highly consistent scale in the present sample (α = .84). We defined extreme burnout as a mean score above the 75 percentile (corresponding to a score of 29) (n = 71).
The Jefferson Scale of Physician Empathy (JSPE) is a 20-item physician self-assessment tool, which evaluates empathy on a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Previous studies have suggested that the scale consists of three components: perspective taking, compassionate care and standing in the patient's shoes. A study with the French version of the scale confirmed the three-factor structure of the scale, but did not support the calculation of a global score. We used the perspective taking subscale to evaluate the cognitive aspect of physicians' clinical empathy. A sample item is, "I try to think like my patient in order to render better care". Previous studies have evidenced the validity (construct, divergent, convergent, criterion related) and reliability (Cronbach's alpha, test-retest) of the JSPE among medical students and physicians.
The Toronto Empathy Questionnaire (TEQ) consists of 16 items, each rated on a 5-point Likert scale (0 = never, 4 = always), which assesses a single factor of general empathic concern. The TEQ conceptualizes empathy as a primarily emotional process. The scale provides a score ranging from 0 to 64, whereby the higher the score, the higher the self-reported emotional concern. An example of a positively worded item is, "I find that I am 'in tune' with other people's moods". The TEQ has demonstrated good internal consistency, high test-retest reliability and strong convergent validity.
Pearson correlation coefficients were calculated to explore the links between burnout scores, socio-demographic characteristics, perspective taking and empathic concern. A multiple linear regression explored the effects of empathic concern, perspective taking and their interaction on burnout. Further, we performed logistic regressions to compute the odds ratios regarding the presence of extreme burnout associated with perspective taking, empathic concern as well as their interaction. Odds ratios were adjusted for marital status, as this was related to burnout in preliminary analyses. We set the probability of type 1 error at an alpha of .05. SPSS version 19 was used to perform the statistical analyses.
Methods
Participants
French general practitioners were approached in two ways. The majority (80%) were recruited through the e-mail registry of the French national professional society 'Société de Formation Thérapeutique du Généraliste' (professional society for the continuing education of general practitioners). All members of this society were prompted by e-mail to invite physicians to participate in an Internet based survey (with a maximum of two prompts). Physicians were also approached during the yearly national congress for general practice (20%). The inclusion criterion was that the participant needed to be a working general practitioner. There were no criteria regarding age, gender or seniority. Each participant gave written informed consent before the beginning of the study. The study received ethical approval from the institutional ethics committee at the University Paris Descartes. A full description of participant recruitment procedures is available in a previous report.
Measurement of Burnout
The widely used Maslach Burnout Inventory (MBI) consists of 22 items that are scored on 7-point Likert scales (0 = never, 6 = everyday). The MBI comprises 3 subscales: emotional exhaustion (score range 0 to 54), depersonalization (score range 0 to 30) and personal accomplishment (score range 0 to 49). High scores on the emotional exhaustion and depersonalization subscales paired with low scores on the personal accomplishment subscale were indicative of high levels of burnout. An example of a positively worded item is, "I feel emotionally drained from my work". The MBI has been previously validated in samples of health care professionals, including general practitioners, and has been shown to have strong content, internal structure and criterion validity. As previously suggested, we recoded the personal accomplishment items and summed the 22 items of the MBI to form a single global measure of burnout. This procedure resulted in a highly consistent scale in the present sample (α = .84). We defined extreme burnout as a mean score above the 75 percentile (corresponding to a score of 29) (n = 71).
Measurement of Perspective Taking
The Jefferson Scale of Physician Empathy (JSPE) is a 20-item physician self-assessment tool, which evaluates empathy on a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Previous studies have suggested that the scale consists of three components: perspective taking, compassionate care and standing in the patient's shoes. A study with the French version of the scale confirmed the three-factor structure of the scale, but did not support the calculation of a global score. We used the perspective taking subscale to evaluate the cognitive aspect of physicians' clinical empathy. A sample item is, "I try to think like my patient in order to render better care". Previous studies have evidenced the validity (construct, divergent, convergent, criterion related) and reliability (Cronbach's alpha, test-retest) of the JSPE among medical students and physicians.
Measurement of Empathic Concern
The Toronto Empathy Questionnaire (TEQ) consists of 16 items, each rated on a 5-point Likert scale (0 = never, 4 = always), which assesses a single factor of general empathic concern. The TEQ conceptualizes empathy as a primarily emotional process. The scale provides a score ranging from 0 to 64, whereby the higher the score, the higher the self-reported emotional concern. An example of a positively worded item is, "I find that I am 'in tune' with other people's moods". The TEQ has demonstrated good internal consistency, high test-retest reliability and strong convergent validity.
Statistical Analyses
Pearson correlation coefficients were calculated to explore the links between burnout scores, socio-demographic characteristics, perspective taking and empathic concern. A multiple linear regression explored the effects of empathic concern, perspective taking and their interaction on burnout. Further, we performed logistic regressions to compute the odds ratios regarding the presence of extreme burnout associated with perspective taking, empathic concern as well as their interaction. Odds ratios were adjusted for marital status, as this was related to burnout in preliminary analyses. We set the probability of type 1 error at an alpha of .05. SPSS version 19 was used to perform the statistical analyses.
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