MEZIESBLOG

Abstract

Background: Empathy in healthcare service refers to the ability of healthcare workers (HCWs) to put themselves in patients’ shoes, which is necessary to ensure a good physician-patient relationship and provide quality care. Various studies have shown that empathy varies depending on the country, the instrument used, the evaluator, and the HCW’s specialty. This systematic review aims to estimate the levels of empathy among HCWs in South American countries between 2000 and 2019.

Methods: We conducted searches in 15 databases (PubMed, Scopus, Web of Science, EMBASE, Scielo, PsycoInfo, ScientDirect, Latindex, and LILIACS), four preprint servers (medRxiv, bioRxiv, SportRxiv, and Preprints), and other search engines such as Dimensions (20), Google Scholar, Yahoo!, and Alicia CONCyTec (c). We followed the PRISMA guidelines, and this study was registered in PROSPERO (CRD42023454007).

Results: Out of 18,532 documents identified from November 10 to 28, 2021, 10 articles were included (n = 2,487 participants, of which 1989 were patients). Among the studies focusing on self-evaluated empathy, four relied on the Jefferson Scale of Empathy for medical professionals (JSE-HP).

However, assessments from patients employing Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) and Consultation and Relational Empathy (CARE) scale suggested high levels of empathy We found that both professionals and patients perceived that empathic care was provided, often at a medium or regular level. Surgery residents presented lower levels of empathy compared to obstetrics-gynecology and pediatrics physicians.

Conclusion: Empathy is crucial in determining the quality of care and patient satisfaction during healthcare services provided by HCWs. Therefore, it is important to support professionals so that the various stressful situations they encounter in their work and daily life do not negatively influence the approach they provide to patients.

1 Introduction

Healthcare encompasses a series of formalized processes aimed at delivering services and assistance to preserve and promote well-being (1). According to the World Health Organization (WHO), quality healthcare entails providing the most appropriate diagnostic and treatment services with minimal risk and maximal patient satisfaction (2). Consequently, patient satisfaction primarily hinges on their perception and evaluation of the received care and offered services (3). Healthcare professionals (HCWs) can evaluate themselves or undergo assessments from third parties, often patients or supervisors, to gage the quality of care (4). These assessments prominently feature empathy, denoting the ability to comprehend others’ emotions (5). In healthcare, empathy signifies HCWs’ capacity to empathize with patients, understanding the emotions stirred by their health conditions (6). It serves as the cornerstone of the physician-patient relationship and a pivotal element in delivering high-quality healthcare (7).

A recent review highlighted that empathy played a causal role in the fundamental dimensions assessing healthcare quality in 58.1% of the scrutinized studies (8). This is because high levels of empathy are linked to several beneficial outcomes, including patients feeling more at ease in expressing their symptoms, better treatment adherence, reduced conflicts with HCWs, improved medical outcomes, and ultimately, heightened satisfaction (7). Furthermore, dating back to 1979, it has been well-established that human relationships promote health by preventing diseases, whereas their absence is significantly associated with increased mortality rates (9). An empathic rapport between HCWs and patients contributes to the overall well-being of both parties (9). Conversely, the absence of empathy also impacts healthcare providers, giving rise to emotional and physical work-related issues like burnout, depression, sleep disturbances, and decreased concentration (10). This chronic work-related stress burden can lead to exhaustion and burnout, further influencing empathy levels and the overall quality of healthcare (11, 12).

Latin America, particularly South America, grapples with pervasive issues of violence and a multitude of complex social and health challenges (13). This region exhibits considerable demographic diversity and operates distinct healthcare systems across its various areas (14). Consequently, the quality of care and empathy levels among HCWs can exhibit notable variations. Empirical studies have underscored these discrepancies in perceived empathy among HCWs, where, for instance, 47.1% of Mexican physicians and 83% of Chilean nurses have reported elevated levels of empathy (15, 16). Furthermore, patients and their families have contributed to assessing the empathy of healthcare professionals in Latin America, yielding estimates that span from 32 to 80% in favor of recognizing high levels of empathy (17, 18). HCWs in South America form a diverse mosaic, characterized by variations in healthcare policies and quality, both within individual countries and across the region. Morover, the assessment of empathy levels among these HCWs remains an underexplored area, highlighting the need to gain insights from existing research on this crucial subject.

Given the importance and influence of empathy on patients, HCWs, and healthcare management, we aimed to estimate the empathy among HCWs in South American countries between 2000 and 2019. Additionally, we describe differences in empathy based on work, bibliometric, and methodological characteristics, as well as the source of evaluation (patient evaluations or self-assessments by HCWs).

2 Methods

2.1 Study design, data sources, and search strategy

This review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 (19) and was registered in PROSPERO(CRD42023454007). Manual searches were conducted in 15 databases (PubMed, Scopus, Web of Science, Scopus, Scielo, PsycoINFO, ScientDirect, Cochrane, Latindex, and LILIACS), four preprint servers (SocArXiv, bioRxiv, and medRxiv), and other search engines such as Dimensions, Google Scholar, Yahoo!, and Alicia CONCyTec (Peruvian thesis repository) from November 28th to November 10th, 2021 (Suppl. 1).

The database search strategy was conducted using the following search equation: ((Job description OR Work schedule) AND (Healthcare workers OR Health personnel) AND (Empathy OR Consultation and Relation Empathy)). The search query was tailored for each scientific search engine, and we utilized both Spanish and Portuguese translations when searching on platforms such as Google Scholar, LILACS, Scielo, Yahoo!, and Alicia CONCyTec (Suppl. 2).

2.2 Inclusion and exclusion criteria

The included studies met the following criteria: (i) Research in HCWs on empathy, (ii) original articles, brief reports, scientific letters, and letters to the editor; (iii) articles published between 2000 and 2019; and (iv) studies involving HCWs in South America. Systematic reviews, meta-analyses, narrative reviews, scoping reviews, historical articles, reflection articles, editorials, commentaries, errata, proceedings, and case reports were excluded. Studies focusing on empathy in other populations (infants, pregnant women, older adults, individuals with physical disabilities, or conditions affecting their physical activity) or health students (medical specialty, undergraduate and graduate students) were also excluded (Figure 1).

Figure 1

Latin America encompasses the geographical area located to the south of the United States, comprising Mexico, the Caribbean, and South America. This diverse region is home to countries where Spanish and Portuguese are the primary languages, totaling 20 sovereign nations (e.g., Brazil) and 8 dependent territories (e.g., Puerto Rico). South America, a subregion of the Americas, stretches along the coastlines of both the Atlantic and Pacific Oceans. Comprising a total of 14 countries, it includes Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela.