Mixed methods evaluation of using the ‘EMPathicO’ communication skills e-learning in primary care: “ a super weapon to make the whole experience a bit better”
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Objectives
To examine primary care practitioners’ experiences and use of EMPathicO e-learning to enhance communication of clinical empathy and realistic optimism.
Design
Mixed methods evaluation incorporating thematic analysis of qualitative interviews and quantitative analysis of EMPathicO usage patterns and practitioner survey data.
Setting
Cluster randomised controlled trial of EMPathicO in general practices in England and Wales.
Participants
Primary care practitioners allocated to the intervention arm.
Analysis
Thematic analysis of qualitative data explored experiences of undertaking EMPathicO and implementing change in subsequent consultations. Descriptive quantitative analysis of EMPathicO usage and practitioner-reported survey data examined practitioner engagement with the e-learning. These parallel analyses were integrated using a triangulation protocol to explore convergence, complementarity and dissonance between the datasets.
Results
23 interviews (16 initial and 7 follow up) across 14 GP practices were undertaken with 11 GPs, 1 nurse practitioner, 3 physiotherapists and 1 physician associate, purposively sampled for diversity from the 115 participants randomised to receive EMPathicO in the trial. Interviewees were positive about EMPathicO, perceiving it as convenient and manageable (approx. 75 minutes online), informative, important, and relevant to their consultations. Over 95% of the 115 EMPathicO practitioners completed the e-learning modules, set goals and felt motivated to adopt EMPathicO communication skills following the e-learning. Interviewees appreciated the autonomy of setting personal goals; found their chosen empathy and optimism goals feasible to incorporate into everyday practice without lengthening consultations and felt such changes led to more positive interactions that were mutually beneficial for practitioners and patients. Aside from their own personal benefit some felt EMPathicO would be particularly helpful if integrated into existing training programmes. One interviewee described how they did not adopt the EMPathicO communication skills (despite feeling positive towards the e-learning overall) due to nearing retirement and another described not using specific tools within the e-learning (e.g. goal setting) because they did not fit with their preferred learning style. Additional content on communicating clinical empathy and realistic optimism flexibly in some situations (e.g., remote consultations especially telephone due to limitations on non-verbal communication) would be welcomed.
Conclusions
Practitioners across the multidisciplinary primary care team found completing EMPathicO to be a positive experience, manageable in the current pressurised clinical context and worthwhile, perceiving it to enhance their communication skills. They felt it benefitted both them and their patients and could also be particularly helpful within GP training and medical education settings. These important findings would have been missed if the mixed methods evaluation had not been incorporated into the trial. If widely disseminated, EMPathicO is likely to be well-received by primary care practitioners and straightforward to integrate into everyday practice.
Summary
What is already known
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Effective practitioner-patient communication, including clinical empathy can help enhance healthcare interactions, patient outcomes and self-management and improve practitioner job satisfaction and reduce burnout.
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Existing clinical empathy training can be too lengthy for busy primary care clinicians, is commonly delivered face to face limiting accessibility, and has not usually been offered across the multidisciplinary team.
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EMPathicO is rigorously developed, evidence-based brief communication skills e-learning to enhance communication of clinical empathy and realistic optimism.
What this study adds
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Primary care practitioners across the multidisciplinary team valued EMPathicO, finding it relevant, accessible, manageable in the context of busy clinical practice and a positive worthwhile experience.
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Practitioners felt motivated to adopt EMPathicO communication skills and most reported doing so, perceiving benefits for themselves and their interactions with patients, without lengthening consultation length.
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If widely disseminated, EMPathicO is likely to be very well-received by primary care practitioners and straightforward to integrate into everyday practice.
