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(Howick + 2018)*

Meta Study

Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis
  •  Jeremy Howick
  •  Andrew Moscrop
  • Alexander Mebius
  • Thomas R Fanshawe
  • George Lewith
  • Felicity L Bishop
  • Patriek Mistiaen
  • Nia W Roberts 
  • Egle_ Dieninyte
  •  Xiao-Yang Hu
  • Paul Aveyard
  •  Igho J Onakpoya

Summary 

Background: 
Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised

Objective: 
To estimate the effects of empathy and expectations interventions for any clinical condition.

 Design: 
Systematic review and meta-analysis of randomised trials. 

Data sources: 
Six databases from inception to August 2017. 

Study selection: 
Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older.

 Review methods:
 Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis.

 Results: 
We identified 28 eligible (n ¼ 6017). 

In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference 0.18 [95% confidence interval 0.32 to 0.03]). 

Twenty-two trials tested the effects of positive expectations. 
Eighteen of these (n ¼ 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference 0.43 [95% confidence interval 0.65 to 0.21]); 11 (n ¼ 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference 0.18 [95% confidence interval 0.32 to 0.05]). Within 11 trials (n ¼ 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. 

The main limitations were difficulties in blinding and high heterogeneity for some comparisons.

Conclusions: 
Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain.



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Communication between patients and practitioners Benefits
  • enhance diagnostic accuracy,
  •  promote patient-centred treatment decisions and
  •  improve a number of clinical outcomes ranging from treatment adherence  to safety. 
  • Good communication can also lower the risk of malpractice claims.


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