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Defining and Assessing Empathic Communication in Patient Portal Secure Messages: Adapted Coding Framework Development
Vishal A Shetty1,2, Christina M Gregor1, Lorraine D Tusing1
1Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, PA, 17822, United States, 1 413-230-4015.
JMIR Formative Research
|July 20, 2026
Summary
Patients frequently express needs for empathy in secure messages, but clinicians rarely respond with it. This study highlights communication gaps in patient portals, suggesting AI could help improve empathic interactions.
Area of Science:
- Health Informatics
- Clinical Communication
- Patient-Provider Relationship
Background:
- Empathic communication improves patient outcomes, satisfaction, and trust.
- Patient portal secure messages are increasingly used, but empathic communication within them is poorly understood.
Purpose of the Study:
- To develop a coding schema to identify patient-initiated empathic opportunities.
- To assess primary care clinicians' empathic responses to these opportunities in patient portal messages.
Main Methods:
- Manual review of 1100 adult patient and clinician secure messages from a regional health care system.
- Development and application of the Empathic Communication Coding System, adapted for the patient portal context.
- Double-coding of messages for reliability and iterative refinement of coding definitions.
Main Results:
- Over half (52.4%) of patient messages contained empathic opportunities (emotion, progress, challenge).
- Clinicians responded to 77.4% of messages with empathic opportunities.
- Only 13.2% of clinician responses expressed empathy.
Conclusions:
- Significant gaps exist in empathic communication within patient portal messaging.
- Findings provide a foundation for using AI to measure and enhance empathy in digital health interactions.
- Improving empathic communication in patient portals is crucial for patient care.
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