Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Mar 3;16(3):e0247259.
doi: 10.1371/journal.pone.0247259. eCollection 2021.

Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

Brian W Roberts  1   2   3 , Nitin K Puri  1   4 , Christian J Trzeciak  1 , Anthony J Mazzarelli  1   2   3 , Stephen Trzeciak  1   3   4
Affiliations
Meta-Analysis

Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

Brian W Roberts et al. PLoS One. .

Abstract

Introduction: Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy.

Methods: Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity.

Results: Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance.

Conclusion: These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity.

Trial registration: Registration (PROSPERO): CRD42019142809.

PubMed Disclaimer

Conflict of interest statement

Authors Anthony Mazzarelli and Stephen Trzeciak are authors of a book on compassion science, entitled “Compassionomics”. This does not alter our adherence to PLOS ONE policies on sharing data and materials. None of the other authors have potential competing interests to disclose.

Figures

Fig 1
Fig 1. Search, inclusion and exclusion of studies flow diagram.
Fig 2
Fig 2. Forest plot of the results of the random effects model for patient-reported experience of clinician empathy comparing patients with low socioeconomic status (SES) to patients with not low SES.
Fig 3
Fig 3. Forest plot of the results of the random effects model for patient-reported experience of clinician empathy comparing all non-white patients to white patients.
See this image and copyright information in PMC

References

    1. Riess H. The Science of Empathy. Journal of Patient Experience. 2017;4(2):74–7. Epub 2017/07/21. 10.1177/2374373517699267 - DOI - PMC - PubMed
    1. Attar HS, Chandramani S. Impact of physician empathy on migraine disability and migraineur compliance. Annals of Indian Academy of Neurology. 2012;15(Suppl 1):S89–94. 10.4103/0972-2327.100025 - DOI - PMC - PubMed
    1. Burns DD, Nolen-Hoeksema S. Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model. Journal of Consulting and Clinical Psychology. 1992;60(3):441–9. 10.1037//0022-006x.60.3.441 - DOI - PubMed
    1. Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al.. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine. 2012;87(9):1243–9. 10.1097/ACM.0b013e3182628fbf - DOI - PubMed
    1. Flickinger TE, Saha S, Roter D, Korthuis PT, Sharp V, Cohn J, et al.. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. Patient Education and Counseling. 2016;99(2):220–6. 10.1016/j.pec.2015.09.001 - DOI - PMC - PubMed