A systematic review of research on empathy in health care

How obstetricians experience stillbirth and perinatal loss: a systematic review and meta-synthesis

Objective

Globally, ∼2 million babies are stillborn annually, many in low- and middle-income countries. We aim to understand the experience of obstetricians caring for parents who experience stillbirth and perinatal loss across global settings.

Data Sources

: Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsychINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via Proquest were searched, database inception-June 2024.

Study Eligibility Criteria

Studies with qualitative components describing experiences of obstetricians providing stillbirth care in any global setting.

Study Appraisal and Synthesis Methods

The Critical Appraisal Skills Programme checklist for qualitative research was utilized to conduct quality assessment. NVivo software was employed for inductive coding and thematic analysis.

Results

Thirteen qualitative studies from both low- and high-resource settings met the inclusion criteria for meta-synthesis. We identified several major themes including the emotional burdens experienced by obstetricians providing stillbirth care, the challenges of patient-provider interactions following adverse outcomes, and a lack of support and resources. Obstetricians across global settings felt devastation, guilt, blame, and a sense of personal responsibility following stillbirth. Obstetricians struggled to navigate the burden of expectation placed on their overall provision of care and tended to question their own professional competence. A subset of obstetricians felt unprepared for the complexity of patient-provider interactions following stillbirth.

Conclusions

Obstetricians experienced complex and conflicting emotions, citing high emotional burden from managing stillbirth cases. Obstetricians identified lack of training and support for providing bereavement care across healthcare settings, indicating a gap that should be filled by stillbirth and bereavement care interventions and education in obstetrical training programs across global settings. Infrastructure for bereavement care training and support systems for obstetricians are crucial to improve the quality of stillbirth and perinatal loss care and prevent an exodus of needed providers for women's care worldwide.

An Evaluation of co-Delivered Foundational BPD Training With Health Service Staff

Individuals with Borderline Personality Disorder (BPD) are frequent users of mental health services and may be perceived negatively by mental health professionals. Educational training has been associated with improved attitudes towards individuals with this diagnosis, but few interventions have been delivered in collaboration with lived experience experts. This study evaluated an educational intervention for mental health professionals that was delivered with lived experience experts. The impact of the training on staff attitudes, namely personal competence, empathy and treatment optimism was examined. Professionals in South Australian public sector health and community-based services attended a 1-day training on Foundation Skills for working with individuals with BPD. Each session was co-delivered with a lived experience expert. Participants (N = 694) completed a brief survey to assess staff attitudes, namely personal competence, empathy and treatment optimism towards people with BPD pre- and post-training. They also provided open-ended feedback about what they liked most and least about the training. Personal competence, empathy and treatment optimism were significantly improved post-training. Participant characteristics related to experience and familiarity with BPD were key factors associated with training outcomes. The findings provide support for training delivered collaboratively with lived experience experts. Further research is needed to determine to what extent the lived experience perspective contributed to training outcomes.

The impact of an empathy education programme on empathy, communication skills and emotional competency in nursing students: A quasi-experimental study

AIMS

This study aimed to evaluate the impact of an empathy education programme on the empathy, communication skills and emotional competency of fourth-year undergraduate nursing students in Korea.

BACKGROUND

Empathy is crucial for building rapport with patients and supporting person-centred care. There is a need to integrate a sustainable empathy education programme into the nursing curriculum.

DESIGN

This quasi-experimental study assigned 50 fourth-year nursing students from two universities in Korea to experimental and control groups.

METHODS

The experimental group was exposed to an 8-week empathy programme, with 90-minute weekly sessions. The program included self-understanding, understanding others and therapeutic communication skills. Data were collected via questionnaires on empathy, communication skills and emotional competency at baseline, post-test and follow-up.

RESULTS

The experimental group showed significant improvements in empathy, communication skills and emotional competency, with a sustained impact at the four-week follow-up.

CONCLUSION

The empathy education programme effectively enhanced empathy, communication and emotional competency in nursing students, serving as a valuable educational tool at the undergraduate level.

Validity and reliability study of the Turkish version of the Empathy Quotient- 8 in Turkish university students

BACKGROUND

Empathy is an important psychological construct that plays a significant role in social interactions, mental health, and well-being. Despite the significance of empathy in psychological research and mental health, there is a lack of validated and concise measures available in Turkish.

OBJECTIVE

This study aims to evaluate the psychometric properties of the eight-item Empathy Quotient (EQ- 8) in Turkish university students, assessing its reliability, convergent validity, and factor structure. Therefore, we seek to determine its suitability for use in psychological and mental health research within Turkish-speaking populations.

METHODS

We collected the data from two groups. The data of the first group (N = 198) was used to test the factor structure of the EQ- 8 by randomly splitting the data into two halves. The first half was used for the exploratory factor analysis (EFA), and the second half was used for confirmatory factor analysis (CFA), while the second group (N = 47) was carried out to test the reliability of EQ- 8.

