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Anesthesiologist trainees’ perceived barriers to providing empathetic care for women undergoing unscheduled cesarean deliveries
Abstract Number: T-32
Abstract Type: Original Research
Intro: Patient satisfaction, a key patient-centered outcome, is critical to improving health outcomes.1 In systematic reviews, the most important factor influencing maternal satisfaction and birth experience was, “the attitudes and behaviors of the caregivers.” 2 Emergency cesarean delivery can lead to emotional distress, postpartum depression, and post-traumatic stress disorder, particularly in mothers who did not feel supported by their healthcare professionals.3,4 Empathy declines throughout medical training.5 In academic centers, the anesthesiologist trainee is the primary physician interacting with women during unscheduled cesarean delivery (UCD) potentially influencing maternal satisfaction and postpartum well-being. This is a qualitative exploratory study to elicit anesthesiologist trainees’ perceived barriers to providing empathetic care during UCD.
Methods: This is part of an IRB-approved study. Resident and fellow anesthesiologists were recruited via email, consented and compensated to participate. They were individually interviewed regarding their approach to communicating with women during UCD. Semi-structured interviews consisting of nine questions lasted approximately 15 minutes. Interviews were conducted by a qualitative researcher who was not a physician or a resident supervisor. Interviews (N=10) continued until saturation of themes was achieved. Interviews were audiotaped and transcribed. Two researchers independently reviewed the interviews for themes. Individual codes were then complied into one document and the two coders met and discussed inconsistencies to identify the emergent themes.
Results: Trainees’ typical approach to caring for mothers involves completing medical tasks and providing factual information. Communicating with the mother beyond factual information is viewed as “optional” to clinical care. Primary barriers that residents perceived in providing empathetic care in urgent cases include managing their own affect and completing medical tasks quickly, which they prioritize over communication. Trainees felt they should provide “reassurance without commitment” and wanted to learn “best practice phrases”. They feel they learn communication skills through role models but no resident could verbalize or model empathetic phrases when asked. They believe nonverbal support (i.e. physical touch) should be based on resident comfort level.
Discussion: Anesthesiologist trainees perceive communication and empathetic care as separate and less important when providing medical care to women particularly in urgent situations. Resident empathy curriculums should address these issues to provide residents with strategies to maximize their interpersonal interactions with women undergoing UCD in an effort to improve women’s postpartum emotional states.
1. JAMA 2013; 309:8 14-822.
2. Am J Obstet Gynecol 2002; 186: S160-72.
3. Birth 2008; 35: 107-116.
4. J Affect Disord 1998; 49: 167-180.
5. Acad Med. 2011; 86: 996-1009.