Improving empathy in healthcare consultations - a secondary analysis of interventions

Kirsten A Smith, Lucy Yardley, et al.

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A recent systematic review of randomized 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), 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.
Original languageEnglish
Number of pages8
JournalJournal of General Internal Medicine
Publication statusPublished - 14 Jul 2020

Bibliographical note

The EMPATHICA trial is supported by a National Institute for Health Research (NIHR) School for Primary Care Research (project number 389). The Primary Care Department is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. MR is an NIHR School for Primary Care Research funded ACF. HDM is funded through an NIHR Clinical Lectureship. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The research programme of LY and LM is partly supported by the NIHR Southampton Biomedical Research Centre (BRC).
This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, HEE or the Department of Health. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Structured keywords

  • Physical and Mental Health


  • Empathy
  • Communication
  • consultations

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