Evaluation and benefits of empathy in the medical context: A review
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Keywords

Medical consultation
Physician- patient relationship
Evaluation
Empathy
Benefits Consulta médica
Relación médico-paciente
Evaluación
Empatía
Beneficios

Abstract

Background. Various authors cited in the international research literature have pointed out that empathy shown by the physician during contact with patients benefits them and the health professional him/herself. Such sources pose difficulties for generalization since empathic behavior is affected by the culture and nationality of both the physician and the patient. Furthermore, not all authors consider the relevance of empathy as key in the healthcare context. Empathy is sometimes assumed as a matter of course due to the absence of consensus on measuring and operationalizing it. Objective. The present study aimed at examining the results of a review of the national and international research literature. Method. The scrutiny included original articles reporting a beneficial effect of empathy or its relationship to improvement for the patient or the health professional. The analysis also describes the instruments used to evaluate the construct in studies reporting benefits. The search included six years (2014-2020) from the following databases: Pubmed, Cochrane, Scielo, Latindex, and Redalyc. Results. A total of 420 articles appeared, but only nine covered the search requirements. Also, seven measuring instruments emerged. Discussion. The present paper discusses some implications on the evaluation of empathy based on current research. We include relevant information aimed at healthcare professionals interested in evaluating the benefits of empathy.

https://doi.org/10.25009/pys.v32i2.2749
PDF (Español)

References

Alcorta G., A., González G., J.F., Tavitas H., S.E., Rodríguez L., F.J. y Hojat, M. (2005). Validación de la Escala de Empatía Médica de Jefferson en estudiantes de medicina Mexicanos. Salud Mental, 28(5), 57-63.

Andersen, F.A., Johansen, A.S.B., Søndergaard, J., Andersen, C.M. y Assing Hvidt, E. (2020). Revisiting the trajectory of medical students’ empathy, and impact of gender, specialty preferences and nationality: A systematic review. BMC Medical Education, 20(1), 52. Doi: 10.1186/s12909-020-1964-5.

Bachmann, C., Abramovitch, H., Barbu, C.G., Cavaco, A.M., Elorza, R.D., Haak, R., Loureiro, E., Ratajska, A., Silverman, J., Winterburn, S. y Rosenbaum, M. (2013). An European consensus on learning objectives for a core communication curriculum in health care professions. Patient Education and Counseling, 93(1), 18-26. Doi: 10.1016/j.pec.2012.10.016.

Barnicot, K., Wampold, B. y Priebe, S. (2014). The effect of core clinician interpersonal behaviours on depression. Journal of Affective Disorders, 167, 112-117. Doi: 10.1016/j.jad.2014.05.064.

Barrett-Lennard, G.T. (2015). The relationship inventory: A complete resource and guide. Chichester (UK): Wiley Blackwell.

Bernardo, M.O., Cecílio, D., Costa, P., Quince, T.A., Costa, M.J. y Carvalho-Filho, M.A. (2018). Physicians’ self-assessed empathy levels do not correlate with patients’ assessments. PLoS ONE, 13(5), e0198488. Doi: 10.1371/journal.pone.0198488.

Cameron, C.D. e Inzlicht, M. (2020). Empathy choice in physicians and non-physicians. British Journal of Social Psychology, 59(3), 715-732. Doi: 10.1111/bjso.12342.

Cavaco, A. y Roter, D. (2010). Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist-patient communication. The International Journal of Pharmacy Practice, 18(3), 141-148. Doi: 10.1211/ijpp/18.03.0003.

Chen, X., Zhang, Y., Xu, X., Wang, W., Yan, H., Li, S. y Yang, N. (2019). Mediating roles of anxiety, self-efficacy, and sleep quality on the relationship between patient-reported physician empathy and inflammatory markers in ulcerative colitis patients. Medical Science Monitor, 25, 7889-7897. Doi: 10.12659/MSM.917552.

