Published online Jan 10, 2019. doi: 10.13105/wjma.v7.i1.1
Peer-review started: November 28, 2018
First decision: December 10, 2018
Revised: December 16, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 10, 2019
Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.
To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.
A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.
Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.
The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.
Core tip: No consensus is available about which tools are more reliable to assess clinical empathy in healthcare students. The present study is the first to assess the reliability of clinical empathy scales with meta-analysis. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components, with the presence of heterogeneity and publication bias. Future research should focus on standardizing scales and creating consensus statements regarding empathy definitions and use of appropriate scales.