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

Figures & data

Table 1 Patients’ demographics and disease conditions

Variable	Number	%
Educational background
Primary school or below	42	24
Junior middle school	77	44
Senior middle school	44	25.1
College or above	12	6.9
Marital status
Unmarried	3	1.7
Married	152	86.9
Divorced or widowed	20	11.4
Home place
Countryside	58	33.1
County town	30	17.2
Urban area	87	49.7
Monthly family income per capita (yuan)
<3,000	64	36.6
3,000–5,000	87	49.7
>5,000	24	13.7
Medical insurance
Private health care provision	39	22.3
Social security or commercial insurance	93	53.1
New rural cooperative medical system	35	20
Socialized medicine	8	4.6
Self-evaluation family relationship
Poor	38	21.7
General	65	37.1
Good	72	41.2
Tumor metastasis
Yes	81	46.3
No	94	53.7
Long-term drinking
Yes	13	7.4
No	162	92.6
Smoking
Yes	52	29.7
No	123	70.3
Insomnia
Yes	13	7.4
No	162	92.6

Table 2 Comparison of cellular immune indices and psychological indicators of patients at admission, after 14 days, and after 3 months

%	At admission	After 14 days	After 3 months	F	P-value
CD3	58.818±7.209	59.314±6.543	60.032±6.878	1.369	0.255
CD4	34.482±6.323	35.122±5.557	34.721±6.022	0.512	0.599
CD8	28.346±6.127	29.010±6.262	28.872±7.021	0.504	0.606
B	7.648±2.141	8.081±2.330	8.172±1.961	2.928	0.054
NK	16.823±7.112	19.313±8.442	21.778±8.136	18.670	<0.0001
Anxiety	15.429±4.872	18.12±5.218	11.269±5.618	75.750	<0.0001
Self-efficacy	67.691±13.558	60.352±14.869	68.326±15.860	15.720	<0.0001
Stigma	68.123±14.321	72.652±15.501	63.303±16.495	16.000	<0.0001

Note: Data presented as mean ± SD.

Table 3 The effects of demographics and disease on the patients’ NK activity

	β	Standard error	t	P-value
Constant term	18.862	7.775	2.430	0.016
Age	−0.023	0.074	−0.320	0.753
Hospitalization days	0.448	0.733	0.610	0.542
Difference value of NK	1.136	0.174	6.520	<0.0001
Education (reference group: primary school or below)
Junior middle school	−0.790	1.552	−0.510	0.612
Senior middle school	0.117	1.984	0.060	0.953
College or above	−0.014	2.858	0.004	0.996
Marriage (reference group: unmarried)
Married	−4.166	4.416	−0.940	0.347
Divorced or widowed	−2.397	4.758	−0.500	0.615
Home place (reference group: countryside)
County town	−0.710	2.229	−0.320	0.751
Urban area	−2.679	2.335	−1.150	0.253
Monthly family income per capita (yuan) (reference group: <	3,000 yuan)
3,000–5,000	0.181	1.642	0.110	0.913
>5,000	−2.003	2.142	−0.930	0.351
Medical insurance (reference group: private health care provision)
Social security or commercial insurance	3.367	1.771	1.900	0.059
New rural cooperative medical system	0.690	2.038	0.340	0.736
Socialized medicine	−1.198	2.959	−0.400	0.686
Self-evaluation family relation (reference group: poor)
General	1.105	1.628	0.680	0.498
Good	1.402	1.826	0.770	0.444
Transfer (reference group: no)
Yes	−0.239	1.353	−0.180	0.860
Long-term drinking (reference group: no)
Yes	0.280	2.259	0.120	0.902
Smoking (reference group: no)
Yes	−3.741	1.250	−2.990	0.003
Insomnia (reference group: no)
Yes	0.183	2.146	0.090	0.932

Table 4 The correlations among doctors’ empathy and patients’ stigma, self-efficacy, anxiety, and NK subset

Item	Score	Empathy	Self-efficacy	Stigma	Anxiety	NK subset
Empathy	102.740±13.356	1
Self-efficacy	68.990±15.345	0.542*	1
Stigma	63.30±16.495	−0.648*	−0.613*	1
Anxiety	11.270±5.618	−0.643*	−0.690*	0.669*	1
NK subset	21.778±8.136	0.508*	0.654*	−0.610*	−0.688*	1

* Note: P<0.01.

Figure 1 The model of relationships among doctors’ empathy abilities and patients’ stigma, self-efficacy, anxiety, and NK subset.

Abbreviations: MIPA, maintaining independence and positive attitude; PMC, participating in medical care; CSM, coping and stress management; MA, managing affect; SPS, standing in the patient’s shoes; PK, perspective taking; CC, compassion care; SR, social rejection; FI, financial insecurity; IS, internalized shame; SI, social isolation.

Table 5 Normalized path coefficients

Path	Normalized path coefficient	SE	CR	P-value
Doctors’ empathy → patients’ stigma	−0.616	0.558	−5.079	<0.001
Doctors’ empathy → patients’ self-efficacy	0.371	0.278	3.411	<0.001
Doctors’ empathy → patients’ anxiety	−0.728	0.431	−7.674	<0.001
Patients’ anxiety → stigma	0.264	0.097	2.747	0.006
Patients’ anxiety → self-efficacy	−0.482	0.056	−4.882	<0.001
Patients’ anxiety → NK subset	−0.264	0.136	−2.806	0.005
Patients’ stigma → NK activity	−0.208	0.121	−2.452	0.014
Patients’ self-efficacy → NK activity	0.370	0.252	3.760	<0.001

Abbreviations: CR, construct reliability; SE, standard error.

Table 6 Bootstrap indirect effects analysis of nonparametric ratios

Mediating effect	Effect	Standard error	95% CI
			Boot LLCI	Boot ULCL
Gross effect	0.315	0.043	0.240	0.410
Anxiety	0.143	0.039	0.073	0.227
Self-efficacy	0.095	0.032	0.036	0.163
Stigma	0.077	0.045	0.005	0.176

Abbreviations: LLCI, lower level confidence level; ULCL, upper level confidence level.

Table 7 Direct effects of doctors’ empathy on patients’ NK activity

Mediating effect path	Effect	Standard error	LLCI	ULCL
Empathy → NK subset	−0.006	0.044	−0.093	0.082

Abbreviations: LLCI, lower level confidence level; ULCL, upper level confidence level.