RESULTS

The results of the EFA and CFA yielded a one-factor solution for the EQ- 8. The internal consistency reliability was found to be good in both subsamples. Test-retest reliability was established as.86. As to the convergent validity, the scores on EQ- 8 were significantly positively related to the scores of the Toronto Empathy Questionnaire.

CONCLUSIONS

These results provide support for the Turkish version of the EQ- 8 as a psychometrically sound instrument for measuring empathy. These results contribute to cross-cultural research and the evaluation of interventions targeting empathy.

Empathy Increased in Rural and Remote Health and Social Care Workers by Participation in the Hearing Voices That Are Distressing Simulation Workshop

Evidence suggests that health care workers are often uncomfortable talking with people about hearing voices, despite recommendations that voice-hearers be provided with opportunities to freely discuss their experiences. Moreover, in rural and remote Australia, workforce shortages mean that a broader range of workers, often non-specialists, are providing services for people with complex mental health presentations. Improving the skills of this non-specialist workforce is therefore an important endeavour. The Hearing Voices that are Distressing (HVD) simulation workshop was originally developed by voice-hearers and provides participants with first-hand experience of what it might be like to hear voices that are distressing. HVD simulation workshops were delivered by a mental health academic, a mental health clinician, and a person with lived experience to 62 health and social care workers in rural South Australia. Mixed methods were used to examine the impact of the workshop on participants' level of empathy for people who hear distressing voices. The revised Kiersma-Chen Empathy Scale assessed changes in empathy, and post-simulation reflective group discussions were qualitatively analysed. Statistically significant increases in empathy were reported following participation in the simulation (p's < 0.001). Participants reflected that having practical experience helped them develop deeper understanding of the impact hearing distressing voices has on a person's day-to-day life; how they may be preoccupied with their internal world; impacting their concentration and engagement with others. Results indicated that this training would be highly valuable for health and social care workers, and particularly generalist workers in rural settings where resources are stretched.

The effect of comics and Interprofessional community dialogue on health humanities, empathy, and communication among healthcare students

BACKGROUND

Healthcare providers' health humanities, empathy, and communication effectiveness positively correlate with care recipient outcomes. These abilities can be enhanced by teaching design courses. In particular, comics and community dialogues are suitable for cultivating professional students' abilities. However, this method has not yet been used in studies involving healthcare professional students.

OBJECTIVES

This study develops a Comics and Interprofessional Community Dialogue (CICD) action programme for healthcare professional students to be used during emotion management courses and to evaluate the effects of this programme on changes in students' health humanities competence, empathy, and communication effectiveness. An additional aim is to determine the predictors of effective communication.

METHODS

A single-group longitudinal study is conducted with professional healthcare students recruited from a medical university. The students completed three questionnaires: the Health Humanities Competence Scale, the Jefferson Scale of Empathy, and the Communication Effectiveness Profile at the beginning of the semester (Time 1), mid-semester (Time 2), and the end of the semester (Time 3). Changes in the scores for each questionnaire are analysed using generalised estimation models.

RESULTS

The study's findings show that at Time 3, communication effectiveness is significantly higher than at Times 1 and 2 and is positively related to empathy and health humanities competence. These results indicate that a CICD action programme improves healthcare professional students' communication effectiveness and that students' empathy and health humanities affect their communication competence.

CONCLUSION

Health humanities competence and empathy are enhanced with a CICD, which helps healthcare professional students improve their communication effectiveness. Furthermore, the semester period, empathy, and health humanities competencies are predictors of healthcare professional students' communication effectiveness competencies.

Assessing virtual patients for empathy training in healthcare: A scoping review

OBJECTIVE

A growing body of virtual patients (VPs) generated by computers has been incorporated into medical education that includes empathy training. We sought to uncover the validity and effectiveness of VPs in empathy training.

METHOD

The authors carried out a comprehensive search of all articles published between 1991 and 2023 in the seven databases of literature in the areas of health science and education. In total, 2170 abstracts were reviewed, and ultimately, the final corpus consisted of 44 articles.

RESULTS

Guided by the Computer-as-social-actor framework, this study identified four types of primary social cues presented in current literature to arouse trainees' social responses. Overall, the social cues used across the included studies were similar. However, the efficacy and effectiveness of VPs varied, and we identified four factors that may influence these outcomes. First, technology matters. VPs for VR systems were found to be effective in clinical empathy training, but limited empirical evidence supported web-or-mobile-based VPs. Second, improvement was only observed in the cognitive empathy dimension. Third, studies that have longer interaction duration (over 30 minutes). Last, using self-report measurements were more likely to observe significant improvements. Qualitative findings revealed that VPs for VR systems can create an immersive experience that allows users to understand the needs of patients and put themselves in patients' shoes, while web-or-mobile-based VPs are more convenient for trainees.

PRACTICAL IMPLICATIONS

This review displays evidence supporting the efficacy and effectiveness of VPs in future medical empathy training. Mechanisms and future research agendas were discussed.

CONCLUSION

VPs are promising tools for future empathy training.

