Presentation
SE2 - Empathy Training in Healthcare: An Umbrella Review
DescriptionIntroduction
Empathy, defined as the ability to perceive and resonate with the emotions of others (Riess, 2017), is an important skill for healthcare workers to improve patient care. Specifically, empathy has been associated with increased patient satisfaction, improved patient trust, and enhanced physician attitudes, which can lead to better clinical outcomes (Derksen et al., 2013). Patient-centered communication, which includes empathy as a core component, has similarly been positively associated with patient satisfaction (Decety & Fotopoulou, 2015). Further, empathy also has benefits for healthcare workers: for example, physicians who received empathy training reported higher levels of compassion satisfaction, reduced burnout, and increased resilience (West et al., 2018).
Empathy training plays a pivotal role in fostering effective communication between doctors and patients, leading to the establishment of trust-based relationships. By honing their empathetic skills, doctors can navigate difficult conversations, address patient concerns, and foster a sense of partnership, which is essential for shared decision-making and collaborative care (Wu et al., 2022). Heightened communication and trust-building not only contribute to better patient outcomes, but also create a more positive healthcare experience for patients. Additionally, positive healthcare experiences boost the morale of workers, leading to higher job satisfaction and decreased burnout (Yue et al., 2022).
Empathy is malleable and can be increased via training. Several reviews have been conducted to determine the impact of empathy training in healthcare. However, they vary in terms of sample type (healthcare workers vs. students), training strategies (e.g., simulation, lectures, any vs specific, etc.), and outcomes examined, with differing results. An integrative umbrella review is needed to determine the conditions under which empathy training is most effective in healthcare.
Methods
We conducted an umbrella review using PubMed, SCOPUS and Web of Science and search terms such as “patients,” “empathy,” “training,” “healthcare workers” to identify reviews and/or meta-analyses on training interventions to improve empathy among healthcare providers.
We followed detailed inclusion and exclusion criteria to select studies that implemented empathy training for any type of healthcare professional or medical/nursing/allied health student, including but not limited to physicians, nurses, and dental assistants. We included any type of training strategies such as didactic, simulation, or role-play exercises, virtual reality experiences, guest speaker lectures, patient storytelling sessions, and reflective writing. Our inclusion criteria were not held to restrictions of comparison groups or outcome measures, which ensured a general assessment of the evidence. We also included myriad review types, including systematic reviews, scoping reviews, umbrella reviews, qualitative studies, and meta-analyses. We excluded studies focused on empathy training for patients or caregivers, studies in which less than 50% of participants were healthcare professionals/students, and those in which the content did not focus on increasing empathy toward patients.
Two coders conducted title/abstract screening and full-text reviews with discrepancies resolved between the researchers. A standardized data extraction form was used to systematically code details of the reviews, with high interrater agreement.
Results
We identified 476 articles for screening, with 351 excluded based on title/abstract, and 73 excluded based on a full-text review. This left 52 studies for our umbrella review. The reviews within this umbrella review ranged from 3 studies to 305 studies, depending on inclusion/exclusion criteria related to study design, sample type, training strategies, and outcomes assessed. Reviews in this area most commonly focused on any type of study design (including both qualitative and quantitative). In terms of sample type, reviews tended to restrict their inclusion criteria to one of three primary groups: physicians, nurses, or students; however, some reviews included a mix of sample types. Most reviews did not specify inclusion or exclusion criteria related to training strategy, and thus included studies of several strategies and methods such as lectures, simulation, and reflective writing.
Primary studies within the reviews most commonly examined the impact of empathy training on the outcome of improved self-reported empathy. Along these lines, most reviews found that training interventions are generally effective in improving empathy skills in healthcare practitioners and/or students. Among healthcare workers, empathy training has also been shown to decrease barriers to practicing compassionate care and increase skills in leadership and communication (Coffey et al., 2019). Further, a byproduct of educational empathy intervention includes mental health care and decreased rates of burnout for practitioners and students (Winter et al., 2022). Approaches that modeled real-life interactions between patient and practitioner, such as simulations and mock appointments involving patients, were found to have a significant positive impact on patient care and relationships (Pakkonen et al., 2021; Moreau et al., 2018).
