Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study.

BACKGROUND: Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies. METHODS: The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care. DISCUSSION: The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.

Spiritual, religious, and existential concerns of cancer survivors in a secular country with focus on age, gender, and emotional challenges.

PURPOSE: The purpose of this study was to examine the associations between self-reported spiritual/religious concerns and age, gender, and emotional challenges among cancer survivors who have completed a 5-day rehabilitation course at a rehabilitation center in Denmark (the former RehabiliteringsCenter Dallund (RC Dallund)). METHODS: The data stem from the so-called Dallund Scale which was adapted from the NCCN Distress Thermometer and comprised questions to identify problems and concerns of a physical, psychosocial, and spiritual/religious nature. Descriptive statistics were performed using means for continuous variables and frequencies for categorical variables. Odds ratios were calculated by logistic regression. RESULTS: In total, 6640 participants filled in the questionnaire. Among participants, 21% reported one or more spiritual/religious concerns, the most reported concerns related to existence and guilt. Having one or more spiritual/religious concerns was significantly associated with age (OR 0.88), female gender (OR 1.38), and by those reporting emotional problems such as being without hope (OR 2.51), depressed (OR 1.49), and/or anxious (OR 1.95). Among participants, 8% stated they needed help concerning spiritual/religious concerns. CONCLUSIONS: Cancer patients, living in a highly secular country, report a significant frequency of spiritual/religious and existential concerns. Such concerns are mostly reported by the young, female survivors and by those reporting emotional challenges. Spiritual/religious and existential concerns are often times tabooed in secular societies, despite being present in patients. Our results call for an increased systemic attention among health professionals to these concerns, and a particular focus on identifying and meeting the spiritual/religious and existential concerns of women, the young and those challenged by hopelessness, depression, and anxiety.

'Someone to hold the hand over me': the significance of transpersonal 'attachment' relationships of Danish cancer survivors.

The aim of this article is to present findings about self-reported spirituality of a group of Danish cancer survivors. The findings derive from a qualitative study that was carried out during rehabilitation week courses at a Danish rehabilitation centre. Methods comprised participant observation, semi-structured interviews and focus group interviews. Employing interpretative phenomenological analysis as analytical strategy, a prominent part of the informants' self-reported spirituality was found to centre around a perceived sense of relatedness to a transpersonal entity that transcends the self and extends beyond spatial-temporal boundaries. Three transpersonal entities were identified: 'God', a 'guardian angel' and a 'deceased family member'. The key findings of the study demonstrate that the transpersonal entities were experienced as empowering and supportive resources during cancer treatment and rehabilitation and that they were furthermore perceived as responsible for the informants' healing and survival. These findings are interpreted through the lenses of two interrelated theoretical frameworks: Hay and Nye's approach to spirituality as 'relational consciousness' and Kirkpatrick and colleagues' understanding of religion and/or spirituality as attachment relationships. These two theoretical understandings are suggested as useful frameworks for capturing spiritual dimensions of cancer survivors' meaning making and coping in a secular society.