Jeremy Howick
University of Leicester, Medical School, Faculty Member
- University of Oxford, Primary Health Care Sciences, Faculty Memberadd
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BACKGROUNDEmpathic healthcare has been shown to benefit patients and practitioners, including by improving patient satisfaction. However, the quality of evidence for the benefits of empathic care is often lacking. ObjectivesThis... more
BACKGROUNDEmpathic healthcare has been shown to benefit patients and practitioners, including by improving patient satisfaction. However, the quality of evidence for the benefits of empathic care is often lacking. ObjectivesThis systematic review aims to assess the relationship between empathy and patient satisfaction.DesignA systematic review and meta-analysis of randomised controlled trials.METHODSEligibility criteriaWe will include randomised trials that investigated the effect of empathy training for practitioners on patient satisfaction. We will exclude non-randomised trials.Information sourcesWe will search MEDLINE, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP), and OpenGrey, the Grey Literature report all from inception to 31 March 2023. We will also screen the reference lists and conduct cited reference searches for all included studies. In addition, reference chasing of rele...
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Background: Practitioners who deliver enhanced empa- thy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. Purpose: To evaluate the... more
Background: Practitioners who deliver enhanced empa- thy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival.
Purpose: To evaluate the effect of health care practi- tioner empathy on patient satisfaction, using a system- atic review of randomized trials.
Data Sources: Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023.
Study Selection: Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale.
Data Extraction: Data extraction, risk-of-bias assess- ments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus.
Data Synthesis: Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogene- ous in terms of geographic locations (North America,Europe, Asia, and Africa), settings (hospital and pri- mary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials sug- gested a positive change in patient satisfaction, inad- equate reporting hindered the ability to draw definitive conclusions about the overall effect size.
Limitations: Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence.
Conclusion: Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction.
Primary Funding Source: Stoneygate Trust. (PROSPERO: CRD42023412981)
Purpose: To evaluate the effect of health care practi- tioner empathy on patient satisfaction, using a system- atic review of randomized trials.
Data Sources: Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023.
Study Selection: Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale.
Data Extraction: Data extraction, risk-of-bias assess- ments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus.
Data Synthesis: Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogene- ous in terms of geographic locations (North America,Europe, Asia, and Africa), settings (hospital and pri- mary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials sug- gested a positive change in patient satisfaction, inad- equate reporting hindered the ability to draw definitive conclusions about the overall effect size.
Limitations: Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence.
Conclusion: Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction.
Primary Funding Source: Stoneygate Trust. (PROSPERO: CRD42023412981)
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Research Interests: Mathematics, Epidemiology, Bioethics, Animal Studies, Clinical Trials, and 15 moreRandomization, Model organisms, Medicine, Multidisciplinary, Biological Sciences, Clinical Medicine, Animals, Overview, Research Assessment, Animal Experimentation, Medline, Meta Analysis, PLoS one, Randomized Controlled Trial, and Animal models
Full set of clinical study reports for the neuraminidase inhibitor Tamiflu (Oseltamivir) produced by Roche and made available to the Cochrane collaboration for the production of their meta-analysis of neuraminidase inhibitors for... more
Full set of clinical study reports for the neuraminidase inhibitor Tamiflu (Oseltamivir) produced by Roche and made available to the Cochrane collaboration for the production of their meta-analysis of neuraminidase inhibitors for preventing and treating influenza in healthy adults and childre
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ObjectivesTo determine the effect of oseltamivir on mortality in 2009A/H1N1 influenza patients.
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Background: The way potential benefits and harms of trial interventions are shared within patient information leaflets (PILs) varies widely and may cause unnecessary harms (“nocebo effects”). The aim of this meta-analysis will be to... more
Background: The way potential benefits and harms of trial interventions are shared within patient information leaflets (PILs) varies widely and may cause unnecessary harms (“nocebo effects”). The aim of this meta-analysis will be to evaluate the influence on recruitment rates and early effects on patient reported adverse events of principled patient information leaflets (PrinciPILs) compared with standard PILs. Methods: Eligible studies will include those that report the effects on recruitment and patient reported adverse events of PrinciPILs compared to standard PILs. We will include in this meta-analysis all the standard PILs in studies within trials (SWATs) of PrinciPILs that were developed as part of the Medical Research Council (MRC) funded PrinciPIL project. By publishing this as a living meta-analysis, we will allow the meta-analysis to be updated with future SWATs of PrinciPILs. We will use the Cochrane Risk of Bias tool to evaluate the risk of bias for each outcome. We will...
