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"The Consultation and Relational Empathy (CARE) Measure is a person-centred process measure that was developed and researched at the Departments of General Practice in Glasgow University and Edinburgh University. The CARE Measure is a quick (only 10 questions), clear and easy to complete patient-completed questionnaire. It measures empathy in the context of the therapeutic relationship during a one-on-one consultation between a clinician and a patient. Originally developed and rigorously tested for use by GPs, it has since been successfully used by other medical staff, allied health professionals (AHPs) and nurses."

The CARE Approach: A learning tool for healthcare professionals
"The Consultation and Relational Empathy (CARE) Measure is a consultation process measure has that been developed by Dr Stewart Mercer and colleagues in the Departments of General Practice at Glasgow University and Edinburgh University. It is based on a broad definition of empathy in context of a therapeutic relationship within the consultation. The wording reflects a desire to produce a holistic, patient-centred measure that is meaningful to patients irrespective of their social class, and has been developed and applied in over 3,000 general practice consultations in areas of high and low deprivation in the west of Scotland.

The scoring system for each item is ‘poor’=1, ‘fair’ = 2, ‘good’ = 3, ‘very good’ = 4, and ‘excellent’= 5. All ten items are then added, giving a maximum possible score of 50, and a minimum of 10. Up to two ‘Not Applicable’ responses or missing values are allowable, and are replaced with the average score for the remaining items. Questionnaires with more than two missing values or ‘Not Applicable’ responses are removed from the analysis.

The theoretical background and validation of the CARE measure can be found in:

  • Mercer SW, McConnachie A, Maxwell M, Heaney DH, and Watt GCM. Relevance and performance of the Consultation and Relational Empathy (CARE) Measure in general practice. Family Practice 2005, 22 (3), 328-334 
  • Mercer SW, Watt, GCM, Maxwell M, and Heaney DH. The development and preliminary validation of the Consultation and Relational Empathy (CARE) Measure: an empathy-based consultation process measure. Family Practice 2004, 21 (6), 699- 705 
  • Mercer SW and Reynolds W J. Empathy and quality of care. BJGP 2002, 52 (Suppplement); S9-S12."

The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure
"In this paper, we have reported the development and preliminary validation of a new process measure based on a broad definition of clinical empathy, in the context of the clinical encounter. We have called this the CARE measure. The aim of this measure is to provide a tool for the evaluation of the quality of consultations in terms ofthe ‘human’ aspects of medical care
How was the doctor at.…

1. Making you feel at ease
2. Letting you tell your story
3. Really listening
4. Being interested in you as a whole person
5. Fully understanding your concerns
6. Showing care and compassion
7. Being positive
8. Explaining things clearly
9. Helping you to take control
10. Making a plan of action with you"

Please rate the following statements about today’s consultation.
Please tick one box for each statement and answer every statement.
Poor - Fair - Good - Very good - Excellent - Does not apply

1) Making you feel at ease…
(being friendly and warm toward you, treating you with respect; not cold or abrupt)

2) Letting you tell your “story”…
(giving you time to fully describe your illness in your own words; not interrupting or diverting you)

3) Really listening…
(paying close attention to what you were saying; not looking at the notes or computer as you were talking)

4) Being interested in you as a whole person…
(asking/knowing relevant details about your life, your situation; not treating you as just a number)

5) Fully understanding your concerns…
(communicating that he/she had accurately understood your concerns; not overlooking or dismissing anything)

6) Showing care and compassion…
(seeming genuinely concerned, connecting with you on a human level; not being indifferent or “detached” )

7) Being positive…
(having a positive approach and a positive attitude; being honest but not negative about your problems)

8) Explaining things clearly…
(fully answering your questions, explaining clearly, giving you adequate information; not being vague)

9) Helping you to take control…
(exploring with you what you can do to improve your health yourself; encouraging rather than “lecturing” you)

10) Making a plan of action with you…
(discussing the options, involving you in decisions as much as you want to be involved; not ignoring your views)


Reliability and validity of the Dutch version of the Consultation and Relational Empathy Measure in primary care
Inge van Dijk +

Background. Empathy is an essential skill in doctor–patient communication with positive effects on compliance, patient satisfaction and symptom duration. There are no validated patient-rated empathy measures available in Dutch.

Objective. To investigate the validity and reliability of a Dutch version of the Consultation and Relational Empathy (CARE) Measure, a widely used 10-item patient-rated questionnaire of physician empathy.

Methods. After translation and back translation, the Dutch CARE Measure was distributed among patients from 19 general practitioners in 5 primary care centers. Tests of internal reliability and validity included Cronbach’s alpha, item total correlations and factor analysis. Seven items of the QUality Of care Through the patient’s Eyes (QUOTE) questionnaire assessing ‘affective performance’ of the physician were included in factor analysis and used to investigate convergent validity.

Results. Of the 800 distributed questionnaires, 655 (82%) were returned. Acceptability and face validity were supported by a low number of ‘does not apply’ responses (range 0.2%–11.9%). Internal reliability was high (Cronbach’s alpha 0.974). Corrected item total correlations were at a minimum of 0.837. Factor analysis on the 10 items of the CARE Measure and 7 QUOTE items resulted in two factors (Eigenvalue > 1), the first containing the CARE Measure items and the second containing the QUOTE items. Convergent construct validity between the CARE Measure and QUOTE was confirmed with a modest positive correlation (r = 0.34, n = 654, P < 0.001).

Conclusion. The findings support the preliminary validity and reliability of the Dutch CARE Measure. Future research is required to investigate divergent validity and discriminant ability between doctors."