Toward Safe and Ethical Implementation of Health Care Artificial Intelligence: Insights From an Academic Medical Center

Claims abound that advances in artificial intelligence (AI) will permeate virtually every aspect of medicine and transform clinical practice. Simultaneously, concerns about the safety and equity of health care AI have prompted ethical and regulatory scrutiny from multiple oversight bodies. Positioned at the intersection of these perspectives, academic medical centers (AMCs) are charged with navigating the safe and responsible implementation of health care AI. Decisions about the use of AI at AMCs are complicated by uncertainties regarding the risks posed by these technologies and a lack of consensus on best practices for managing these risks. In this article, we highlight several potential harms that may arise in the adoption of health care AI, with a focus on risks to patients, clinicians, and medical practice. In addition, we describe several strategies that AMCs might adopt now to address concerns about the safety and ethical uses of health care AI. Our analysis aims to support AMCs as they seek to balance AI innovation with proactive oversight.

Exploring Nursing Students' Experiences of Empathy and User Experiences in an Immersive Virtual Reality Simulation Game: Cross-Sectional Study

BACKGROUND

Empathy is associated with better clinical outcomes and patient-care experiences, and it has been demonstrated that training can improve nursing students' empathy. The use of virtual reality (VR) as an experiential learning strategy may increase the empathetic behavior of caregivers. Although much research exists on the use of VR in education, there is still little research on learning empathy in nursing education through immersive VR games that include a head-mounted display and hand controllers. In addition, it is important to study both learning and user experiences in nursing education that utilizes VR technology.

OBJECTIVE

This study aims to explore nursing students' experiences of empathy and user experiences in an immersive VR simulation game.

METHODS

A cross-sectional design was used. A total of 52 graduating nursing students from 3 universities of applied sciences in Finland participated in the study. The immersive VR simulation game employed in the study was played with a head-mounted display and hand controllers. The instruments used were the Basic Empathy Scale in Adults (BES-A) before the VR simulation gaming session and the Comprehensive State Empathy Scale (CSES) and AttrakDiff 2.0 Scale after the session.

RESULTS

The students' overall level of empathy experienced in the immersive VR simulation game was favorable (CSES; mean 2.9, SD 0.57). Participants who had a higher level of empathy (BES-A) before playing the immersive VR simulation game also experienced slightly more feelings of empathy after playing (CSES). However, the association between the measures was not statistically significant (r=0.187, P=.18). The overall empathy (CSES) experienced in the immersive VR simulation game was positively correlated with its subscales. The use of the VR simulation provided a positive user experience in all 4 factors of the AttrakDiff 2.0 Scale. Overall User Experience and Emotion Sharing correlated negatively (r=-0.248, P=.042), as did Attractiveness and Emotion Sharing (r=-0.327, P=.018). Hedonic Quality Stimulation correlated negatively with Cognitive Empathy (r=-0.279, P=.045).

CONCLUSIONS

The results of this study indicate that the use of an immersive VR simulation game in nursing education as a means of increasing empathy seems promising and justified. The immersive VR simulation game offered positive user experiences, which further supported the idea of implementing it in education. However, more research is needed on what kinds of VR environments are the most effective in promoting empathy among nursing students. Furthermore, when using VR technology in learning, one should consider that the VR setting must not be too technical but rather simple, straightforward, and predictable.

Validity and reliability of the Swedish version of the Visual CARE Measure for assessing children's perceptions of nurses' empathy

The purpose of this study was to translate and validate a questionnaire to be used by children with chronic diseases during procedures. Specific research questions were as follows: Is the translated versions reliable? Is there a correlation between VCM and another questionnaire measuring discomfort to enhance the validity of VCM? The three versions of Visual CARE measure (VCM) were translated following the principles of good practice for translation and cultural adaptation of patient-reported outcome measures, according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Cognitive debriefing interviews with children, parents, and healthcare professionals were carried out. The correlation between empathy and discomfort was evaluated using DISCO-RC. The final versions of VCM were administered to children and their parents after a needle procedure or a nasal tube insertion. The Cronbach's alpha was 0.89 for the 5Q version, 0.93 for the 10Q version, and 0.96 for the 10Q-Parent version, which implies high internal consistency. The intra-class correlation was 0.623 for VCM 5Q, with a mean difference of 1.35 and an ICC of 0.767 for VCM 10Q, with a mean difference of 1.17. This is considered a good agreement between children's and their parents' assessments. A significant difference in the children's reports could be seen when experiencing high discomfort as opposed to low discomfort.

CONCLUSION

VCM is a useful Patient-Reported Experience Measure (PREM) that can help enhance the quality of care for children in a paediatric setting by capturing their perception of the empathy shown.

WHAT IS KNOWN

• Parents' by-proxy reports are not always aligned with children's self-reports. In healthcare situations, children can be hurt when they are ignored. • Research shows that empathic encounters relieve distress, improve the relationship between the patient (who could be a child) and carer, and create an open, trusting relationship.

WHAT IS NEW

• This study shows that all three versions of the Visual CARE Measure are valid for assessing children's experience of empathy shown by nurses during a procedure.. • This is one of the first studies that confirms the correlation between children's experience of nurses' levels of empathy and the child's discomfort. • This study shows that the Visual CARE Measure can support the evaluation of children's rights with regards to communication in a clinical context.

