The role of general practitioner empathy on patient-reported outcomes in telephone consultations: a cross-sectional study with validation of the Consultation and Relational Empathy (CARE) Measure for measuring empathy in telephone consultations

Background The Consultation and Relational Empathy (CARE) Measure is a validated measure of GP empathy in face-to-face consultations (FTFC) and higher CARE scores predict better patient outcomes. However, the validity of CARE and its importance in telephone consultations (TC) is unknown. Aims 1. To determine the validity and reliability of CARE in TCs 2. To determine the associations between CARE and outcomes in TC compared with FTFC. Design and setting Cross-sectional survey of 1023 patients who had a TC (n=369) or FTFC (n=654) with a GP in Scotland within the preceding 30 days. Methods Validity and reliability testing of CARE using standard methods. Associations between low, medium, and high CARE scores and three patient outcomes (enablement, symptom change, and satisfaction) were determined using multilevel binary logistic regression. Results CARE was valid and reliable. Compared with the low CARE group, high CARE was positively associated with enablement (adj.OR 6.4; 95%CI 3.48 to 11.84), symptom improvement (adj.OR 5.7; 95%CI 2.70 to 11.93) and satisfaction (adj.OR 20.1; 95%CI 8.93 to 45.35) in TC. Findings were similar in FTFC (enablement adj.OR 6.21; 95%CI 3.90 to 9.89, symptom improvement adj.OR 4.26; 95% CI 2.53 to 7.16, and satisfaction adj.OR 36.29; 96%CI 17.85 to 73.78) , and were not influenced by patient or consultations characteristics. Conclusion The CARE Measure is valid and reliable in TC and predicts better patient outcomes in TC, similar to FTFC. Given the common use of TC in primary care, strategies to support empathic communication are essential irrespective of consultation modality.