Danzi, O.P., Perlini, C., Tedeschi, F., Nardelli, M., Greco, A., Scilingo, E.P., Valenza, G. y Del Piccolo, L. (2018). Affective communication during bad news consultation. Effect on analogue patients’ heart rate variability and recall. Patient Education and Counseling, 101(11), 1892-1899. Doi: 10.1016/j.pec.2018.06.009.

Decety, J. (2020). Empathy in medicine: What it is, and how much we really need it. American Journal of Medicine, 133(5), 561-566. Doi: 10.1016/j.amjmed.2019.12.012.

Eide, H., Frankel, R., Haaversen, A.C.B., Vaupel, K.A., Graugaard, P.K. y Finset, A. (2004). Listening for feelings: Identifying and coding empathic and potential empathic opportunities in medical dialogues. Patient Education and Counseling, 54, 291-297. Doi: 10.1016/j.pec.2003.09.006.

Fernandez, A.V. y Zahavi, D. (2020). Basic empathy: Developing the concept of empathy from the ground up. International Journal of Nursing Studies, 110, 103695. Doi: 10.1016/j.ijnurstu.2020.103695.

Finset, A. y Ørnes, K. (2017). Empathy in the clinician-patient relationship: the role of reciprocal adjustments and processes of synchrony. Journal of Patient Experience, 4(2), 64-68. Doi: 10.1177/2374373517699271.

Gold, K.J., Sen, A. y Schwenk, T.L. (2013). Details on suicide among US physicians: Data from the National Violent Death Reporting System. General Hospital Psychiatry, 35(1), 45-49. Doi: 10.1016/j.genhosppsych.2012.08.005.

Goodwin, M.A., Stange, K.C., Zyzanski, S.J., Crabtree, B.F., Borawski, E.A. y Flocke, S.A. (2017). The Hawthorne effect in direct observation research with physicians and patients. Journal of Evaluation in Clinical Practice, 23(6), 1322-1328. Doi: 10.1111/jep.12781.

Halpern, J. (2003). What is clinical empathy? Journal of General Internal Medicine, 18(8), 670-674. Doi: 10.1046/j.1525-1497.2003.21017.x.

Hermans, L., Hartman, T.O. y Dielissen, P.W. (2018). Differences between GP perception of delivered empathy and patient-perceived empathy: A cross-sectional study in primary care. British Journal of General Practice, 68(674), e621-e626. Doi: 10.3399/bjgp18X698381.

Höglander, J., Eklund, J.H., Spreeuwenberg, P., Eide, H., Sundler, A.J., Roter, D. y Holmström, I.K. (2020). Exploring patient-centered aspects of home care communication: a cross-sectional study. BMC Nursing, 19, 91.

Hojat, M. (2016). Empathy and patient outcomes. En M. Hojat Ed.: Empathy in Health Professions Education and Patient Care. New York, NY: Springer International. Doi: 10.1007/978-3-319-27625-0.

Hojat, M., DeSantis, J., Shannon, S.C., Mortensen, L.H., Speicher, M.R., Bragan, L., LaNoue, M. y Calabrese, L.H. (2018). The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Advances in Health Sciences Education, 23(5), 899-920. Doi: 10.1007/s10459-018-9839-9.

Hojat, M., DeSantis, J., Shannon, S.C., Speicher, M.R., Bragan, L. y Calabrese, L.H. (2020). Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States. Medical Education, 54(6), 571-581. Doi: 10.1111/medu.14138.

Howick, J., Mittoo, S., Abel, L., Halpern, J. y Mercer, S. (2020). A price tag on clinical empathy? Factors influencing its cost-effectiveness. Journal of the Royal Society of Medicine, 0(0), 1-5.

Howick, J., Steinkopf, L., Ulyte, A., Roberts, N. y Meissner, K. (2017). How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC Medical Education, 17(1), 136. Doi: 10.1186/s12909-017-0967-3.

Johnson Shen, M., Ostroff, J.S., Hamann, H.A., Haque, N., Banerjee, S.C., McFarland, D.C., Molena, D. y Bylund, C.L. (2019). Structured analysis of empathic opportunities and physician responses during lung cancer patient-physician consultations. Journal of Health Communication, 24(9), 711-718. Doi: 10.1080/10810730.2019.1665757.