Understanding public response: Government communication during the COVID-19 crisis through the eyes of the Swiss public

Objective

To analyze the Swiss public perception of COVID-19 communication by the government and its impact on behavior and trust.

Methods

A cross-sectional representative online survey was conducted in January 2022 in a sample of 2587 Swiss residents.

Results

Overall the survey showed moderate satisfaction with communication, with relevance rated highly. Perceptions of communication varied across demographics. Also, differences were noted in trust in institutions, risk perception, and attitudes towards public health measures based on perceived communication quality.

Conclusion

This study highlights the dynamic nature of public health communication and underscores the significance of continuous adaptation and evaluation of strategies to effectively reach and influence diverse audiences. As misinformation persists, the study underscores the need for informative, empathetic, and honest communication, as well as tailored approaches to build public trust-an essential asset for managing health crises successfully.

Innovation

This study provides innovative concrete insights into how governmental communication could be designed more strategically to effectively communicate with the public in contexts characterized by disinformation, emphasizing the role of quality, honest, and empathetic communication in public health messaging.

Genetics, Epigenetics, and the Environment: Are Precision Medicine, Provider Compassion, and Social Justice Effective Public Health Measures to Mitigate Disease Risk and Severity?

Environmental forces impacting public health include exposure to toxic substances, adverse childhood experiences (ACEs), diet, and exercise. Here, we examine the first two of these forces in some detail since they may be amenable to correction through cultural, medical, and practitioner intervention. At the same time, changing people's dietary and exercise routines are likely more resistant to these interventions and are referred to only incidentally in this review. That is, societal efforts could prevent exposure to toxicants and ACEs-not necessarily requiring cooperation by the affected individuals-whereas changing diet and exercise practices requires an individual's discipline. Toxic substances considered in this review include endocrine disruptors, arsenics, 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the organic solvent, Trichloroethylene (TCE), and the Benzo[a]pyrene (B[a]P) produced from incomplete combustion of tobacco and other organic materials. Exposure to each of these toxic substances may have serious adverse health effects, especially in genetically more susceptible individuals. For example, children of mothers exposed to the endocrine disruptor, Atrazine, have significantly lower birth length, weight, and head circumference. Moreover, male offspring exhibit genital abnormalities, and all of these effects may be transgenerational. However, analyses of interactions among genes, the environment, and epigenetic modifications have already revealed distinctive individual risks of adverse reactions to toxic exposure. So, interventions through precision medicine might improve the health of those exposed individuals. Adults previously exposed to more than one ACE (e.g., child abuse and inter-parental violence) are more likely to develop anxiety, cancer, and diabetes. Detecting ACE exposures in children in the general population is fraught with difficulty. Thus, the risks of ACEs to our health remain even more insidious than exposures to toxicants. Nevertheless, higher provider compassion is associated with significantly better clinical outcomes for patients with these afflictions. For all these reasons, the first major aim of this review is to recount several of the major forces contributing to or impairing public health. Our second major aim is to examine mitigating influences on these forces, including social justice and provider compassion in the setting of precision medicine. Idealistically, these mitigators might eventually lead to the development of more cooperative and compassionate cultures and societies.

Perceptions of Empathy Among Nursing Assistants in Long-Term Care Facilities: A Qualitative Study

Background: Empathy is a fundamental component of the therapeutic relationship between healthcare providers and patients and has the potential to yield significant benefits, including heightened care satisfaction, enhanced care quality, and improved mental well-being for patients. As nursing assistants (NAs) are primary direct care providers in long-term care facilities (LTCFs), it is necessary to understand NAs' views on empathy in their care provision for residents, but a gap exists in the literature regarding NAs' perspectives on empathy in this context. Aim: In this study, we aimed to explore perceptions of empathy among NAs in LTCFs. Research Design: A qualitative approach was applied in this study. Participants and Research Context: Through purposive and snowball sampling, 18 NAs who provided care for residents in six LTCFs in Taiwan were recruited. Face-to-face in-depth interviews were conducted using a semistructured interview guide, and data were analyzed using a content analysis. Ethical Considerations: Ethical approval was obtained from the Institutional Review Board. All participants signed a written informed consent form prior to the interview. Results: Four themes encompassing 11 categories were generated including "being fundamental to caregiving to establish trust and enhance quality care," "practicing altruistic behavior in the pursuit of ethical caregiving," "cycling empathic flow in care," and "facing challenges in delivering empathetic care." Conclusions: NAs in LTCFs viewed empathy as an essential element of the caregiving process. They saw empathy as selfless care, assistance to others, and alleviation of residents' suffering. Understanding residents' emotions, thoughts, and needs, active listening and compassionate engagement were vital to expressing empathy. However, NAs faced challenges in expressing empathy due to demanding tasks, time limitations, and insufficient knowledge and communication skills. In addition, emotional desensitization further complicated the provision of empathic care. The findings of this study can provide information for nurse managers and directors to understand NAs' perspectives on empathy and difficulties when providing empathic care in the long-term care context.

