(Vassilios + 2016)*

Empathy promoting interventions for health professionals: a systematic review of RCTs

DOI or Website Link:

Publication: Journal of Compassionate Health Care2016

Authors:

• Vassilios N. Kiosses,

• Vassilios T. Karathanos and

• Athina Tatsioni

Citation:

Comments:

Meta-analysis of 17 papers

Abstract:

Purpose

Authors assessed systematically the effectiveness of interventions aiming at health professionals’ increase of empathic responses.

Method

Authors searched Pubmed, Cochrane Database of Clinical Trials, Scopus, and PsycInfo for randomized controlled trials (RCTs) (latest search on November 2012). They included trials in English that evaluated interventions, which may promote empathy in health professionals. Studies were categorized according to the type of the outcome on empathy (attitude or opinion, knowledge or skills, and behavior).

Authors considered change in empathy as the main outcome. Standardized mean differences (SMD) with 95 % confidence interval (95 % CI) were calculated for the studies that provided adequate data. Primary analysis included all the studies that provided adequate data per outcome category. In addition, authors proceeded in subgroup analyses for the following groups

• (a) type of intervention (experiential vs. non-experiential;

• (b) training specifically for promoting empathy vs. other;

• (c) type of assessor (external observer, health professional participants, and patients); and

• (d) type of process used for empathy evaluation, (simulated interview, actual interview, and questionnaire completion without interview).

Results

Out of 722 items, 17 articles were eligible. ..

Conclusion

There are interventions, which may contribute to a significant improvement in empathic behavior among health professionals. However, the type of intervention that would be effective needs to be supported by future studies. Whether empathic behavior may last, or whether it may affect patients’ outcomes is yet to be defined.

Quotes: (Any pithy quotes)

Topic Area: (In which field / sector / perspective was this study conducted?)

• • healthcare

Definition: (How was empathy defined?)

"The ambiguity associated with the definition of empathy obstructs investigators to clearly see what they intend to study, and hinders their ability of how to measure it in the context of patient care.

"a multidimensional concept involving at least three factors:

• “perspective taking,”

• “compassionate care,”

• “standing in the patient’s shoe”

"Clinical empathy includes understanding the patient’s situation, perspective and feelings as well as their attached meanings; communicating understanding and checking its accuracy; and acting on that understanding with the patient in a therapeutic way "

Benefits: (Were any benefits of empathy mentioned?)

positive attributes, including

• dutifulness,

• prosaic behavior,

• moral reasoning,

• reduced malpractice litigation,

• improved history taking and physical examination,

• patient satisfaction,

• physician satisfaction,

• improved therapeutic relationships,

• and overall improved clinical outcomes

Criticisms (Were any criticisms, negative effects or risks of empathy mentioned?)

"Moreover, reduced empathy may sometimes allow physicians to complete clinical tasks more accurately [17, 18]. In certain clinical contexts, such as surgery [14] or oncology, is argued that keeping an emotional distance from patients maintains clinical neutrality [19] while being empathic has a psychological cost for health care professionals [20, 21], which can lead to ‘compassion fatigue’ [22]."

Methods: (What were the methods used to train empathy?)

Target Group: (Who participated in this study / training?)

• • healthcare profession

Measurements: (About the assessment: How was the change in empathy measured before/after the intervention/method?)

• • simulated interview,

  • actual interview,

  • questionnaire completion without interview

  • Attitude towards empathy: Jefferson Scale of Physician Empathy

• Physician’s knowledge of the neurobiology and physiology of empathy: Neurobiology and Physiology of Empathy Test

• MITI 3.0 behavioral coding system Global Scores: Empathy

• Basic empathy subscale

• CRCWEM rated utterances directed to patients

• “distress” words: Frequency score

• Number of empathic statements per conversation

• “anxiety” words: Density score

• Carkhuff scale

• Perceived Empathy Scale

  • Patient perception of physician’s empathy

  • Affect Sensitivity Scale

• GRS - Global Rating Score,

• SPIR - Staff-Patient Interaction Rating Scale,

• Likert scale

• BEES - Balanced Emotional Empathy Scale

• ECCS - Empathy Communication Coding System,

• MCI - Medical Communication Index,

• HRI - Helping Relationship Inventory

• PPRI - Physician—Patient Relationship Inventory

• CARE - Consultation and Relational Empathy Measure

Result: (What was the result?)