Though infrequent, non-significant and negative outcomes for empathy training were occasionally noted, and seem to be related to provider specialty and training design. Though students experience positive outcomes from the curricula in the short term, a common limitation of these studies was their inability to monitor the retention of empathy skills post-training (Pratiwi et al., 2022). Additionally, there is a common theme within the systematic reviews of suggesting less biased study design to prevent discrimination against underrepresented and disabled patient populations (Stepien et al., 2006).
Unclear outcomes of empathy training emerge from non-consensus definitions of empathy and patient-centeredness. The various dimensions of what constitutes empathy and patient-centered care make it difficult for researchers to reach a consensus on which operational definition is best to use, which similarly impacts the guidelines for finding the most appropriate tool to measure the phenomena (Brouwers et al., 2017).
Discussion
The results of this study indicate that there are certain conditions under which empathy education and training is more effective across factors such as sample type, training strategies, and outcomes. For training strategies, the results indicate that it is unclear what the best method for empathy education/training is, however the results do show that any type of empathy education or training is more common than specific empathy education or training methods and yields more positive outcomes. Methods of empathy education, methods to assess empathy, impact of empathy training, and the need to determine long-term impacts of empathy training were common themes in the reviews.
The scope of this study is centered around identifying the outcomes of methods such as didactic, simulation, or role-play exercises, virtual reality experiences, guest speaker lectures, patient storytelling sessions, reflective writing, and other methods of improving empathy. We found that empathy training leads to improvements in professional healthcare workers’ empathy. Our umbrella review identified a need for more evidence regarding the implementation of empathy and compassion teaching programs, the long-term implications of such programs, and the effects of student-focused empathy training rather than health care worker-focused empathy training. Implications include improving medical curricula by incorporating the elements of empathy training that we found the most effective. The results also reinforce that empathy is not an inherent trait but is a skill that can be developed through effective and reoccurring teaching methods.
Empathy, defined as the ability to perceive and resonate with the emotions of others (Riess, 2017), is an important skill for healthcare workers to improve patient care. Specifically, empathy has been associated with increased patient satisfaction, improved patient trust, and enhanced physician attitudes, which can lead to better clinical outcomes (Derksen et al., 2013). Patient-centered communication, which includes empathy as a core component, has similarly been positively associated with patient satisfaction (Decety & Fotopoulou, 2015). Further, empathy also has benefits for healthcare workers: for example, physicians who received empathy training reported higher levels of compassion satisfaction, reduced burnout, and increased resilience (West et al., 2018).
Empathy training plays a pivotal role in fostering effective communication between doctors and patients, leading to the establishment of trust-based relationships. By honing their empathetic skills, doctors can navigate difficult conversations, address patient concerns, and foster a sense of partnership, which is essential for shared decision-making and collaborative care (Wu et al., 2022). Heightened communication and trust-building not only contribute to better patient outcomes, but also create a more positive healthcare experience for patients. Additionally, positive healthcare experiences boost the morale of workers, leading to higher job satisfaction and decreased burnout (Yue et al., 2022).
Empathy is malleable and can be increased via training. Several reviews have been conducted to determine the impact of empathy training in healthcare. However, they vary in terms of sample type (healthcare workers vs. students), training strategies (e.g., simulation, lectures, any vs specific, etc.), and outcomes examined, with differing results. An integrative umbrella review is needed to determine the conditions under which empathy training is most effective in healthcare.
Methods
We conducted an umbrella review using PubMed, SCOPUS and Web of Science and search terms such as “patients,” “empathy,” “training,” “healthcare workers” to identify reviews and/or meta-analyses on training interventions to improve empathy among healthcare providers.