Comparison of Empathy with Patients between Surgical and Psychiatric Medical Residents

Background

Empathy is considered paramount to the medical profession because it affects patients' satisfaction, compliance, and quality of care. It has been studied that medical residents in non-psychiatry specialties (especially general surgery) pay less attention to their patients' experiences and emotions. This study measured and compared surgical and psychiatric medical residents' empathy scores.

Materials and Methods

In 2021, we studied all first- to third-year medical residents of psychiatry and general surgery who worked in hospitals affiliated with the Iran University of Medical Sciences (IUMS), Tehran, Iran. Eighty-eight eligible residents, including 53 psychiatric and 35 surgical residents, were enrolled in this cross-sectional study. The Persian-validated Jefferson empathy scale was used to evaluate empathy among the residents. Chi-square, t-test, and ANOVA were used for group comparisons. A multivariable linear regression analysis was used to find the factors associated with the empathy score. Data analysis was conducted using the SPSS version 21.

Results

The total mean score (SD) of empathy was 104.34 (11.10). Female residents had higher mean (SD) empathy scores compared to their male counterparts (109.21 [9.29] vs. 99.14 [12.72]; p < 0.001), and psychiatric residents scored higher than surgical residents (109.18 [8.91] vs. 96.67 [12.50]; p < 0.001). Psychiatric residency was independently associated with a higher empathy score (standardized coefficients; beta = 0.41, p = 0.001).

Conclusions

Psychiatric residents have significantly higher empathy with patients than surgical residents. There was also a significant difference among male and female residents. Therefore, it may be recommended that structural education directions be developed for residents to promote empathy during the residency program.

Prehospital Patient and Family Aftercare Service in Helicopter Emergency Medical Services: A Patient's Perspective

Over the past decade the medical profession has witnessed patient and family aftercare becoming increasingly rooted within a patient-centric approach. Furthermore, there has been strong consensus within the Helicopter Emergency Medical Service (HEMS) sector for a Patient and Family Aftercare Service (PFAS) at Air Ambulance Charity Kent Surrey Sussex to further support an individual's experience from their core primary retrieval, through to the rehabilitation experience. This patient narrative highlights key interconnections between HEMS and an aftercare team that are important to the patient experience. Firstly, the clinical team provide prompt and expert medical intervention, which is crucial in managing critical injury and illness at the scene of an injury. Secondly, the narrative explores the emotional support provided by the healthcare professionals. Thirdly, the role of the support network, comprising of family, friends, and the wider community is discussed as integral for both physical and emotional rehabilitation post-incident. Furthermore, the narrative highlights that ongoing engagement from PFAS is important to continued rehabilitation and enhanced quality of life.

Introducing the ELPIS scale: a novel tool for measuring emotional empathy toward cancer patients

Empathy, defined as the ability to understand and share another person's feelings, is crucial in the healthcare setting, particularly for patients with cancer who face significant psychosocial challenges. We aimed to develop a novel tool, the Empathy, Life with Cancer, and Psychosocial Skills (ELPIS) Scale that prioritizes emotional and cognitive components in order to determine the reflection of the negative stigmatization of cancer in societies on individuals, excluding the behavioral and ethical dimensions of empathy. The study was conducted using a quantitative research design with a sample of first- and second-year medical students in Türkiye. An initial pool of 48 items was developed based on an extensive review of the literature and existing empathy scales. Following expert review and pilot testing, the scale was refined to 24 items. Exploratory factor analysis and confirmatory factor analysis were conducted to establish the scale's factor structure and validate its reliability and validity. The exploratory factor analysis revealed a three-factor structure comprising "emotional empathy," "sympathetic responses," and "realistic approaches," with a total of 20 items after refinement. Confirmatory factor analysis confirmed the model fit, with the scale demonstrating high internal consistency across all three dimensions. The scale's reliability was further supported by high Cronbach's alpha values. The results suggest that the ELPIS Scale is a reliable and valid instrument for measuring emotional empathy toward cancer patients. It offers a nuanced approach by separately assessing emotional, sympathetic, and realistic components of empathy, making it a valuable tool for both educational and clinical applications. Future research should explore the scale's application in diverse populations and settings, as well as its utility in tracking empathy development over time. In conclusion, the ELPIS Scale, which focuses on the emotional and cognitive components of empathy, a multifaceted construct, fills a critical gap in the measurement of empathy in the context of cancer care and provides a comprehensive tool that can improve both patient care and the education of healthcare providers.

