Patient and Practitioner Perspectives on the Definition and Measurement of Therapeutic Empathy: Qualitative Study

Most definitions of therapeutic empathy are based on practitioners' perspectives, and few account for patients' views. Therefore, we do not understand what therapeutic empathy means to patients. Given that therapeutic empathy involves a relationship between patients and practitioners, the underrepresentation of the patient voice threatens to undermine the validity of therapeutic empathy definitions and subsequently, how the concept is measured, taught, and practiced.

The aim of the study is to explore the perspectives of patients and practitioners on the definition of therapeutic empathy and how it should therefore be measured.

A qualitative study, underpinned by a social constructivist stance, was conducted. Patients and practitioners were purposively sampled from a medical school and a school of health care to represent a diversity of lived experiences and health care professions. In-depth, semistructured interviews were undertaken, and the data were analyzed using reflexive thematic analysis. Data collection ceased upon reaching meaning saturation.

In total, 16 participants (8 patients and 8 practitioners) were interviewed in June and July 2024. Reflexive thematic analysis generated three overarching themes that synthesize the views of patients and practitioners on therapeutic empathy and how it should be measured: (1) therapeutic empathy involves the practitioner showing the patient (that they are interested in the patient as a person, that they are actively listening, that they understand, that they are emotionally engaged, and that they are responding to their needs), (2) context matters (eg, the clinical scenario, time, and the patient), and (3) short, simple scales are a pragmatic approach to measurement.

Patients and practitioners have similar views about what empathy is and define therapeutic empathy as involving the practitioner demonstrating specific attitudes and behaviors to their patients. These attitudes and behaviors should be included in interventions to enhance therapeutic empathy and in measures of the concept. However, contextual factors may influence the expression of therapeutic empathy in practice. The findings highlight the need for, and can inform the development of, a short therapeutic empathy scale that allows the comparison of scores between patients, practitioners, students, and observers.