Effect of Clinicians' Empathetic Communication on Anxiety: A Randomized Video Vignette Study

Empathetic communication is a core component of serious illness conversations. The NURSE statement (Name, Understand, Respect, Support, Explore) is widely used to respond to emotion, but its independent effect on anxiety and the role of cultural adaptation remain unclear.

To evaluate whether empathetic communication using the NURSE framework mitigates the anxiety-provoking effect of difficult news and improves satisfaction among patients with serious illness and their family members, and to compare culturally adapted and non-adapted versions.

We conducted a randomized video vignette study in which Japanese patients with serious illness and their families viewed one of three scenarios: no empathetic response, the U.S. NURSE version, or a culturally adapted Japanese NURSE version. The State-Trait Anxiety Inventory (adjusted for baseline) was the primary outcome; satisfaction with communication was secondary.

Among 120 participants, both NURSE groups had significantly lower anxiety and higher satisfaction than the no-empathy group (all p < 0.01), with no significant difference between the U.S. and Japanese versions. Results were consistent across patients and family members.

Structured empathetic communication using the NURSE framework mitigated the anxiety-provoking effect of difficult news and improved satisfaction, with comparable effects between a directly translated and a culturally adapted version, both delivered within a Japanese-language clinical context.