Empathy promoting interventions for health professionals: a systematic review of RCTs

Authors assessed systematically the effectiveness of interventions aiming at health professionals’ increase of empathic responses. Authors searched Pubmed, Cochrane Database of Clinical Trials, Scopus, and PsycInfo for randomized controlled trials (RCTs) (latest search on November 2012). They included trials in English that evaluated interventions, which may promote empathy in health professionals. Studies were categorized according to the type of the outcome on empathy (attitude or opinion, knowledge or skills, and behavior). Authors considered change in empathy as the main outcome. Standardized mean differences (SMD) with 95 % confidence interval (95 % CI) were calculated for the studies that provided adequate data. Primary analysis included all the studies that provided adequate data per outcome category. In addition, authors proceeded in subgroup analyses for the following groups (a) type of intervention (experiential vs. non-experiential; (b) training specifically for promoting empathy vs. other; (c) type of assessor (external observer, health professional participants, and patients); and (d) type of process used for empathy evaluation, (simulated interview, actual interview, and questionnaire completion without interview). Out of 722 items, 17 articles were eligible. Trials were highly heterogeneous in terms of participants, interventions, and outcome measures. Interventions usually covered a broad training on communication skills. Thirteen studies used experiential while four non-experiential learning approaches. There were only two studies that evaluated interventions specifically aiming at promoting empathy; one of these trials reported significant increase in residents’ empathy related knowledge, skills, and behavior. Based on 13 trials with adequate data, health professionals in intervention group improved empathic behavior when compared to control group (SMD 0.8, 95 % CI 0.4, 1.2; P value <0.001). None of the trials assessed patients’ health care outcomes. There are interventions, which may contribute to a significant improvement in empathic behavior among health professionals. However, the type of intervention that would be effective needs to be supported by future studies. Whether empathic behavior may last, or whether it may affect patients’ outcomes is yet to be defined.