TCOM student has article published in the British Journal of General Practice
Student doctor Naomi Fortier co-authored an original research article entitled “Association
of Clinical Empathy with Suicidal Ideation Among Patients with Chronic Pain: Target
Trial Emulation,” which was published today in the British Journal of General Practice.
The research was conducted under the direction of John Licciardone, DO, MS, MBA, regents
professor in the Texas College of Osteopathic Medicine at UNT Health Fort Worth, along
with Subhash Aryal, PhD, professor at Johns Hopkins University.
Fortier was invited to participate in the TCOM Honors Research Practicum in Fall 2024
because of her standing in the top 10 percent of the class. As the outstanding student
during the practicum, she was then offered the opportunity to work on this study involving
clinical empathy and suicidal ideation. She completed the Summer Program in Clinical
Research sponsored by the Osteopathic Research Center at UNT Health earlier in the
year and published another article based on that research experience.
This research involved 370 patients selected from over 2,400 patients in the Pain
Registry for Epidemiological, Clinical, and Interventional Studies and Innovation
(PRECISION), which was established by the Osteopathic Research Center in 2016. The
novel study design known as “target trial emulation” enabled the research team to
test a hypothesis in a manner that would not have been feasible or ethical in a clinical
trial.
Using data reported by patients on the Consultation and Relational Empathy measure
and the Pain Catastrophizing Scale, the study found that chronic pain patients treated
by more empathic physicians were less likely to feel helpless. Correspondingly, they
reported 40% less suicidal ideation over 12 months than control patients who were
treated by less empathic physicians.
The need for empathy is a common theme reported by suicide attempt survivors. Only
recently has clinical empathy been recognized as a strategy for creating a therapeutic
alliance with patients. The findings of this target trial emulation underscore the
need for more research, including whether clinical empathy may also decrease the risk
of suicide attempts and completed suicides.
“This research is very meaningful to me because many people in the world die by suicide
every day,” Fortier said. “I am privileged to participate in research that works toward
reducing these deaths by investigating practical ways to prevent suicidal ideation
in vulnerable patients. I am especially grateful that this research is being published
in a journal focused on general practitioners, who often treat patients with chronic
pain. I hope this research will remind them of how important it is to show empathy
to every patient they treat because it has measurable impact on their health.”
“It is very rewarding to see students such as student doctor Fortier take advantage
of the various clinical research training opportunities that we provide at the ORC,”
said Licciardone, who is executive director of the Osteopathic Research Center. “She
also co-authored another article on race and social determinants of health along with
her fellow student research team members in our summer program using PRECISION data.”
The PRECISION registry uses a digital research platform with electronic data capture
to study the epidemiology and treatment of chronic pain across the United States.
Such digital technologies have the potential to greatly expand access to research
by bringing study activities directly to participants, especially in rural areas or
regions with limited research infrastructure. These technologies are also making clinical
research much less costly in many cases, which is very important in facilitating TCOM
student research.
“The number of enrolled research patients nationwide coupled with the breadth of research
instruments used by the PRECISION registry has enabled TCOM students in our ORC training
programs to undertake a variety of research projects beyond our legacy research in
osteopathic medicine,” Licciardone said. “This has led to remarkable success in publishing
their research in such journals as the British Journal of General Practice.”
“I am very grateful to have participated in a project that is published in a peer-reviewed journal,” Fortier said. “Not every student gets that opportunity, so I am excited to get to contribute work that can be read and utilized by physicians and researchers around the world. I also see this experience as good preparation for residency and beyond, as I have also learned a lot about communication, teamwork, and perseverance as well as the fundamentals of doing research.”