The Empathetic Involvement of Nurses in the Context of Neuroscience: A Mixed-Methods Study

Background/Objectives: Empathy and emotional regulation (susceptibility and resistance) play an important role in a nurse's well-being and the provision of high-quality care. This phenomenon has not yet been studied in the context of nurses working in neuroscience. This study aimed to explore the perceptions related to empathy among nurses working in neuroscience contexts. Methods: Employing a mixed-methods approach, we conducted an online quantitative survey with 211 nurses working in various neuroscience settings using the Balanced Emotional Empathy Scale (BEES) and 15 online semistructured qualitative interviews to delve deeper into empathetic experiences. The mean and measures of dispersion, such as standard deviation, were used to analyze the quantitative data. Thematic analysis investigated qualitative data, and data triangulation was performed. Results: The quantitative findings revealed no significant differences in empathy or emotional regulation across the different neuroscience settings but highlighted an increase in susceptibility related to young age (under 29) and years of service (first 5 years). The interviews brought to light the challenges nurses face in highly emotional situations and the strategies they employ to manage empathy and maintain professional detachment, such as self-care strategies, awareness development, and team support. One hindering factor is managers. Conclusions: The findings of this study underscore the essential role of empathetic capability in nursing care in neuroscience. The experience of younger nurses and the first 5 years of employment are elements to be considered by managers for burnout risk. Nurses demonstrate susceptibility and resistance and maintain a balance in dealing with high-emotional-stress situations. The implications of these findings are significant and should guide future research and practice in the field of neuroscience nursing.

Developing empathy in healthcare professions students: protocol of a mixed-methods non-controlled longitudinal intervention study

Despite the necessary focus on clinical skills and knowledge during the tertiary education of healthcare professionals, the literature highlights the importance of developing psycho-social competencies. Empathy, a cognitive-behavioral attribute linked to various benefits for patients and healthcare professionals, is one such competency. Pedagogical approaches to successfully develop empathy in tertiary healthcare students are available. However, these approaches are often integrated piecemeal throughout the tertiary education journey. Research on a more empathy-focused curriculum is scarce. This manuscript describes the design of a study that aims to examine the effects of a more empathy-focused curriculum on empathy in tertiary healthcare profession students in Singapore. Freshmen dentistry, medicine, nursing, and pharmacy students enrolled in a novel curriculum with a strong empathy focus will be recruited for the study and followed for the program's extent. Mixed-methods data collection at various time points will be conducted. Quantitative data will be collected on cognitive-behavioral empathy, intentions to provide empathic care, and engagement in courses of the curriculum. Qualitative data on perceptions of patient care and empathy in relation to relevant courses of the curriculum will be collected to provide context for quantitative findings. Ethics approval was granted by the Departmental Ethics Review Committee of the Saw Swee Hock School of Public Health, National University of Singapore (Ethics ID: SSHSPH-214).

The moderating role of emotional self-efficacy and gender in teacher empathy and inclusive education

The role of teacher empathy is recognized as a key factor in improving teacher-student interaction, motivation and academic performance. Despite the importance of teacher empathy, its role in promoting inclusive education is still largely unknown. High levels of empathy are not necessarily associated with greater ability to implement inclusive education, as they can lead to excessive emotional engagement and stress, which negatively affect teachers' abilities. Therefore, the present study explored whether the relationship between high empathy and perceived ability to implement inclusive education could be moderated by other variables, such as emotional self-efficacy and gender. A large sample of Italian support teachers (N = 739; Mage = 37.7; females = 86.9%) was recruited for this study. We found that higher levels of empathy were related to higher levels of self-efficacy in inclusive education, especially when levels of emotional self-efficacy were higher. This relationship was only found for female teachers. The results contribute to knowledge about the role of teachers' empathy for inclusion as well as the moderating role of the ability to regulate negative emotions. The study has implications for pre-service teacher education and in-service teacher training.

Empathy in Nutrition and Dietetics: A Scoping Review

BACKGROUND

Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care.

OBJECTIVE

This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table.

RESULTS

Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies.

CONCLUSIONS

This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.

The association between empathy and burnout in medical students: a systematic review and meta-analysis

BACKGROUND

Burnout levels in medical students are higher than in other student groups. Empathy is an increasingly desired outcome of medical schools. Empathy is negatively associated with burnout in physicians. Our objective was to quantitatively review the available literature on associations between empathy and burnout in medical students, and to explore associations between specific empathy aspects (cognitive and affective) and burnout sub-dimensions (emotional exhaustion, depersonalization and personal accomplishment).

METHODS

A comprehensive search of the literature published up until January 2024 was undertaken in the PubMed, EMBASE, CINAHL, The Cochrane Library, and PsycINFO databases. Two independent reviewers screened 498 records and quality-rated and extracted data from eligible studies. The effect size correlations (ESr) were pooled using a random-effects model and between-study variation explored with meta-regression. The review was preregistered with PROSPERO (#CRD42023467670) and reported following the PRISMA guidelines.

RESULTS

Twenty-one studies including a total of 27,129 medical students published between 2010 and 2023 were included. Overall, empathy and burnout were negatively and statistically significantly associated (ESr: -0.15, 95%CI [-0.21; -0.10], p < .001). When analyzing sub-dimensions, cognitive empathy was negatively associated with emotional exhaustion (ESr: -0.10, 95%CI [-0.17; -0.03], p = .006) and depersonalization (ESr: -0.15, 95%CI [-0.24; 0.05], p = .003), and positively associated with personal accomplishment (ESr: 0.21, 95%CI [0.12; 0.30], p < .001). Affective empathy was not statistically significantly associated with emotional exhaustion, depersonalization or personal accomplishment. Supplementary Bayesian analysis indicated the strongest evidence for the positive association between cognitive empathy and personal accomplishment. Response rate and gender moderated the relationship so that higher response rates and more male respondents strengthen the negative association between empathy and burnout.