We followed detailed inclusion and exclusion criteria to select studies that implemented empathy training for any type of healthcare professional or medical/nursing/allied health student, including but not limited to physicians, nurses, and dental assistants. We included any type of training strategies such as didactic, simulation, or role-play exercises, virtual reality experiences, guest speaker lectures, patient storytelling sessions, and reflective writing. Our inclusion criteria were not held to restrictions of comparison groups or outcome measures, which ensured a general assessment of the evidence. We also included myriad review types, including systematic reviews, scoping reviews, umbrella reviews, qualitative studies, and meta-analyses. We excluded studies focused on empathy training for patients or caregivers, studies in which less than 50% of participants were healthcare professionals/students, and those in which the content did not focus on increasing empathy toward patients.
Two coders conducted title/abstract screening and full-text reviews with discrepancies resolved between the researchers. A standardized data extraction form was used to systematically code details of the reviews, with high interrater agreement.
Results
We identified 476 articles for screening, with 351 excluded based on title/abstract, and 73 excluded based on a full-text review. This left 52 studies for our umbrella review. The reviews within this umbrella review ranged from 3 studies to 305 studies, depending on inclusion/exclusion criteria related to study design, sample type, training strategies, and outcomes assessed. Reviews in this area most commonly focused on any type of study design (including both qualitative and quantitative). In terms of sample type, reviews tended to restrict their inclusion criteria to one of three primary groups: physicians, nurses, or students; however, some reviews included a mix of sample types. Most reviews did not specify inclusion or exclusion criteria related to training strategy, and thus included studies of several strategies and methods such as lectures, simulation, and reflective writing.
Primary studies within the reviews most commonly examined the impact of empathy training on the outcome of improved self-reported empathy. Along these lines, most reviews found that training interventions are generally effective in improving empathy skills in healthcare practitioners and/or students. Among healthcare workers, empathy training has also been shown to decrease barriers to practicing compassionate care and increase skills in leadership and communication (Coffey et al., 2019). Further, a byproduct of educational empathy intervention includes mental health care and decreased rates of burnout for practitioners and students (Winter et al., 2022). Approaches that modeled real-life interactions between patient and practitioner, such as simulations and mock appointments involving patients, were found to have a significant positive impact on patient care and relationships (Pakkonen et al., 2021; Moreau et al., 2018).
Though infrequent, non-significant and negative outcomes for empathy training were occasionally noted, and seem to be related to provider specialty and training design. Though students experience positive outcomes from the curricula in the short term, a common limitation of these studies was their inability to monitor the retention of empathy skills post-training (Pratiwi et al., 2022). Additionally, there is a common theme within the systematic reviews of suggesting less biased study design to prevent discrimination against underrepresented and disabled patient populations (Stepien et al., 2006).
Unclear outcomes of empathy training emerge from non-consensus definitions of empathy and patient-centeredness. The various dimensions of what constitutes empathy and patient-centered care make it difficult for researchers to reach a consensus on which operational definition is best to use, which similarly impacts the guidelines for finding the most appropriate tool to measure the phenomena (Brouwers et al., 2017).
Discussion
The results of this study indicate that there are certain conditions under which empathy education and training is more effective across factors such as sample type, training strategies, and outcomes. For training strategies, the results indicate that it is unclear what the best method for empathy education/training is, however the results do show that any type of empathy education or training is more common than specific empathy education or training methods and yields more positive outcomes. Methods of empathy education, methods to assess empathy, impact of empathy training, and the need to determine long-term impacts of empathy training were common themes in the reviews.
The scope of this study is centered around identifying the outcomes of methods such as didactic, simulation, or role-play exercises, virtual reality experiences, guest speaker lectures, patient storytelling sessions, reflective writing, and other methods of improving empathy. We found that empathy training leads to improvements in professional healthcare workers’ empathy. Our umbrella review identified a need for more evidence regarding the implementation of empathy and compassion teaching programs, the long-term implications of such programs, and the effects of student-focused empathy training rather than health care worker-focused empathy training. Implications include improving medical curricula by incorporating the elements of empathy training that we found the most effective. The results also reinforce that empathy is not an inherent trait but is a skill that can be developed through effective and reoccurring teaching methods.
Event Type
Poster Presentation
TimeTuesday, March 264:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives