JMIR Publications

ABSTRACT

Background:

Empathic communication in the clinical setting has been associated with lower blood sugar and cholesterol levels among diabetic patients, decreased anxiety, and increased satisfaction, treatment adherence, and trust. Despite recent growth in patient portal use, the expression of empathic communication through patient portal secure messages is not well understood.

Objective:

We aimed to construct a coding framework to define and assess empathic opportunities initiated by patients and primary care clinician responses to these opportunities within a patient portal messaging environment.

Methods:

Data for this study included adult patient secure messages and responding messages from clinicians working in family practice clinics of a regional healthcare system serving central and northeast Pennsylvania between January 2018 to December 2023. We conducted a manual review of messages using the Empathic Communication Coding System as a guiding framework, which defines empathic opportunities created by patients and corresponding empathic responses by clinicians. We double coded 500 patient messages for three empathic opportunity types: statements of emotion, progress, and challenge. Coding definitions were iteratively updated to describe specific textual cues unique to the patient portal context. This procedure was repeated to code for empathy in clinician responses to empathic opportunities. An additional 100 patient messages were double coded for inter-rater reliability testing, and 500 patient messages were single coded using the finalized coding schema.

Results:

Among 1100 patient messages coded, 576 included an empathic opportunity (52.4%). Of these messages, 100 (17.3%) included a statement of emotion, 85 (14.7%) included a statement of progress, and 539 (93.6%) included a statement of challenge. Statements of challenge were primarily characterized by patients explicitly describing physical or mental health issues, a barrier in care, or difficulties in one’s personal life. Among the 576 patient messages with empathic opportunities, 446 (77.4%) received at least one response from a clinician. Clinicians sent 483 response messages, of which 64 (13.2%) expressed empathy.

Conclusions:

While patients created empathic opportunities in over half of patient portal secure messages, primary care clinicians infrequently responded with empathy. The findings of this study provide initial evidence of gaps in empathic communication over patient portal secure messages and lay the groundwork for using artificial intelligence models to systematically measure and improve this communication across the patient portal messaging system.