CONCLUSION

Greater empathy, in particular cognitive empathy, is associated with lower burnout levels in medical students. This appears to be primarily driven by cognitive empathy's positive association with personal accomplishment.

PROTOCOL REGISTRATION

#CRD42023467670.

Understanding Men's Lived Experience of Mental Distress Through Metaphors

The use of tailored language, which involves a clinician's ability to adapt communication styles and employ accessible terms and concepts, has long been touted as key to engaging men with mental health services. Metaphors are one communication device that can provide men with ways through which to meaningfully express themselves and communicate their mental distress experiences. Using qualitative photovoice research, the current study examined how New Zealand-based men (n = 21) communicatively constructed their meaning of mental distress through metaphors. Analysis of interview data was used to derive three metaphor groupings men consistently drew on to articulate their lived experiences: metaphors of emotions (darkness and weight), metaphors of survival (battle and entity), and metaphors of disembodiments (debility and entrapment). The findings highlight the power of metaphors as a tool for men in communicating their experiences of mental distress and are valuable for health professionals to contemplate across an array of contexts. The implications and importance of a metaphor-enriched perspective for engaging men in professional health care settings and services are discussed.

Substantial Increases in Healthcare Students' State Empathy Scores Owing to Participation in a Single Improvisation Session

PURPOSE

To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session.

METHODS

Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale.

RESULTS

The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively).

CONCLUSIONS

These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.

Patients' experiences of GP consultations following the introduction of the new GP contract in Scotland: a cross-sectional survey

BACKGROUND

The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities.

AIM

To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland.

DESIGN AND SETTING

In 2022, a postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days was undertaken.

METHOD

Patient characteristics and consultation experiences in the three areas (DU, AU, RR) were evaluated using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI).

RESULTS

In total, 1053 responses were received. In DU areas, multimorbidity was more common (78% versus 58% AU versus 68% RR, P<0.01), complex presentations (where the consultation addressed both psychosocial and physical problems) were more likely (16% versus 10% AU versus 11% RR, P<0.05), and more consultations were conducted by telephone (42% versus 31% AU versus 31% RR, P<0.01). Patients in DU areas reported lower satisfaction (82% DU completely, very, or fairly satisfied versus 90% AU versus 86% RR, P<0.01), lower perceived GP empathy (mean CARE score 38.9 versus 42.1 AU versus 40.1 RR, P<0.05), lower enablement (mean PEI score 2.6 versus 3.2 AU versus 2.8 RR, P<0.01), and less symptom improvement (P<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement, and perceived GP empathy than telephone consultations in RR areas (all P<0.05).

CONCLUSION

Four years after the start of the new GP contract in Scotland, patients' experiences of GP consultations suggest that the inverse care law persists.

The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review

OBJECTIVES

This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness.

METHODS

We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis.

RESULTS

Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations.

CONCLUSIONS

For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.

Measures of empathy and compassion: A scoping review

Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.

Medical practitioner perspectives on AI in emergency triage

Introduction

A proposed Diagnostic AI System for Robot-Assisted Triage ("DAISY") is under development to support Emergency Department ("ED") triage following increasing reports of overcrowding and shortage of staff in ED care experienced within National Health Service, England ("NHS") but also globally. DAISY aims to reduce ED patient wait times and medical practitioner overload. The objective of this study was to explore NHS health practitioners' perspectives and attitudes towards the future use of AI-supported technologies in ED triage.

Methods

Between July and August 2022 a qualitative-exploratory research study was conducted to collect and capture the perceptions and attitudes of nine NHS healthcare practitioners to better understand the challenges and benefits of a DAISY deployment. The study was based on a thematic analysis of semi-structured interviews. The study involved qualitative data analysis of the interviewees' responses. Audio-recordings were transcribed verbatim, and notes included into data documents. The transcripts were coded line-by-line, and data were organised into themes and sub-themes. Both inductive and deductive approaches to thematic analysis were used to analyse such data.

Results

Based on a qualitative analysis of coded interviews with the practitioners, responses were categorised into broad main thematic-types, namely: trust; current practice; social, legal, ethical, and cultural concerns; and empathetic practice. Sub-themes were identified for each main theme. Further quantitative analyses explored the vocabulary and sentiments of the participants when talking generally about NHS ED practices compared to discussing DAISY. Limitations include a small sample size and the requirement that research participants imagine a prototype AI-supported system still under development. The expectation is that such a system would work alongside the practitioner. Findings can be generalisable to other healthcare AI-supported systems and to other domains.

