Clinician Empathy Linked to Patient Satisfaction but Needs More Research

Leila Keshtkar, PhD

Credit: University of Leicester

A new study suggests clinicians who interact with their patients with enhanced empathy improve patient satisfaction.¹ However, the inadequate reporting prevented the investigators from reaching a definitive conclusion about the association.

“The poor reporting and quality of the underpinning evidence is a major barrier to implementing the evidence from this review,” wrote the investigators, led by Leila Keshtkar, PhD, from the Stoneygate Centre for Empathic Healthcare at Leicester Medical School, University of Leicester. “The training interventions were often sparsely described, rendering the interventions difficult to apply.”

Investigators continued to explain how the exceptions are BATHE (Background, Affect, Trouble, Handling, and Empathy) and SHARE interventions, which were described before the trials, but it was difficult to apply the interventions beyond the limited settings.

“How empathy training changes practitioner behavior and which behaviors are most likely to improve patient satisfaction are unknown,” the team wrote. “This makes it difficult to choose the training intervention that might be most effective in a particular situation.”

Patient satisfaction may sound good on the surface, leaving patients pleased with their care, but it is associated with improved survival after myocardial infarction, reduced hospital readmission, greater general quality of care, better patient safety, lower mortality after surgery, and improved medication adherence.

Since patient satisfaction is linked to greater care, it is routinely measured. Research found many patients are unsatisfied with their care, with a 2022 US study finding fewer than half of Americans were satisfied with their health care and a UK survey finding only 36% of patients were satisfied with their care in the National Health Service. In fact, 70% of health professionals struggle to develop empathy with their patients.²

To see how practitioner empathy could improve patient satisfaction, investigators conducted a systematic review, leveraging data from 14 randomized trials found on Ovid MEDLINE, CINAHL, PsycInfo, Cochrane, Central Register of Controlled Trials, and Scopus up to October 23, 2023.¹ In total, 80 practitioners and 1986 patients were included in the analysis.

Only 7 trials reported practitioners’ gender, and of them, 13% - 75% were female. Trials were heterogeneous as they took place in a wide range of locations, had different types of practitioners, and had a couple of types of randomizations.

Although the trials were heterogeneous, the heterogeneity also served as a limitation, as highlighted by the investigators. The investigators were uncertain about the results due to the way empathy was delivered and patient satisfaction was measured. They noted there was incomplete reporting.

Studies took place across several countries, with 6 from Asia, 4 from Europe, 3 from North America, and 1 from Africa. None of the trials reported baseline measurements of empathy.

Moreover, practitioners were family physicians in 5 trials, hospital physicians in 3 trials, nurses in 2 trials, anesthesiologists in 2 trials, psychologists in 1 trial, and caregivers in 1 trial. As for settings, 8 trials took place in a hospital, 4 trials in a primary care clinic, 1 trial in an outpatient clinic, and 1 trial in another community setting.

Consultation time in 6 trials lasted > 10 minutes and in 3 trials consultation time lasted ≤ 10 minutes. The other 5 trials did not report consultation time.

Furthermore, 6 trials used the BATHE training intervention, requiring practitioners to ask patients about their background, how they felt, what troubled them about the issue, how they were coping, and ending with providing an empathetic response. Other trials that taught empathy also strived to enhance a practitioner’s ability to understand and express understanding to their patients.

Trials with family physicians, hospital nurses, anesthesiologists, psychologists, and caregivers who practiced enhanced empathy found a positive effect on patient satisfaction. Studies with hospital physicians only found a small effect of empathy intervention with 1 trial finding benefit with the BATHE intervention.

In total, 5 studies had a high risk of bias and 9 had some concerns about bias. Due to risk and concerns of biases, several trials had low certainty of evidence.

“Although all studies found improvements in patient satisfaction, the ability to draw conclusions was limited by concerns about the quality and applicability of the underpinning evidence,” investigators concluded.

^References

1. ^{Keshtkar L, Madigan CD, Ward A, et al. The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Ann Intern Med. Published online January 30, 2024. doi:10.7326/M23-2168}
2. ^{The Secret to Quality Doctor-Patient Relationship. HCPLive. March 4, 2021. https://www.hcplive.com/view/the-secret-to-quality-doctor-patient-relationships. Accessed February 1, 2024.}