Analyzing the “nature” and “specific effectiveness” of clinical empathy: A theoretical overview and contribution towards a theory-based research agenda

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Abstract

Objective

To establish sound empirical evidence that clinical empathy (abbreviated as CE) is a core element in the clinician–patient relationship with profound therapeutic potential, a substantial theoretical-based understanding of CE in medical care and medical education is still required. The two aims of the present paper are, therefore, (1) to give a multidisciplinary overview of the “nature” and “specific effectiveness” of CE, and (2) to use this base as a means of deriving relevant questions for a theory-based research agenda.

Method

We made an effort to identify current and past literature about conceptual and empirical work focusing on empathy and CE, which derives from a multiplicity of disciplines. We review the material in a structured fashion.

Results

We describe the “nature” of empathy by briefly summarizing concepts and models from sociology, psychology, social psychology, education, (social-)epidemiology, and neurosciences. To explain the “specific effectiveness” of CE for patients, we develop the “Effect model of empathic communication in the clinical encounter”, which demonstrates how an empathically communicating clinician can achieve improved patient outcomes. Both parts of theoretical findings are synthesized in a theory-based research agenda with the following key hypotheses: (1) CE is a determinant of quality in medical care, (2) clinicians biographical experiences influence their empathic behavior, and (3) CE is affected by situational factors.

Conclusion

The main conclusions of our review are twofold. First of all, CE seems to be a fundamental determinant of quality in medical care, because it enables the clinician to fulfill key medical tasks more accurately, thereby achieving enhanced patient health outcomes. Second, the integration of biographical experiences and situational factors as determinants of CE in medical care and medical education appears to be crucial to develop and promote CE and ultimately ensuring high-quality patient care.

Practice implications

Due to the complexity and multidimensionality of CE, evidence-based investigations of the derived hypotheses require both well-designed qualitative and quantitative studies as well as an interdisciplinary research approach.

Introduction

While clinicians acknowledge the value of empathy as a core element in high-quality patient care [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], there is still a lack of providing sound empirical evidence that empathy deserves an unchallenged place in medical care and medical education. One explanation for the insufficient empirical findings is a rare synthesizing of existing multidisciplinary empathy theories, which could, in turn, lead both to a better understanding, operationalisation, and measurement of empathy as well as the ability to derive theory-guided research questions. In this way, we might be able to study clinical empathy (abbreviated as CE) through the systematic testing of theory-guided hypotheses [21]. The latter could provide sound empirical evidence of the profound therapeutic potential of CE, thus, bridging the gap between patient-centered medicine and evidence-based medicine [22]. For those reasons, the two objectives of the present paper are (1) to give a multidisciplinary theoretical overview of the “nature” and the “specific effectiveness” [23] of CE and (2) to use this theoretical base as a means of deriving relevant questions for an evidence-based empirical research in the future.

Section snippets

Method

To reach these two study objectives, we made an effort to identify current and past literature about theories and empirical results concerning the “nature” and “specific effectiveness” of empathy and CE. So, Section 3.1 gives a multidisciplinary overview of the key theories on the “nature” of empathy, which are particularly relevant for application to CE. By reviewing prior empirical studies of CE, we develop a model in Section 3.2, which describes the “specific effectiveness” of CE. However,

Empathy as an affective event

Empathy has its origin in the German word Einfühlung (“feeling into”) [24]. Lipps [25], [26] established Einfühlung as a standard term in psychology and, a few years later, Tichener sought to translate Lipps’ term Einfühlung by coining the word empathy in English based on the Greek empathein [27]. Since then various authors, who see empathy first and foremost as an affective action [28], [29], [30], [31], [32], [33], [34], [35] have attempted to define empathy. Friedlmeier summarizes their

Discussion

Towards a theory-based research agenda on the “nature” and “specific effectiveness” of clinical empathy.

Conclusion

In this paper, we proposed to expand the focus of empathy theories in order to attain an enhanced understanding, operationalisation and measurement of CE and to incorporate these theories into a theory-based research agenda on the “nature” and “specific effectiveness” of CE. The main conclusions of our theoretical analyses are the following hypotheses:

  • (a)

    CE is a fundamental determinant of quality in medical care because it enables the clinician to fulfill key medical tasks more accurately, thereby

Acknowledgments

We are grateful to the Else Kröner-Fresenius Foundation for providing Melanie Neumann with financial support during the course of this study (grant number P43/05//A33/05/F0). Stewart W. Mercer is supported by a Primary Care Research Career Award from the Chief Scientist Office of the Scottish Executive.

We would also like to thank Fawn Zarkov for her qualified support concerning our application of the English language.

Moreover, we are grateful to the anonymous reviewers for their very

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