The effectiveness of empathy training in health care: a meta-analysis of training content and methods

Teaching cognitive and affective empathy in medicine: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Empathy can be divided into cognitive empathy (CE) and affective empathy (AE). CE is defined as the accurate understanding and appropriate response to others' thoughts whereas AE is defined as the accurate understanding and appropriate response to others' emotions. The overall purpose of this systematic review and meta-analysis is to assess the effectiveness of empathy interventions in physicians and physicians-in-training in increasing CE and AE. Specifically, we are interested in examining whether specific teaching methods and intervention designs may contribute to greater empathy intervention effectiveness for CE and AE outcomes.

METHOD

Studies searched included randomized controlled trials conducted between 1971 to 2022 examining empathy interventions for medical students and physicians. Thirty-six studies, consisting of 3,833 participants, met the inclusion criteria. Data were analysed using random-effects pairwise meta-analysis.

RESULTS

Empathy interventions have moderate effect sizes on both CE [d = .50 (95% CI = .30, .70)] and AE [d = .46 (95% CI = .30, .62)]. Heterogeneity of effects was evident for both analyses. The effectiveness of interventions on AE was moderated by measurement type. Intervention effectiveness was not significantly moderated by other intervention and study characteristics for either type of empathy.

CONCLUSIONS

There is evidence of key differences, and similarities, in how CE and AE is taught to medical students and professionals; however, the small number and high level of heterogeneity in studies makes this difficult to confirm. Research in this field will benefit from investigators standardizing teaching and research methods across studies.

Preventing healthcare worker burnout in primary care settings through the trauma-informed CARES Leadership Competency Model

Staff burnout, a pervasive and persistent issue in the Canadian primary care environment, demands urgent and immediate attention. The managerial response to this problem has been largely reactive, especially in the post-COVID era. The need for proactive approaches to equip health leaders to detect early signs of burnout in healthcare workers and intervene effectively is more pressing than ever. Health leaders are beginning to acknowledge the significant role that trauma plays in impacting workers' propensity to experience burnout, leading to the growing recognition of trauma-informed best practices in healthcare management. This article will introduce the CARES Model, a leadership competency framework that underscores the connections between leadership competencies and employee-leader engagement to detect early signs of burnout in primary care workers. The model, along with the proposed CARES toolkit, strongly emphasizes trauma-informed best practices and will enable health leaders to better proactively prevent burnout through appropriate, empathetic, and efficient interventions.

Mental Health, Mentalising and Empathy in Australian Healthcare Workers During COVID-19: A Cross-Sectional Study

Since the outbreak of a Coronavirus Disease (COVID-19), healthcare workers have consistently exhibited increased stress, anxiety and depression. However, no study to date, has yet examined whether these symptoms are associated with social cognitive skills, known to be paramount in delivering high quality patient care. This cross-sectional study aimed to investigate whether the symptoms of stress, anxiety and depression were related to both empathy and mentalising in healthcare workers who worked during the COVID-19 outbreak in Australia. Participants were healthcare workers with an average age of 31.9 years (N = 177). Participants completed the Depression, Anxiety and Stress Scale-21 (DASS-21), the Interpersonal Reactivity Index (IRI) and the Reading the Mind in The Eyes Test (RMET) between May 24th and June 21st, 2021. We found that higher stress levels in healthcare workers were associated with improved abilities in understanding others' emotions and mental states, showing affective empathy and engaging in imaginative thinking. Conversely, increased anxiety was linked to reduced understanding of others' emotions and mental states in this cohort. No other significant associations were observed. Our findings suggest that organisational initiatives are needed to deliver targeted interventions and specialised programs to support social cognitive skills in healthcare workers. Future studies with longitudinal designs are needed to better characterise mental health-social cognition associations and disentangle its directionality.

Empathy and Mentalizing of Mental Health Nurses: A Cross-Sectional Correlational Study

In mental healthcare, therapists' empathy and mentalizing are associated with better opportunities to establish positive working relations with patients. The present study aimed to explore mental health nurses' level of empathy and mentalizing (compared with reference groups studying or working in different contexts), the association between mental health nurses' level of empathy and mentalizing and sociodemographic characteristics of these nurses, and the association between mental health nurses' level of empathy and mentalizing. A cross-sectional design was used in adherence with the Strengthening the Reporting of Observational Studies in Epidemiology statement. The 28-item Empathy Quotient was used to investigate empathy, and the 28-item Mentalisation Scale was used to assess mentalizing. One hundred and seven mental health nurses working in different work-intensity settings (intensive and intermittent-intensive) participated in the study. Our analyses showed that mental health nurses had statistically significantly higher levels of empathy and mentalizing than the matched reference groups. They also showed that most mental health nurses' demographic characteristics were not statistically significantly associated with their level of empathy and mentalizing: not with age, years of work experience, or educational level. Only two aspects were statistically significantly associated: female gender (for higher levels of empathy and mentalizing) and practicing in an intermittent-intensive work setting (for higher scores on the subscale 'Motivation' of the Mentalisation Scale). Furthermore, empathy and mentalizing of mental health nurses were strongly associated and also emerged as two partly overlapping concepts. We conclude that mental health educational institutions and supervisors could pay extra attention to the aspects of gender and work situation concerning mental health nurses' mentalizing and empathy in patient relations.

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.

Rapid Scoping Review: Empathy in Health Sciences Curriculum

Empathy, the process of coming to know, understand, and care for another person, is a skill that can be learned; however, there is not a shared definition of empathy or understanding of how to operationalize empathy into practice. Healthcare worker empathy has been shown to have a beneficial effect on both patient health outcomes and the emotional wellness of healthcare workers. Empathic care is associated with more efficient, cost-effective, improved healthcare, and increased provider trust. The purpose of this rapid scoping review is to identify, compare, and contrast empathy training offered to select healthcare professional students (e.g., nurses, nurse practitioners, and pharmacists) as part of the general curriculum or as an elective. We utilized a rapid scoping review approach to identify potentially relevant peer-reviewed articles and studies for inclusion. Six electronic databases were searched, including: MEDLINE; EMBASE; PUBMed; CINAHL; EBSCOHOST; and ERIC, covering the past 10 years. A total of 4977 citations, 3480 abstracts, and 428 papers were screened. Fifty studies fulfilled the eligibility criteria. Of those, 21 primarily non-randomized experimental studies published between 2012 and 2021 were included in the final review. Over 80 percent of the training took place in the classroom setting and utilized active learning strategies. There is little consensus on how to best train future healthcare providers to provide empathic care to patients.