Document Type
Dissertation
Date of Degree
11-4-2025
Primary Advisor
Philip J. van der Wees
Keywords
Empathy Building; Physician Assistant Students; Healthcare Providers; Chronic Pain; Pain Management; Opioid Prescription
Abstract
Background: Empathy has been identified as a crucial skill for all healthcare providers who treat patients with chronic pain. It has been directly linked to higher patient satisfaction and improved health outcomes. It has also been linked to reduced burnout, fewer medical errors, and improved job satisfaction among healthcare providers. Despite the many interventions that have been developed to promote empathy, the decline of empathy in healthcare providers and trainees continues to be of great concern, especially in pain management and opioid prescribing, thus affecting the quality of care given to these patients. In physician assistant students, this decline has been observed from the initial pre-clinical years of training into clinical practice. Therefore, education and the development of interventions are essential to better equip them with skills that will facilitate better interactions with patients with chronic pain in the clinical setting.
Study Objectives: The purpose of this study was to develop a perspective-taking peer role-play intervention and to assess its feasibility, acceptability, and appropriateness in improving cognitive and affective empathy, as well as reducing stigma in pre-clinical physician assistant students towards patients who are using opioids for chronic pain.
Method: An embedded pre-post mixed-methods feasibility study was conducted using the Medical Research Council framework. Phases I (Development of the intervention) and II (Feasibility) of the MRC framework were used to better understand the elements related to the intervention and its processes for potential implementation. In Phase I, a theoretical intervention was developed through a literature review and key informant interviews. In Phase II, an embedded pre-post mixed-methods design was used to assess the feasibility (including recruitment, retention, and adherence rates), acceptability, and appropriateness of the peer role-play intervention and to measure changes in cognitive and affective empathy levels among pre-clinical physician assistant students at the George Washington University School of Medicine and Health Sciences. Quantitative data were collected using the Feasibility Intervention Measure (FIM), Acceptability Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), the Jefferson Scale of Empathy (JSE), and the Toronto Empathy Questionnaire (TEQ). Qualitative data were collected using reflective writing, observation, debriefing discussions, and individual or small- group discussions.
Results: The median scores of 13 participants for the FIM, AIM, and IAM were 5, indicating that the intervention was feasible, acceptable, and appropriate. Recruitment, retention, and adherence rates were 24%, 59%, and 88%, respectively. The moderate recruitment and retention rates pointed to challenges in recruiting participants. The high adherence rate suggested that the intervention was well planned and showed promise for future implementation in the physician assistant program. The JSE showed a significant increase in cognitive empathy from pre- to post-intervention [118 to 127.0 (Z = -2.76, p = 0.006)]. Meanwhile, there was no significant change in TEQ scores for affective empathy [52 to 53 (Z = -0.874, p = 0.382)]. Qualitative results provided deeper insights into participants’ perceptions, with participants expressing that playing the role of the patient was enjoyable, a new experience, and helped develop their skills and attitudes toward patients on opioids for chronic pain in clinical settings. The peer role-play intervention improved participants’ self-awareness, particularly because stigmatization was perceived as a barrier to empathy. There was strong alignment between the feasibility, acceptability, and appropriateness scores and the qualitative findings. Qualitative results confirmed and expanded our understanding that burnout and time constraints were primary reasons behind the challenges in recruiting and retaining participants. The increase in cognitive empathy was also supported by the qualitative data; however, there was some discrepancy between affective empathy scores and participant' reports of feeling sadness during the intervention.
Discussion: The quantitative results showed that the intervention was feasible, acceptable, and appropriate; however, the qualitative findings offered a deeper understanding of areas needing improvement. The significant rise in cognitive empathy scores indicated that the peer role-play effectively enhanced cognitive empathy; however, it did not improve affective empathy. Still, the qualitative findings confirmed that participants indeed experienced affective empathy. The participants not only provided insight into how their attitude and behaviors were a barrier to treating patients who use opioids for chronic pain, leading to patients feeling stigmatized, but also how healthcare systems do not provide a supportive environment, especially when it comes to prescribing opioids for patients with chronic pain. This highlighted the need for more education and interventions, such as the peer role-play intervention, that enhance empathy. Burnout, although not an outcome in this study, was a major concern for the participants, underscoring the need for more supportive systems in both pre-clinical and clinical settings.
Conclusion: This study provided a foundation and preliminary results for a larger study. The findings of this present study contribute to the body of knowledge by increasing the understanding of how empathy in pre-clinical physician assistant students, an understudied population, is crucial especially towards patients that use opioids for chronic pain. This study provided a foundation and preliminary results for a larger study. The findings of this present study contribute to the body of knowledge by increasing the understanding of how empathy in pre-clinical physician assistant students, an understudied population, is crucial especially towards patients that use opioids for chronic pain.
Recommended Citation
Senton Stephen, Barbie Ann, "Improving Empathy and Reducing Stigmatization in Pre-Clinical Physician Assistant Students Towards Patient Taking Opioids for Chronic Pain: The Feasibility of a Perspective-Taking Peer Role-Play Intervention" (2025). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 43.
https://hsrc.himmelfarb.gwu.edu/smhs_crl_dissertations/43
Open Access
1
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