Empathic Skills Research Articles

Effect Of Communication Training Rubric On Empathic Communication Skills Of Nurses At A Tertiary Care Hospital: A Randomized Controlled Trial

Effect Of Communication Training Rubric On Empathic Communication Skills Of Nurses At A Tertiary Care Hospital: A Randomized Controlled Trial

Effectiveness of different strategies to teach empathy among medical students: A randomized controlled study

ObjectivesTo explore the effectiveness of two educational strategies for teaching empathy to medical students, focusing on their skills and on the theoretical knowledge and self-perception of empathy by patients, professors, and observers. MethodsThis is a randomized controlled study. Clerkship students were divided into two groups: an active group - Role Play and Reflection Group(RRG), and a more traditional group - Lecture Presentation Group(LPG). They were assessed pre- and post-intervention using the Jefferson Empathy Scale(JSPE), ESWIM Empathy Scale, CARE, empathic skills through simulated patient encounters, and a theoretical knowledge test. ResultsA total of 169 students were included. The RRG had higher scores (d=0.81) and greater gains (d=0.82) in empathic skills than the LPG. However, there were no significant differences in knowledge or other scales. Upon assessing skill acquisition (Post–Pre gains), there was a significant increase in both groups for all outcomes, except for JSPE in the LPG group and ESWIM for both groups. ConclusionMedical empathy can be taught, and active learning methodologies can lead to better outcomes, especially on the ability to provide empathic care. Practice implicationsThese findings reinforce existing literature and helps medical schools make informed decisions regarding their teaching methodologies. Trial registryhttps://ensaiosclinicos.gov.br/rg/RBR-8rwx89c.

Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.

Introduction. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. Methods. In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. Discussion. Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.

Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study.

Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. PRR1-10.2196/60361.

Using and Measuring Motivational Interviewing in a New Setting: Experiences From a Project Highlighting Relationship-Building Skills in the Process of Recruiting New Staff

Relationship-building skills, with empathy and empathic abilities as crucial ingredients, are described as central in human service professions. These professions usually require training on relationship-building skills. However, in many professional groups, with support or care functions, rather than functions specifically oriented towards treatment, the level of education and training required varies. Empathic skills are central in the concept of Motivational Interviewing (MI). It has been suggested that for the ethical reason that treatment staff should not harm clients, workplaces should assess staff members’ empathic skills and ability to refrain from harmful behaviours, and these capabilities should be investigated when recruiting new staff. In accordance with this suggestion, the residential homes at the Swedish National Board of Institutional Care (SiS), which provides compulsory care for young people, initiated a project to develop and trial a work test based on the concept of MI. The aim of the article is to, based on 59 interviews with stakeholders in the SiS-project, add to the discussion on the balancing act required in evidence-based practise of maintaining psychometric stringency versus making contextual and situational adjustments. Focus is on exploring the possibilities for using and interpreting measures of MI in a new setting as well as the possibilities for assessing relationship-building skills in the recruitment process. The results suggest that tinkering is often necessary when using standardised measures for complex skills like relationship building. The study proposes that a nuanced understanding of the method, measurement, and organisational context is essential even with well-established methods.

Empathic communication skills training to reduce lung cancer stigma: Study protocol of a cluster randomized control trial

BackgroundPrior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. MethodsThis paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9–11 OCPs per site, and 6 PwLCs per OCP. ResultsThe goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal – relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). ConclusionFindings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery.ClinicalTrials.govIdentifier: NCT05456841

Medical narrative ability and humanistic care ability of Chinese clinical nurses: The mediating role of empathy ability.

To investigate the relationship between medical narrative ability and humanistic care ability among Chinese clinical nurses, examining the potential mediating role of empathy. In the context of the bio-psychosocial medical model and humanistic nursing care, understanding the core competencies of medical narrative ability, empathyand humanistic care in nursing is crucial. This study explored the mediating role of empathy between medical narrative ability and humanistic care ability. A cross-sectional study. The study employed a descriptive, cross-sectional survey design, involving 741 nurses from Wuxi People's Hospital. It assessed nurses' demographic characteristics, medical narrative ability, empathy, and humanistic care ability using an online questionnaire from December 2022 to February 2023. Pearson correlation analysis evaluated variable correlations, and PROCESS v3.3 model 4 was utilised for mediation analysis. The STROBE statement was chosen as the EQUATOR checklist. A positive correlation was found between nurses' medical narrative ability, humanistic care abilityand empathy. Empathy partially mediated the relationship between medical narrative ability and humanistic care ability. Nurses' medical narrative ability directly and indirectly (via empathy) influences their humanistic care ability. Enhancing nurses' narrative and empathic skills can improve humanistic care, nursing qualityand nurse-patient relationships. Managers should prioritise programmes to improve nurses' storytelling and empathy skills to enhance humanistic care, improving nursing quality and patient relationships. This study involves clinical nurses as participants and does not involve patients. This study collected data from clinical nurses using an online questionnaire platform in China. The questionnaire consisted of four sections, including demographic information and scales such as Narrative Competence Scale, Caring Ability Inventoryand the Jefferson Scale of Empathy-Health Professional. Clear instructions were given to participants on how to complete each scale, and measures were taken to prevent missing or duplicate responses.