• • health professionals in intervention group improved empathic behavior

Posted By:

Notes: (Any other relevant information)

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(BLAIRE-IRVINE + 2012)

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(BONVICINI + 2009)

Bonvicini KA, Perlin MJ, Bylund CL, Carroll G, Rouse RA, Goldstein MG. Impact of communication training on physician expression of empathy. Pat Ed Couns. 2009;75:3–10.

View Article Google Scholar

(BUTOW + 2008)

Butow P, Cockburn J, Girgis A, et al. Increasing oncologists’ skills in eliciting and responding to emotional cues: evaluation of a communication skills training program. Psych-Oncology. 2008;17:209–18.

View ArticleGoogle Scholar

(DAEPPEN + 2011)

Daeppen JB, Fortini C, Bertholet N, et al. Training medical students to conduct motivational interviewing: A randomized controlled trial. Pat Ed Couns. 2012;87:313–8.

View ArticleGoogle Scholar

(DANIELS + 1988)

Daniels T, Denny A, Andrews D. Using microcounseling to teach RN students skills of therapeutic communication. J Nurs Ed. 1988;27(6):246–52.

Google Scholar

(DELVAUX + 2005)

Delvaux N, Merckaert I, Marchal S, et al. Physicians’ communication with cancer patient and a relative: A randomized study assessing the efficacy of consolidation workshops. Cancer. 2005;103(11):2397–411.

View ArticlePubMedGoogle Scholar

(FALLOWFIELD + 2002)

Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy of a cancer research UK communication skills training model for oncologists: A randomized controlled trial. The Lancet. 2002;359:650–6.

View ArticleGoogle Scholar

(JENKINS + 2002)

Jenkins V, Fallowfield L. Can communication skills training alter physicians’ beliefs and behavior in clinics. J Clin Onc. 2002;20(3):765–9.

View ArticleGoogle Scholar

(RASK + 2009)

Rask MT, Jensen ML, Andersen J, Zachariae R. Effects of an intervention aimed at improving nurse- patient communication in an oncology outpatient clinic. Cancer Nursing. 2009;32:E1–11.

(Razavi 2002)

(RIESS 2012)

Riess H, Kelley JM, Bailey R, Dunn EJ, Phillips M. Empathy training for resident physicians: A randomized trial of a neuroscience- informed curriculum. J Gen Intern Med. 2012;27(10):1280–6.

View ArticlePubMedPubMed CentralGoogle Scholar

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Robbins AS, Kauss DR, Heinrich R, Abrass I, Dreyer J, Clyman B. Interpersonal skills training: Evaluation in an internal medicine residency. J Med Ed. 1979;54:885–94.

Google Scholar

(SHAPIRO + 2004)

Shapiro J, Morrison EH, Boker JR. Teaching empathy to first year medical students: Evaluation of an elective literature and medicine. Education Health. 2004;17(1):73–84.

View ArticleGoogle Scholar

(SHAPIRO +2009)

Shapiro SM, Lancee WJ, Richard-Bentley CM. Evaluation of a communication skills program for first- year medical students at the University of Toronto. BMC Medical Education. 2009;9:11.

(SMITH 1995)

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(TULSKY 2011)

Tulsky JA, Arnold RM, Alexander SC, et al. Enhancing communication between oncologists and patients with a computer-based training program. Ann of Int Med. 2011;155:593–601.

View ArticleGoogle Scholar

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