Improving Empathy in Healthcare Consultations—a Secondary Analysis of Interventions

Abstract

A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was “Instruction on how to perform behaviour” (e.g. a video demonstration, n = 5), followed by “Credible source” (e.g. delivered by a psychologist, n = 4) and “Behavioural practice” (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice.

The Effects of Physicians’ Communication and Empathy Ability on Physician–Patient Relationship from Physicians’ and Patients’ Perspectives

“…Based on the results of this study, the construction of a harmonious physician-patient relationship should be carried out in conjunction with the physicians' and patients' evaluations of physician empathy and physician communication. First, to improve physician-patient relationship from the physicians' perspective, we should focus on the ability of perspective-taking in the communication process and improve physician communication through the improvement of the ability of perspective-taking, such as role-playing (Armstrong, 2001;Green, 2002;Smith et al, 2020), and subsequently promote the physician-patient relationship. Second, to improve the physician-patient relationship from the patients' perspective, we should focus on both physicians' perspective-taking and empathic concern abilities through more enriching methods, such as face-to-face training, roleplaying, and simulation games (Bas-Sarmiento et al, 2020;Smith et al, 2020).…”

“…First, to improve physician-patient relationship from the physicians' perspective, we should focus on the ability of perspective-taking in the communication process and improve physician communication through the improvement of the ability of perspective-taking, such as role-playing (Armstrong, 2001;Green, 2002;Smith et al, 2020), and subsequently promote the physician-patient relationship. Second, to improve the physician-patient relationship from the patients' perspective, we should focus on both physicians' perspective-taking and empathic concern abilities through more enriching methods, such as face-to-face training, roleplaying, and simulation games (Bas-Sarmiento et al, 2020;Smith et al, 2020). These trainings should include providing explanations of treatment, providing non-specific empathic responses, such as expressing understanding and nonverbal behaviors to improve the physicians' communication skills based on their empathic abilities, thus promoting the physician-patient relationship.…”

Developing a tool to assess technical skills in talented youth table tennis players—a multi-method approach combining professional and scientific literature and coaches’ perspectives

“…Since the archives of the trainers' association covered only professional literature with a narrative approach, the extraction of characteristics was limited to publication year and country for these articles. After this formal analysis, all articles identified in the archive searches were subject to a qualitative content analysis [40,41]. Papers were read and systematically searched in detail to distil elements for the assessment of technique, the focus on certain strokes, and their directions for flawed and excellent executions of technical skills.…”

“…The method set-up refers to the ecological validity and task representativeness, dividing "experimental" (i.e., lab settings, often using isolated actions) and "competition" (i.e., (video) analysis of real matches) methods. After this formal analysis, all articles identified in the systematic searches were subject to a qualitative content analysis [40,41].…”

Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations

“…A recent systematic review and meta-analysis identified 28 studies that trained healthcare practitioners in clinical empathy and/or positive messages ( 24 ). We conducted a secondary analysis of the seven empathy interventions from that review, aiming to identify effective components of existing training to enhance clinical empathy for healthcare practitioners ( 40 ). We also conducted a secondary analysis of the 22 positive messages interventions from that review, aiming to identify effective ways of imparting positive messages that could be used by healthcare practitioners to communicate realistic optimism in clinical practice ( 41 ).…”