International Law Enforcement Observer XIV.

Aim: Despite the fact that this time, the Observer provides insight into a wide range of topics in the international law enforcement literature – from counter-terrorism to football security – the editorial purpose that influenced the selection is still recognisable. The aim is to focus readers’ interest on methods that focus on facts and require publicity. Examples will be given that demonstrate that unjustified secrecy can be an obstacle not only to scientific research but also to effective professional work. Methodology: Tamás Drusza’s review shows that in the United Kingdom, a tactic of combining intelligence and criminal investigation is used to counter terrorism effectively, which also means that the flow of information between organisations is a critical point in the system's operation. Secrecy between authorities can lead to inefficiency. ‘The drawbacks of applying the principle of restricting the transfer of information have been confirmed by a survey of Europol staff. The general view is that proactively sharing information is as important as obtaining it.’ Of course, in order for such a counterproductive application of the principle of confidentiality to come to light, it was necessary for police academics to carry out the necessary research in a sensitive area of service and then publish the results in a way that would allow even Hungarian colleagues interested in the subject to be informed by means of a review. Findings: Beyond the threat of terror, all forms of violent radicalism in the broader sense need to be countered by social cohesion, as András Hunor Lehel illustrates with the Swedish example. ‘According to a 2016 report by the Swedish Security Service, approximately 300 people have left Sweden to join various violent Islamist groups abroad and fight alongside their organisations. Many of these men have returned to Sweden and represent a potential threat to the community.’ The study concludes that local authorities play a key role in detecting and preventing radicalisation, alongside central government. It is no coincidence that resilience has emerged as a key concept. Swedish municipalities are expected to develop plans that include measures to increase resilience at local and community level. Andrea Mészáros gives an insight into research conducted at the Tempe Police Department in Arizona. Here, they sought to understand how measures were affected by the pandemic in March 2020, and then by the national outcry over the death of George Floyd, a victim of police violence. The study analysed 474 measures, selected at random and all of which were recorded on body camera. Researchers said a review of the body-worn camera footage highlighted that despite the extreme circumstances, police officers handled encounters with citizens in a professional manner. Tamás Pressburger reports on new methods of policing football matches. The experience in England suggests that police officers responsible for the security of football grounds have successfully improved the effectiveness of their work through a change of approach, with sufficient training and practical experience. Police officers also need to work closely with the cultural and emotional dynamics of football fans, and need empathic skills to intervene effectively and constructively in escalating situations. Value: The reviews presented a number of solutions that have found new ways to challenge the traditional approach to policing. These include replacing the myth of secrecy with openness that emphasises cooperation, consensus based on empathy rather than confrontation, resilience that leads to the resolution of the trauma that accompanies violence, and the dissolution of centralisation with the principle of self-government.

Association between self-assessed empathic skills, depressive symptoms and job satisfaction: A descriptive correlational study in Greek-speaking critical care nurses in Cyprus

