Does notifying clinicians about poor sleep quality influence patient-perceived empathy? Results from a randomized...

Evidence suggests that greater levels of comfort and capability are associated with lower levels of distress (feelings of anxiety or depression) and lower levels unhelpful thinking (common misconceptions) about bodily sensations. Given the social stigma associated with mental health, patients and clinicians may be hesitant to talk about thoughts and emotions in the setting of musculoskeletal specialty care. Given the relationship between sleep quality and mental health, an alternative may be discussion of sleep quality. Among people presenting for musculoskeletal specialty care, we enrolled people with sleep disturbance, and asked: 1) Is clinician awareness of a patient's poor sleep quality associated with patient perceived clinician empathy? 2) What factors are associated with worse sleep quality? And 3) Is clinician awareness of a sleep disturbance related to discussion of sleep quality interventions?

In a randomized controlled trial, we enrolled 114 patients seeking musculoskeletal specialty care with a score of 3 or higher on the Pittsburg Sleep Quality Index (PSQI) questionnaire and randomized whether to inform their clinician of their sleep score or not. At the end of the visit, patients completed a demographic survey, the Jefferson Scale of Patient's Perception of Physician Empathy (JSPPPE), and indicated whether or not their clinician discussed sleep quality. Factors associated with perceived empathy, sleep quality, and discussion of sleep intervention were sought in multivariable analysis.

Accounting for potential confounders including misconceptions about symptoms, lower perceived clinician empathy was associated with the clinician being informed of the patient's sleep quality (Regression Coefficient [RC] = -0.14 95 % Confidence Interval [95 %CI] = -0.24 to -0.03l; p = 0.011) and greater misinterpretation of symptoms (RC = -0.14 95 %CI = -0.24 to -0.03; p = 0.04). Worse sleep quality was associated with distress regarding symptoms (RC = 0.048 95 %CI = 0.024 to 0.072; p < 0.001). Clinician discussion of sleep intervention was not associated with clinician awareness of sleep quality or any other factors.

The finding that clinician awareness of poor sleep quality was associated with modestly lower perceived clinician empathy whether or not the clinician discussed sleep quality, suggests that addressing sleep may not be more acceptable than addressing mental health. Clinicians can choose to address sleep or mental health as part of fostering a more comprehensive and effective biopsychosocial approach to musculoskeletal illness.

Level I Prognostic Study.