• Ningxi Yang, Han Xiao, Wei Wang, Shiyue Li, Hong Yan, and Yifang Wang.
• Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China, lsywhd@sina.com.
• Patient Prefer Adher. 2018 Jan 1; 12: 1305-1314.

BackgroundThe 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 MethodsData 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.ResultsAt 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.ConclusionDoctors' 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.

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