Background: Critical care nurses face occupational hazards impacting their psychological well-being, job satisfaction, and ability to perform clinical duties effectively, including fostering empathic relationships with healthcare users. Aim: To assess in nurses employed in Emergency Departments, Cardiovascular Care, Intensive Care and Neonatal Intensive Care Units in the Republic of Cyprus: a) the degree of self-assessed depressive symptoms, job satisfaction, and empathic skills, and b) the relationship between these variables, and possible correlations with demographic characteristics. Methods: A correlational, cross-sectional design was employed in 150 critical care nurses (RR: 39.68%). In 2018, a self-reported questionnaire captured socio-demographic and educational/vocational details, alongside measurement tools for depressive symptoms (CES-D), empathic skills (JES-HP), and work satisfaction (IWS-Part B) among participants. Results: Mean scores for CES-D, IWS-Part B, and JES-HP were 14.4(±9.7), 184(±18.6), and 99(±14.7). respectively. Self-assessed depressive symptoms correlated negatively with job satisfaction (r=-0.296, p<0.001) and empathic skills (r=-0.270, p<0.001). Neonatal ICU nurses showed 5.7 points lower depressive symptoms than ED counterparts (b=-5.7, p=0.052). ICU nurses scored 10.4 points higher on IWS-Part B than ED nurses (b=10.39, p=0.015). Participants with 4-5 years of current work experience reported 12.7 points lower on IWS-Part B compared to <1 year (b=-12.7, p=0.042). Similarly, 10-13 years of experience correlated with 16.8 points lower empathic skills (b=-16.8, p=0.015). Conclusion: The relationship between depressive symptoms, job satisfaction and empathic skills was confirmed but is required in-depth qualitative and quantitative exploration for informed longitudinal and interventional studies.

A cross-sectional analysis between physical activity levels, weight status and empathy-related behaviors in a sample of Tuscany primary school children.

The present study aimed to investigate the relationship between physical activity (PA) and the development of relational empathy skills in children, taking into account weight status. Parents/guardians of primary school children were involved in filling out a questionnaire: the Empathy Questionnaire (EmQue-I13) and children were asked to complete the Physical Activity Questionnaire for Children (PAQ-C) to investigate the self-reported PA levels. The weight status was assessed using a self-reported Body Mass Index (BMI). Three hundred seventy parents or guardians of students who attended primary school (8.53±1.61 yrs) were recruited. The total score was 2.41±0.89 for PAQ-C and 41.17±6.32 for EmQue-I13. The three domains of EmQue-I13 were: contagion (8.16±2.67), attention to others' feelings (19.40±2.99) and prosocial actions (13.62±3.01). Linear regression models showed that a higher PAQ-C score was positively associated with empathy-related total score P<0.000. Weight status, age and gender were not associated with EmQue-I13. Our results underline the positive association between physical activity and the development of relational empathic skills.

Beyond Cognitive Empathy: Suggestions for Strengthening Medical Students’ Empathy

A physician’s empathy plays a crucial role in patient-centered care, and in modern medicine, patients, their caregivers, and society demand a high level of empathy from healthcare providers. The conceptualization of clinical empathy, which has emphasized cognitive empathy since the mid-20th century, has been widely accepted in medical schools and the healthcare industry without much critical reflection. This study provides an overview of the ongoing debates on empathy versus sympathy and cognitive empathy versus affective empathy to clarify the concept of empathy. Based on recent research findings, clinical empathy is proposed to encompass three components: cognitive empathy, affective empathy, and empathic motivation. It is suggested that fully demonstrating these components requires empathic communication skills. Additionally, the cognitive characteristics of medical students and the features of the academic environment demonstrate the need for education to strengthen their empathy skills. Considering this, proposed intervention methods that medical schools can consider include utilizing tutoring programs and debriefing processes for team activities, which can facilitate problem-solving as a coping strategy for stress. Learning communities can create an environment where students can receive social support and recover from stress. Medical schools can contribute to the development of students' professional identities as practicing clinicians who embody empathy and respect by cultivating professors as positive role models. Additionally, utilizing scales to assess the empathic nature of doctor-patient communication or incorporating patients and caregivers as evaluators can actively improve empathic communication skills.

Feasibility, acceptability, and initial efficacy of empathic communication skills training to reduce lung cancer stigma in Nigeria: a pilot study.

Effective communication about cancer diagnosis and prognosis in sub-Saharan African oncology settings is often challenged by the cancer-related shame and stigma patients and families experience. Enhancing empathic communication between health care providers, including physicians and nurses, and oncology patients and their families can not only reduce cancer stigma but also improve patient engagement, treatment satisfaction, and quality of life. To reduce lung cancer stigma, we adapted an evidence-based empathic communication skills training intervention to reduce patients' experience of stigma in Nigeria and conducted a pilot study examining the feasibility and acceptability of the empathic communication skills training. Thirty health care providers, recruited from University College Hospital, Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, participated in a 2.25-hour didactic and experiential training session. Participant surveys were completed before and after the training. Overall, participants reported highly favorable training evaluations, with at least 85% of health care providers agreeing or strongly agreeing to survey items assessing training relevance, novelty, clarity, and facilitator effectiveness. Self-efficacy to communicate empathically with patients increased significantly from before-training (Mean [SD] = 3.93 [0.28]) to after-training (Mean [SD] = 4.55 [0.15]; t29 = 3.51, P < .05). Significant improvements were observed in health care provider reports of empathy toward lung cancer survivors and attitude toward lung cancer care as well as significant reductions in lung cancer blame were noted. The empathic communication skills training was feasible, well received by oncology clinicians in Nigeria, and demonstrated improvements in health care provider-reported outcomes from before- to after-training.