Kelly, M., Svrcek, C., King, N., Scherpbier, A. y Dornan, T. (2020). Embodying empathy: A phenomenological study of physician touch. Medical Education, 54(5), 400-407. Doi: 10.1111/medu.14040.

Lamiani, G., Dordoni, P., Vegni, E. y Barajon, I. (2020). Caring for critically ill patients: clinicians’ empathy promotes job satisfaction and does not predict moral distress. Frontiers in Psychology, 10(2902). Doi: 10.3389/fpsyg.2019.02902.

Lelorain, S., Brédart, A., Dolbeault, S. y Sultan, S. (2012). A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psycho-Oncology, 21(12), 1255-1264. Doi: 10.1002/pon.2115.

Leviton, L.C. (2017). Generalizing about public health interventions: a mixed-methods approach to external validity. Annual Review of Public Health, 38, 371-391. Doi: 10.1146/annurev-publhealth-031816-044509.

Llanwarne, N., Newbould, J., Burt, J., Campbell, J.L. y Roland, M. (2017). Wasting the doctor’s time? A video-elicitation interview study with patients in primary care. Social Science and Medicine, 176(2017), 113-122. Doi: 10.1016/j.socscimed.2017.01.025.

Lorié, Á., Reinero, D.A., Phillips, M., Zhang, L. y Riess, H. (2017). Culture and nonverbal expressions of empathy in clinical settings: A systematic review. Patient Education and Counseling, 100(3), 411-424. Doi: 10.1016/j.pec.2016.09.018.

McHale, C.T., Cecil, J.E. y Laidlaw, A.H. (2019). An analysis of directly observed weight communication processes between primary care practitioners and overweight patients. Patient Education and Counseling, 102(12), 2214-2222. Doi: 10.1016/j.pec.2019.07.010.

Moudatsou, M., Stavropoulou, A., Philalithis, A. y Koukouli, S. (2020). The role of empathy in health and social care professionals. Healthcare, 8(1), 26. Doi: 10.3390/healthcare8010026.

Nakayama, C., Kimata, S., Oshima, T., Kato, A. y Nitta, A. (2016). Analysis of pharmacist-patient communication using the Roter Method of Interaction Process Analysis System. Research in Social and Administrative Pharmacy, 12(2), 319-326. Doi: 10.1016/j.sapharm.2015.05.007.

Neumann, M., Scheffer, C., Tauschel, D., Lutz, G., Wirtz, M. y Edelhäuser, F. (2012). Physician empathy: definition, outcome-relevance and its measurement in patient care and medical education. GMS Zeitschrift Für Medizinische Ausbildung, 29(1), Doc11. Doi: 10.3205/zma000781.

Noordman, J., Post, B., Van Dartel, A.A.M., Slits, J.M.A. y Olde Hartman, T.C. (2019). Training residents in patient-centred communication and empathy: Evaluation from patients, observers and residents. BMC Medical Education, 19(1), 128. Doi: 10.1186/s12909-019-1555-5.

O’Sullivan, D., Wilk, S., Michalowski, W. y Farion, K. (2013). Using PICO to align medical evidence with MDs decision making models. Studies in Health Technology and Informatics, 192(1), 1057. Doi: 10.3233/978-1-61499-289-9-1057.

Paradis, E. y Sutkin, G. (2017). Beyond a good story: from Hawthorne effect to reactivity in health professions education research. Medical Education, 51(1), 31-39. Doi: 10.1111/medu.13122.

Parra R., G.J. y Cámara V., R.M. (2017). Nivel de empatía médica y factores asociados en estudiantes de medicina. Investigación en Educación Médica, 6(24), 221-227. Doi: 10.1016/j.riem.2016.11.001.

Parry, R., Pino, M., Faull, C. y Feathers, L. (2016). Acceptability and design of video-based research on healthcare communication: Evidence and recommendations. Patient Education and Counseling, 99(8), 1271-1284. Doi: 10.1016/j.pec.2016.03.013.

