Clinician empathy is associated with differences in patient–clinician communication behaviors and higher medication self-efficacy in HIV care

•We studied links between empathy, communication, and medication self-efficacy.•We analyzed visits between 435 patients and 45 primary HIV care providers.•Higher empathy clinicians used a more positive and activating communication style.•Patients of higher empathy clinicians disclosed more information to them.•Patients of higher empathy clinicians had higher medication self-efficacy.

ObjectiveWe examined associations of clinicians’ empathy with patient-clinician communication behaviors, patients’ rating of care, and medication self-efficacy.MethodsWe analyzed 435 adult patients and 45 clinicians at four outpatient HIV care sites in the United States. Negative binomial regressions investigated associations between clinician empathy and patient-clinician communication, assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions investigated associations between clinician empathy and patient ratings of clinician communication, overall satisfaction, and medication self-efficacy.ResultsClinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk (IRR 0.79, p < 0.05), while clinicians in the middle vs. lowest engaged in more positive talk (IRR 1.31, p < 0.05), more questions (IRR 1.42, p < 0.05), and more patient activating talk (IRR 1.43, p < 0.05). Patients of higher empathy clinicians disclosed more psychosocial and biomedical information. Patients of clinicians in both the middle and highest (vs. lowest) empathy tertiles had greater odds of reporting highest medication self-efficacy (OR 1.80, 95% CI 1.16–2.80; OR 2.13, 95% CI 1.37–3.32).ConclusionsClinician empathy may be expressed through addressing patient engagement in care, by fostering cognitive, rather than primarily emotional, processing.Practice implicationsClinicians should consider enhancing their own empathic capacity, which may encourage patients’ self-efficacy in medication adherence.