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While larger, high-quality trials are now needed, this study marks an important step forward for this conceptually difficult field.
- Dr Jeremy Howick, University of Oxford

Research published in the Journal of the Royal Society of Medicine suggests that empathic, positive messages from doctors may be of small benefit to patients suffering from pain, and improve their satisfaction about the care received.

The study, which combined data from 28 clinical trials involving over 6,000 patients, adds weight to the argument that patient outcomes can be improved when doctors enhance how they express empathy and create positive expectations of benefit.

From the Universities of Oxford and Southampton in the UK, with the Netherlands Institute for Health Services Research and Lithuania’s Vilnius Gediminas Technical University, the research team analysed a series of randomised clinical trials that looked at the effects of empathy or positive communication in healthcare consultations. These trials included data from consultations on a wide range of clinical conditions including pain, asthma, irritable bowel syndrome, osteoarthritis and recovery after surgery. The researchers also reviewed the effects of positive communication on quality-of-life and patient satisfaction, based on reports from patients in these trials.

The most significant benefits were seen when doctors communicated positive and reassuring messages to patients with the intention of improving a patient’s expectations. In these studies, patients reported to be 5% to 20% more satisfied with their treatment compared to those who received standard care, and reported slightly improved quality-of-life 

In pain trials where enhanced empathy expressed by doctors was compared with usual care, patients reported on average an additional half-point reduction in pain on a ten-point visual scale. While this reduction suggests empathy has a small effect on pain, this falls short of the one to two-point reduction which would suggest this effect is clinically relevant. The researchers also did not make any direct comparisons with the effects of drug treatment for pain.

Lead author Dr Jeremy Howick, Director of Oxford University’s Oxford Empathy Programme, said: “Doctors can do much more than prescribe drugs and other treatments to help patients suffering from mild to moderate pain. Based on the clinical trials we reviewed, the potential for these kinds of interventions to help many – perhaps most – patients in general practice appears to be promising. Whether patients need drugs or not, adding a dose of empathy may be likely to reduce their pain and lower their anxiety.”

Urging caution due the limitations of their research, Dr Howick said “For many of the trials we looked at, the quality of the evidence was low and the trials were small, meaning that our conclusions could change with future research. Our study shows that empathy and positive verbal communication only provides a relatively small benefit to patients, and is unlikely to have a harmful effect, so we need to learn more about how to maximise this benefit and the cost-implications of this care. While larger, high-quality trials are now needed, this study marks an important step forward for this conceptually difficult field.”  

The research was funded by the British Medical Association.

For further information or comment, please contact Dr Jeremy Howick, Senior Researcher and Director of the Oxford Empathy Programme, Nuffield Department of Primary Care Health Sciences, University of Oxford. jeremy.howick@phc.ox.ac.uk

Paper reference:

Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis
Jeremy Howick, Andrew Moscrop, Alexander Mebius, Thomas R Fanshawe, George Lewith, Felicity L Bishop, Patriek Mistiaen, Nia W Roberts, Egle Dieninyte, Xiao-Yang Hu, Paul Aveyard, Igho J Onakpoya. Journal of the Royal Society of Medicine 2018. DOI: https://doi.org/10.1177/0141076818769477

 

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