Meta Study
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.
References
* Empathy
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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.