Discussion

This study highlights the benefits and challenges for an AI-supported triage healthcare solution. The study shows that most NHS ED practitioners interviewed were positive about such adoption. Benefits cited were a reduction in patient wait times in the ED, assistance in the streamlining of the triage process, support in calling for appropriate diagnostics and for further patient examination, and identification of those very unwell and requiring more immediate and urgent attention. Words used to describe the system were that DAISY is a "good idea", "help", helpful, "easier", "value", and "accurate". Our study demonstrates that trust in the system is a significant driver of use and a potential barrier to adoption. Participants emphasised social, legal, ethical, and cultural considerations and barriers to DAISY adoption and the importance of empathy and non-verbal cues in patient interactions. Findings demonstrate how DAISY might support and augment human medical performance in ED care, and provide an understanding of attitudinal barriers and considerations for the development and implementation of future triage AI-supported systems.

Dementia Simulation for Family Caregivers of Persons With Dementia: A Scoping Review

BACKGROUND

Alzheimer's disease and related dementias are becoming increasingly prevalent worldwide. Persons with dementia receive substantial assistance from family caregivers over extended periods of time. Family caregivers of persons with dementia are twice as likely to report physical, emotional, and financial challenges related to caregiving compared with other types of family caregivers. Empathy has been demonstrated to improve caregivers' quality of life and their relationships with care recipients.

OBJECTIVE

This scoping review examines the current literature on the effects of dementia simulation on empathy levels in family caregivers of persons with dementia.

METHODS

A librarian-assisted search of 4 databases-PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, and Scopus-was conducted. Key terms included "dementia," "family caregivers," and "simulation." To broaden reference retrieval, "empathy" was not used as a key term but remained an inclusion criterion during reference screening. Data extraction of relevant references was completed.

RESULTS

The search yielded 212 citations. Seven eligible dementia simulation studies were identified, including 1 randomized controlled trial, 3 quasi-experimental studies, and 3 qualitative research studies. Only 3 of the 7 studies focused specifically on family caregivers of persons with dementia.

CONCLUSIONS

Qualitative data supported increased empathy in family caregivers, but quantitative findings on changes in empathy levels were inconclusive. Further research using quantitative or mixed-methods designs is necessary to support benefits of simulation on empathy for family caregivers of persons with dementia.

Factor structure of the Jefferson Scale for Empathy among medical undergraduates from South India

Background

Empathy is a multidimensional construct and is considered an essential attribute among healthcare professionals. The Jefferson Scale for Empathy (JSE) is a commonly used tool to measure physician empathy and has been used in medical students as well; however, the psychometric properties have not been well studied in India. We aimed to study the factor structure of JSE among medical undergraduates.

Methods

This was a secondary analysis of baseline data obtained from the Stigma, Empathy and Attitude module study among medical undergraduates (N = 157). The scores obtained on the 20-item JSE Medical Student Version were subjected to principal component analysis with varimax rotation. Eigenvalues greater than unity, scree plot, and Horn's parallel analysis were used for identifying the factors. Items with loading more than 0.4 were included based on Steven's recommendation.

Results

The sample was adequate for factor analysis (Kaiser-Meyer-Olkin (KMO) measure 0.832). Five factors were extracted using principal component analysis, which explained 60% of the variance. The first three appeared as stable factors, and the last two factors had two items each. The first factor was the strongest (explained 18.8% of variance) with loadings from nine items. The second factor (explained 15.6% of variance) had loadings from six items, and two of the items showed correlation with the first factor.

Conclusions

JSE has a multidimensional structure with five factors in our sample of medical undergraduates.

Behavioral and neural underpinnings of empathic characteristics in a Humanitude-care expert

Background

Humanitude approaches have shown positive effects in elderly care. However, the behavioral and neural underpinnings of empathic characteristics in Humanitude-care experts remain unknown.

Methods

We investigated the empathic characteristics of a Humanitude-care expert (YG) and those of age-, sex-, and race-matched controls (n = 13). In a behavioral study, we measured subjective valence and arousal ratings and facial electromyography (EMG) of the corrugator supercilii and zygomatic major muscles while participants passively observed dynamic facial expressions associated with anger and happiness and their randomized mosaic patterns. In a functional magnetic resonance imaging (MRI) study, we measured brain activity while participants passively observed the same dynamic facial expressions and mosaics. In a structural MRI study, we acquired structural MRI data and analyzed gray matter volume.

Results

Our behavioral data showed that YG experienced higher subjective arousal and showed stronger facial EMG activity congruent with stimulus facial expressions compared with controls. The functional MRI data demonstrated that YG showed stronger activity in the ventral premotor cortex (PMv; covering the precentral gyrus and inferior frontal gyrus) and posterior middle temporal gyrus in the right hemisphere in response to dynamic facial expressions versus dynamic mosaics compared with controls. The structural MRI data revealed higher regional gray matter volume in the right PMv in YG than in controls.

Conclusion

These results suggest that Humanitude-care experts have behavioral and neural characteristics associated with empathic social interactions.

Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda

BACKGROUND

A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda.

METHODS

This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method.

RESULTS

Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs.

CONCLUSION

CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.