Pedersen, R. (2009). Empirical research on empathy in medicine: A critical review. Patient Education and Counseling, 76(3), 307-322. Doi: 10.1016/j.pec.2009.06.012.

Redondo, I. y Herrero F., D. (2018). Adaptación del Empathy Quotient (EQ) en una muestra española. Terapia Psicológica, 2(36), 81-89. Doi: 10.4067/s0718-48082018000200081.

Roter, D. y Larson, S. (2002). The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling, 46(4), 243-251. Doi: 10.1016/S0738-3991(02)00012-5.

Runyan, C., Savageau, J.A., Potts, S. y Weinreb, L. (2016). Impact of a family medicine resident wellness curriculum: A feasibility study. Medical Education Online, 21, 30648. Doi: 10.3402/meo.v21.30648.

Singh, S.P., Modi, C.M., Patel, C.P. y Pathak, A.G. (2017). Low-fidelity simulation to enhance understanding of infection control among undergraduate medical students. National Medical Journal of India, 30(4), 215-218. Doi: 10.4103/0970-258X.218677.

Spreng, R.N., McKinnon, M.C., Mar, R.A. y Levine, B. (2009). The Toronto Empathy Questionnaire: Scale development and initial validation of a factor-analytic solution to multiple empathy measures. Journal of Personality Assessment, 91(1), 62-71. Doi: 10.1080/00223890802484381.

Sulzer, S.H., Feinstein, N.W. y Wendland, C.L. (2016). Assessing empathy development in medical education: A systematic review. Medical Education, 50(3), 300-310. Doi: 10.1111/medu.12806.

van Dijk, I., Lucassen, P.L.B.J., Akkermans, R.P., Van Engelen, B.G.M., Van Weel, C. y Speckens, A.E.M. (2017). Effects of mindfulness-based stress reduction on the mental health of clinical clerkship students: A cluster-randomized controlled trial. Academic Medicine, 92(7), 1012-1021. Doi: 10.1097/ACM.0000000000001546.

van Osch, M., van Dulmen, S., van Vliet, L. y Bensing, J. (2017). Specifying the effects of physician’s communication on patients’ outcomes: A randomised controlled trial. Patient Education and Counseling, 100(8), 1482-1489. Doi: 10.1016/j.pec.2017.03.009.

Visser, L.N.C., Bol, N., Hillen, M.A., Verdam, M.G.E., De Haes, H.C.J. M., van Weert, J.C.M. y Smets, E.M.A. (2018). Studying medical communication with video vignettes: A randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients’ engagement. BMC Medical Research Methodology, 18(1), 15. Doi: 10.1186/s12874-018-0472-3.

Wündrich, M., Schwartz, C., Feige, B., Lemper, D., Nissen, C. y Voderholzer, U. (2017). Empathy training in medical students-a randomized controlled trial. Medical Teacher, 39(10), 1096-1098. Doi: 10.1080/0142159X.2017.1355451.

Xu, X., Zhang, Y., Wang, W., Zhang, Y. y Yang, N. (2020). Effects of patients’ perceptions of physician-patient relational empathy on an inflammation marker in patients with Crohn’s disease: The intermediary roles of anxiety, self-efficacy, and sleep quality. Psychology Research and Behavior Management, 13, 363-371. Doi: 10.2147/PRBM.S221435.

Yuguero, O., Marsal, J.R., Esquerda, M., Galvan, L. y Soler G., J. (2019). Cross-sectional study of the association between empathy and burnout and drug prescribing quality in primary care. Primary Health Care Research & Development, 20(e145). Doi: 10.1017/S1463423619000793.

Zabar, S., Hanley, K., Wilhite, J.A., Altshuler, L., Kalet, A. y Gillespie, C. (2020). In the room where it happens: Do physicians need feedback on their real-world communication skills? BMJ Quality and Safety, 29(3), 182-184. Doi: 10.1136/bmjqs-2019-010384.