Developing and testing a patient-reported empathy scale
Research type
Research Study
Full title
Development and psychometric testing of a single-item scale to measure therapeutic empathy: Patient-reported version
IRAS ID
350113
Contact name
Jeremy Howick
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
1 years, 11 months, 27 days
Research summary
Summary of Research:
BACKGROUND
Empathy is a key component of healthcare practice, research, and education. Existing measures of therapeutic empathy often lack robust psychometric properties and do not assess the construct the authors themselves define, while their wordiness and length stand in the way of widespread use. Single-item scales to assess empathy are used frequently throughout the literature, but have not yet been validated.OBJECTIVE
To develop and psychometrically test a patient-reported version of a single-item measure of therapeutic empathy.METHODS
A mixed-methods, cross-sectional study will be conducted between June 2025 and May 2027 following best-practice guidance for scale development and testing. A mixed-methods, cross-sectional study to develop and psychometrically test a patient-reported version of a single-item scale to measure therapeutic empathy. Qualitative data from free-text feedback from an expert panel and cognitive interviews will be collected as part of the development of the scale. Quantitative data collected from scale administration will be used to further develop and psychometrically test the scale for validity.
The study will be undertaken across several sites, some of which are not NHS sites (remote participation and participation at the University of Leicester), and some are NHS sites.Three groups will participate in the development and validation of the scale:
1. Stakeholders with expertise on empathy in healthcare research, practice and/or education, including patient representatives, to participate in assessment of content validity of the potential single-item scale. This will involve providing feedback remotely (online via the internet), and will require no more than 30 minutes of participants' time.
2. Key stakeholders, including patients, practitioners, students, and educator-observers, to take part in one 1-hour cognitive interview each (either online or in-person at Leicester Medical School) to assess face validity and pre-test the scale.
3. Patients to complete the final scale, alongside existing empathy scales and a measure of clinical neutrality, to enable tests of validity. This will take approximately 30 minutes.Summary of Results:
Study title:
Development and psychometric testing of a single-item scale to measure therapeutic empathy: Patient-reported version
Who carried out the research?
The research was carried out by researchers based at UK academic and healthcare institutions with experience in empathic healthcare research. The study sponsor was the host university (University of Leicester). The study was conducted as academic research and did not involve commercial funding., but was funded by the Stoneygate Trust. The researchers declared no competing interests.
Where and when the study took place:
The study was conducted in the United Kingdom between June 2025 and March 2026.
Why was the research needed?
Empathy from healthcare professionals is an important part of high-quality patient care and is associated with improved patient satisfaction and health outcomes. However, many existing tools used to measure empathy in healthcare are long and complex, which can make them difficult to use in busy clinical or research settings. A shorter, simpler measure could make it easier to assess patients’ experiences of empathic care.
What were the main questions studied?
The study aimed to find out whether a single-question scale could reliably measure patients’ perceptions of empathy from healthcare professionals. Researchers also examined whether this short scale produced similar results to an established empathy questionnaire.
Who participated in the study?
A total of 565 participants took part in the study. This included:
- 9 experts in empathy in healthcare, including researchers, practitioners, and patient representatives.
- 35 patients, practitioners, students, and observers (educators).
- 521 patients who had recently had a consultation with a healthcare practitioner.What treatments or interventions did the participants take or receive?
Participants did not receive any treatments or interventions as part of the study.
What happened during the study?
Data were collected in three different ways:
1) through an online survey to get expert feedback on initial versions of the new empathy scale
2) through interviews with patients, practitioners, students, and observers (educators) to get feedback on the wording and clarity of the refined versions of the empathy scale
3) through a survey of adult patients who had recently had a consultation with a healthcare professional.What were the results of the study?
Two versions of the scale were developed: one pictorial scale (with smiley-face response options) and one text-based. The scales had strong content validity (meaning they covered all aspects of empathy), face validity (meaning that users of the scale thought it was measuring empathy well), convergent validity (meaning that they correlated highly with an existing empathy scale), discriminant validity (meaning that they did not correlate highly with an unrelated concept), and known-groups validity (meaning that they could identify differences in empathy scores between patients of different ethnicities).
This suggests that the new scale is a valid way of measuring patients’ perceptions of empathy. Participants also reported that the question was clear and easy to answer.
How has this study helped patients and researchers?
The study developed a very brief and simple way to measure patients’ experiences of empathy in healthcare consultations. This tool may help researchers and healthcare organisations measure and improve empathic communication in clinical practice.
Details of any further research planned
Further research may explore how the empathy scale performs in different healthcare settings and with different groups of patients and healthcare professionals. Further research will be conducted to test the scale when used by practitioners, students, and observers, following the necessary approvals.
Where can I learn more about this study?
Further details about the research may be available through academic publications produced by the research team or by contacting the study investigators.
REC name
West of Scotland REC 5
REC reference
25/WS/0067
Date of REC Opinion
28 May 2025
REC opinion
Further Information Favourable Opinion