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
Empathy is a particular form of interpersonal understanding and stands for a basic sensitivity to the mindedness of other persons. In general, it is considered that clinical empathy leads to improved patient satisfaction, greater adherence to therapy, better clinical outcomes, greater quality of service delivery perception and lower malpractice liability, while for clinicians and society it promotes the values of humanism, reduces professional burnout and increases diagnostic accuracy, and increases public trust to the healthcare system. Assessing empathy is one of the most important aspects of investigating empathy with over 10 scales currently in use.
There is a multitude of 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. Next, there are 38 systematic reviews in the topic of empathy but only 6 of them are meta-analyses. The lack of quantitative synthesis does not allow for aggregation of research into meta-studies and umbrella reviews that are better in summarizing evidence and guiding policy and practice.
Our hypotheses are that multiple empathy scales are currently in use and their results are heterogeneous. The present study’s objectives are to answer which empathy scales have been used in the years 2012 to 2016 to assess and measure empathy in healthcare students, what their reliability is and which factors contribute to their heterogeneity.
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.
This study is the first meta-analysis of reliability for empathy scales in healthcare education. The results indicate that scales have satisfactory internal consistency but there is a confusion of scales, definitions and empathy components. The meta-analytic mean for Cronbach’s alpha was within the acceptable range for scales. The Jefferson Scale of Physician Empathy is currently being used most frequently and is currently dominating the clinical empathy literature. In practice, there is need for consensus to adopt a certain group of scales with best internal consistency and widespread use. The Jefferson Scale of Physician Empathy seems to be close to an integrated definition of empathy incorporating both cognitive and affective traits. It might benefit from the addition of more items similar to Davis’ Interpersonal Reactivity Index, thus also increasing its alpha. Finally, more meta-analyses and umbrella reviews are needed with various approaches and research questions in the field of clinical empathy.
Future research should focus on standardizing scales that are used throughout healthcare education and production of consensus statements on definition of empathy and use of appropriate empathy scales.