Effectiveness of empathy portfolios in developing professional identity formation in medical students: a randomized controlled trial

BackgroundMedical education requires innovative strategies to enhance empathic skills and the formation of professional identities among students. However, evidence-based teaching of empathy and professional identity formation is inadequately represented, particularly in medical curricula. This study investigated the effectiveness of empathy portfolios in developing Professional Identity Formation (PIF) among medical students and the correlation between empathy and PIF. The objectives of this study were to determine the effectiveness of empathy portfolios for teaching and nurturing PIF in medical students and to investigate the correlation between empathy and PIF.MethodsA randomized controlled trial was conducted at Peshawar Medical College, Pakistan. The protocol adhered to CONSORT guidelines. A total of 120 students participated in the study. Empathy and PIF were assessed using two validated questionnaires JSPE-S and PIQ before randomization. The participants were randomized in a stratified fashion into the experimental (n = 60) and control (n = 60) groups. The Participants in the intervention group attended a training workshop on portfolio use. Students maintained their portfolios and wrote reflections on incidents that evoked empathy. Independent t-tests were performed to determine whether the control and experimental groups differed in terms of mean empathy and PIF scores, and Pearson’s correlation analyses were used to investigate the relationships between pre- and post-empathy, and pre-post-PIF.ResultsThe mean post-test scores on the Empathy and PIF showed a statistically insignificant difference of 0.75 +-17.6 for empathy and 0.45 ± 8.36 for PIF. The intervention had little influence on empathy and PIF scores, as evidenced by nonsignificant effect sizes of 0.32 and 0.36 for empathy and PIF respectively.A strong positive correlation was found between Pre-Empathy and the PIF-Total score (0.519), and between Post- empathy and the PIF-Total score (0.395) (p < 0.001).ConclusionsEmpathy had a positive linear correlation with PIF; however, the use of empathy portfolios as a three-week single-point intervention was ineffective at nurturing PIF.

“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs

BackgroundPatients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.MethodsIn-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.ResultsThe patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.ConclusionsPatients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.

Acquisition of key clinical communication skills through simulation-based education: findings from a program for postgraduate psychiatry trainees (ComPsych)

ObjectiveFew studies have investigated the maintenance of skills acquired in classroom-based clinician education. Using an advanced simulation-based clinical communication skill training program for postgraduate psychiatry education (ComPsych), we aimed to investigate skill acquisition through assessing changes in competence (abilities) and performance (practice).MethodsForty trainee psychiatrists (15 males; age range 26–48) participated. Video-recorded Standardized Patient Assessments (SPAs) were delivered twice pre- and post-training to assess learning. Skills were coded by independent psychologists using the Core Communication Skills (CCS) coding system. Simulated patients (SPs) rated trainees' communication performance using the Sim-Patient SPA checklist. Paired t-tests, linear mixed models and logistic mixed models assessed changes in communication skills over time.ResultsFor SPAs, reliability of coder ratings was deemed acceptable (ICC range 0.67 to 0.87). Mean post-training communication performance significantly increased for skills in agenda setting (p < 0.001), information organization (p < 0.001), empathic skills (p = 0.046), and overall skills performance (p = 0.001). Significant decreases for questioning skills were indicative of reduced reliance on these skills post-training. SPs rated all skillsets higher post-training. A modest relationship was detected between frequency (coded) and (SP-rated) quality of communication skills. Improvements in agenda setting and information organisation skills were retained ~ 6 weeks post-training.ConclusionsTraining improved patient-centered communication skills in psychiatry trainees, particularly skills in agenda setting and information organization, with skills retained ~ 6 weeks post-training. There was reduced reliance on questioning skills, which are well utilised generally. The study supports the benefits of this method of communication skills training into postgraduate psychiatry education.

Algorithms for Empathy: Using Machine Learning to Categorize Common Empathetic Traits Across Professional and Peer-Based Conversations.

