Rapid Assessment of Therapeutic Empathy (RATE): Development of a universal single-item empathy scale and validation...

Therapeutic empathy improves patient and practitioner outcomes, yet existing measures are often lengthy, conceptually inconsistent, and difficult to compare across respondent groups. Brief, universal measures (usable by patients, practitioners, students, and observers) are lacking. We developed a universal single-item scale - the Rapid Assessment of Therapeutic Empathy (RATE) scale - and conducted psychometric testing of the patient-reported version.

We used a three-phase approach: (1) item development; (2) pre-testing the scale by obtaining expert panel feedback (n = 9) and conducting cognitive interviews with stakeholders (n = 35); and (3) scale validation in an international patient sample (n = 521) assessing convergent, discriminant, and known-groups validity. Validation involved assessing correlations with the Consultation and Relational Empathy (CARE) measure and clinical neutrality measure, and by assessing differences in scores by patient ethnicity.

We developed two versions (pictorial and text-based) of each scale. Expert feedback and cognitive interviews confirmed content and face validity. Pictorial and text-based versions showed high convergent validity with the CARE measure (r = 0.761 and r = 0.838, both p < 0.001), and discriminant validity with a clinical neutrality measure (r = 0.131 and r = 0.139, p = 0.003 and p = 0.001, respectively). Correlations with the CARE measure remained high (r > 0.70) and statistically significant (p < 0.001) across patient gender, ethnicity, and practitioner type. Ethnic minority patients rated practitioner empathy lower than White patients (pictorial p = 0.057; text-based p = 0.033), demonstrating known-groups validity. Patients rated doctors' empathy higher than other healthcare practitioners' (p = 0.001 for both pictorial and text-based); there were no significant differences in empathy scores by patient gender.

We developed the first universal single-item therapeutic empathy measure and demonstrated validity. The RATE scale is brief, accessible, and applicable to clinical practice, education, and research. Further research should validate practitioner-, student-, and observer-reported versions, and assess predictive and cross-cultural validity. This robust tool can support patient-reported routine measurement of therapeutic empathy and contribute to improving patient and practitioner outcomes.