A systematic review of research on empathy in health care.

Nembhard, I. M., et al. (2023).

Health services research, 58(2), 250–263.

https://doi.org/10.1111/1475-6773.14016

Abstract

Objective

To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes.

Data Source

We searched MEDLINE, MEDLINE In‐Process, PsycInfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English‐language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971–2021).

Study Design

We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.

Data Collection/Extraction Methods

Title and abstract screening for study eligibility was followed by full‐text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings.

Principal Findings

Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey‐based, cross‐sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational‐level interventions (e.g., empathy‐specific processes or roles) were identified.

Conclusions

Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational‐level interventions for systematic improvement are lacking.

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Here are some thoughts:

The systematic review explores the significance of empathy in health care, analyzing its predictors, outcomes, and interventions to enhance it among health care professionals. The review, which spans 455 studies from 1971 to 2021, reveals that empathy is predominantly studied through cross-sectional, survey-based methods, with a focus on physicians, medical students, and nurses. Empathy is positively linked to better clinical outcomes, patient experiences, and provider performance, including improved adherence to treatment plans and reduced burnout. Key predictors of empathy include provider demographics, characteristics like personality traits and well-being, and behaviors such as communication skills. Educational interventions, particularly training programs and workshops, have proven effective in boosting empathy levels, though organizational-level interventions remain underexplored.

Discrimination in Medical Settings across Populations: Evidence from the All of Us Research Program.

Wang, V. H., Cuevas, A. G., et al. (2024).

American Journal of Preventive Medicine.

https://doi.org/10.1016/j.amepre.2024.05.018

Abstract

Introduction

Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.

Methods

Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021–2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023–2024.

Results

About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05.

Conclusions

The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.

The article is paywalled here.

Here are some thoughts:

A recent national study revealed alarming rates of discrimination in healthcare settings, affecting approximately 37% of U.S. adults. Disproportionately impacted groups include women, Black and Hispanic individuals, those with limited English proficiency, renters, publicly insured or uninsured individuals, and those with chronic conditions or disabilities. These populations face higher odds of experiencing discrimination in healthcare settings, perpetuating existing health disparities.

The study highlights the intersectionality of race/ethnicity and socioeconomic status as a critical factor in exposure to discrimination. Furthermore, specific situations drive experiences of discrimination for certain populations, such as lack of respect or poor communication from healthcare providers.

To address these disparities, healthcare institutions are developing implicit bias training, though research suggests modest effectiveness. Coupling bias training with reflective exercises or perspective-taking may enhance efficacy. Additionally, promoting diversity within the healthcare workforce and policy interventions, such as the Hospital Consumer Assessment of Healthcare Providers and Systems survey, can help monitor and improve patient-provider relationships.

However, the current survey lacks components measuring discrimination. Incorporating these measures can inform national trends, identify vulnerable populations, and guide targeted interventions. Study limitations include data collection during the COVID-19 pandemic and potential underestimation of discrimination due to measurement constraints.

Key Takeaways:

• 37% of U.S. adults experience discrimination in healthcare settings
• Disproportionate impact on vulnerable populations
• Intersectionality of race/ethnicity and socioeconomic status exacerbates disparities
• Targeted interventions and policy changes are necessary to address discrimination
• Measuring discrimination in healthcare settings is crucial for improvement

Recommendations:

• Develop effective bias training programs
• Promote diversity within the healthcare workforce
• Incorporate discrimination measures into national surveys
• Tailor interventions to address specific experiences of discrimination
• Foster patient-centered care to reduce healthcare disparities