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Abstract
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.
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