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Effects of doctors’ empathy abilities on the cellular immunity of patients with advanced prostate cancer treated by orchiectomy: the mediating role of patients’ stigma, self-efficacy, and anxiety

Authors Yang N, Xiao H, Wang W, Li S, Yan H, Wang Y

Received 24 February 2018

Accepted for publication 14 May 2018

Published 24 July 2018 Volume 2018:12 Pages 1305—1314


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu

Ningxi Yang,1,2 Han Xiao,1 Wei Wang,1 Shiyue Li,1,* Hong Yan,1 Yifang Wang2,*

1Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Department of Medical Humanities, Institute of Medical Humanities, Peking University, Beijing, People’s Republic of China

*These authors contributed equally to this work

Background: The empathy of doctors is closely related to patients’ outcomes. This research aimed to examine whether patients’ stigma, self-efficacy, and anxiety mediate the relationship between doctors’ empathy and cellular immunity in patients with advanced prostate cancer treated by orchiectomy.
Participants and methods: Data on the empathy of doctors and the demographics, disease condition, stigma, self-efficacy, and anxiety of patients were collected. Patients’ psychological indicators and cellular immunity were measured at admission, after 14 days, and after 3 months. The variance analysis test was used to compare the immune indices at the three time points. At T3, a multivariate linear regression model was used to analyze the factors that influenced the immune index. Pearson correlation analysis and structural equation modeling were used to examine the relationships among patients’ stigma, self-efficacy, anxiety, and cellular immunity and doctors’ empathy.
Results: At the three time points, all three psychological indicators of the patients were statistically significant. Among the immune indices, only the change in the percentage of NK cells (NK subset) was statistically significant, while the changes in the percentages of CD3+, CD4+, CD8+, and B cells were not statistically significant. The doctors’ empathy showed negative relationships with patients’ stigma and anxiety and a positive relationship with patients’ self-efficacy. Patients’ stigma and anxiety were negatively associated with NK subset, while patients’ self-efficacy showed a positive relationship with NK subset. Anxiety was positively related to stigma and negatively related to self-efficacy. Therefore, the effect of the doctors’ empathy on the patients’ NK subset was mediated by the patients’ stigma, self-efficacy, and anxiety.
Conclusion: Doctors’ empathy affected the NK subset in advanced prostate cancer patients and was related to the patients’ stigma, self-efficacy, and anxiety. In addition, anxiety directly affected stigma and self-efficacy. Thus, medical staff should focus on improving their empathy toward patients. Interventions that focus on patients’ anxiety, stigma, and self-efficacy may be helpful to improve immunity.

Keywords: empathy, prostate cancer, doctor, cellular immunity, stigma, self-efficacy, anxiety

A Letter to the Editor has been received and published for this article.


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