Introduction In this article, we describe our creation of a machine-learning model that uses a combination of rule-based and natural language processing (NLP) algorithms. We show how this "Empathy Algorithm" was developedand how its results compare to three datasets of professional counseling and peer-led conversations. Methods These conversation datasets were rated by people with varying degrees of empathetic expertise (from counselors to student volunteers)and labeled as either low- or high-quality empathy. Our methodology involved running both these "low-empathy" and "high-empathy" conversations through our algorithm and then looking for a correlation between conversations labeled "high empathy" and an increased presence of six empathy skills flagged by our algorithm. Results We found positive correlations between four ofthe six skills that our algorithm measures (i.e., four empathizing skills showed up the same or more in each of the "high-empathy" conversations within the three datasets). This suggests that certain empathizing skills are not only consistently present in effective conversationsbut also quantifiable enough to be measured by today's machine-learning models. Conclusion While limitations of language, binary classifications, and non-verbal cues remain as opportunities for further development, using algorithms to objectively assess empathic skills represents an important step to improveclient outcomes and refine communication practices for today's healthcare professionals.

Interaction of Resting Heart Rate with Empathy in Predicting Externalizing Behavior

Biopsychosocial criminological theories suggest that it is important to consider interactions between risk factors from different domains in the prediction of externalizing behavior. Lower resting heart rate is considered the best replicated biological risk factor for externalizing behavior. The psychological construct of empathy has also shown to be predictive of such behavior, but little is known about the potential interaction between these two different risk factors in predicting externalizing behavior. We examined the moderating role of empathy on the association between resting heart rate in childhood and adolescence with externalizing behavior by young adulthood using two subsets of participants from the Longitudinal Risk Factors for Antisocial Behavior project: Subsample 1 (n = 697) at ages 9–10 and 19–20 years and Subsample 2 (n = 394) at ages 14–15 and 19–20 years. Linear and logistic regressions showed that empathy moderated the association between resting heart rate in adolescence and externalizing behavior by young adulthood. Among individuals with low but not high levels of empathy, increased resting heart rate predicted lower levels of externalizing behavior. Interventions enhancing empathic skills in individuals with psychophysiological risk profiles could be beneficial.

The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients?

Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.

Using the Skill of Noticing to Support Empathy for Third-Year Medical Students in Family Medicine.

Previous research has described a waning interest among third-year students to employ empathetic practice along with decreased opportunity to develop empathic communication skills. In this study we sought to address this decline using the skill of noticing (ie, the capacity to attune to specific aspects of practice and interactions) as an intervention for third-year medical students. We designed a qualitative study to address the following research question: How can a focused noticing tool encourage empathetic moments during the patient interview for third-year medical students? Eight third-year medical students used the Social Emotional Noticing Tool (SENT) during their 4-week family medicine rotation, then joined a focus group to share their experiences with SENT and articulate barriers and opportunities toward practicing empathy during clerkship. Student participants (a) described using the tool, including barriers and opportunities; (b) made connections between the practice of noticing using SENT and enacting empathy; and (c) emphasized how enacting empathy in their third year is largely influenced by interactions with clinical faculty. The use of SENT helped students notice empathy or lack thereof. However, making connections between individual capacity for empathic interactions and the impact of positive or negative role models is necessary. Based on our findings, we encourage the need for shared responsibility among students, faculty and preceptors, and organizations.

The efficacy of compassion training programmes for healthcare professionals: a systematic review and meta-analysis

AbstractContinuous exposure to the suffering and death of patients produces certain syndromes such as compassion fatigue in health professionals. The objective of this study was to analyze the effect and the effectiveness of interventions based on mindfulness, aimed at training or cultivating compassion or self-compassion in compassion fatigue, self-compassion, compassion, and compassion satisfaction of health professionals. A systematic review is reported in line with the PRISMA guideline and was registered in PROSPERO. The PubMed, Web of Science, PsycINFO and CINAHL databases were used. Interventions based on compassion training or cultivation were selected, aimed at health professionals. A meta-analysis was performed using a random-effects model. The effect size and hetereogeneity of the studies were calculated. Eight articles were selected. Among the programmes for the cultivation of compassion we highlight Compassion Cultivation Training (CCT), Mindfulness and Self-Compassion (MSC), Compassionate Meditation (CM), and Loving Kindness Meditation (LKM). The interventions decreased compassion fatigue and increased compassion, self-compassion, and compassion satisfaction in healthcare professionals. Compassion fatigue in healthcare professionals is due to a deficit in empathic and compassionate skills. Health systems should incorporate programmes based on the cultivation of compassion and self-compassion in order to improve the work conditions and quality of life of health professionals.