Background: The way information about potential benefits and harms of trial is presented within participant information leaflets (PILs) varies widely and may cause unnecessary ‘nocebo’ effects. The Medical Research Council (MRC) funded a... more
Background: The way information about potential benefits and harms of trial is presented within participant information leaflets (PILs) varies widely and may cause unnecessary ‘nocebo’ effects. The Medical Research Council (MRC) funded a project in which seven principles were developed to reduce this variation. However, guidance has not been produced to facilitate the implementation of the principles. Stakeholder involvement is recommended to optimise the way these principles are disseminated and explained. The aims of this study were to co-produce: (1) user-friendly guidance for users of the principles; and (2) resources that support the implementation of the principles. Methods: We held a co-production workshop with representation from the following professional groups: the Health Research Authority (HRA), research ethics committee members, and trial managers. Two rounds of discussions focused on generating recommendations for guidance and resources that support the implementation...
ObjectivesTo understand how and why workplace mindfulness-based programmes (MBPs) work or do not work.DesignA realist review.Eligibility criteria for selectionWe considered any studies (experimental quasi-experimental, observational,... more
ObjectivesTo understand how and why workplace mindfulness-based programmes (MBPs) work or do not work.DesignA realist review.Eligibility criteria for selectionWe considered any studies (experimental quasi-experimental, observational, qualitative and mixed-methods studies) of workplace MBPs as long as they provided data to explain our programme theories. All MBP formats and delivery modes were included.AnalysisConsistent with realist review methodology, we systematically screened and analysed data to explain how and why workplace MBPs work or do not work. These explanations were consolidated into a programme theory augmented by theories from organisational literature, such as conservation of resources theory.ResultsFindings from 75 primary studies suggest that workplace MBPs enable participants (including healthcare professionals) to deal more skillfully with stressful events and improve their well-being. The mechanisms involved can be grouped around awareness/self-regulation, accept...
Research Interests: Mindfulness and Medicine
Full set of clinical study reports for the neuraminidase inhibitor Relenza (Zanamivir) produced by GlaxoSmithKline and made available to the Cochrane collaboration for the production of their meta-analysis of neuraminidase inhibitors for... more
Full set of clinical study reports for the neuraminidase inhibitor Relenza (Zanamivir) produced by GlaxoSmithKline and made available to the Cochrane collaboration for the production of their meta-analysis of neuraminidase inhibitors for preventing and treating influenza in healthy adults and childre
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Rationale and Objectives Medical humanities are becoming increasingly popular, required, and recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools... more
Rationale and Objectives Medical humanities are becoming increasingly popular, required, and recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We aimed to review medical school curricula in Canada, the UK, and the US. Our secondary objective was to compare the inclusion of medical humanities in the curricula with rankings of medical schools. Methods We searched the curriculum websites of all accredited medical schools in Canada, the UK, and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman’s correlation and inverse variance weighting meta-analysis. Results We i...
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Background Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested... more
Background Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested that cognitive–behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives This project was undertaken to map the quality and gaps in the cognitive–behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive–behavioural therapy. Data sources The overview was designed with cognitive–behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of s of Reviews of Effects and OpenGrey databas...
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Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate ...
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The majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic... more
The majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic review evidence and evaluate the consistency of CBT's effect across different conditions. We included reviews of CBT randomised controlled trials in any: population, condition, format, context, with any type of comparator and published in English. We searched DARE, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, CDAS, and OpenGrey between 1992 and January 2019. Reviews were quality assessed, their data extracted and summarised. The effects upon health-related quality of life (HRQoL) were pooled, within-condition groups. If the across-condition heterogeneity was I2 < 75%, we pooled effects using a random-effect panoramic meta-analysis. We summarised 494 reviews (221 128 participants), representing 14/20 physical and 13/20 mental conditions (World He...
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Background The way information about potential harms of trial intervention is shared within participant information leaflets (PILs) varies widely and can cause subjective ‘nocebo’ harms. This study aimed to develop principles to improve... more
Background The way information about potential harms of trial intervention is shared within participant information leaflets (PILs) varies widely and can cause subjective ‘nocebo’ harms. This study aimed to develop principles to improve the composition of information about potential trial intervention benefits and harms within PILs so that variability and avoidable harms are reduced. Methods We conducted a two-round modified online Delphi survey, followed by a consensus meeting. For the first round of the survey, 27 statements were developed based on previous research and relevant guidance from the UK, the USA and the World Health Organization. Participants included members from each of the following stakeholder groups: patient and public representatives, research ethics committee members, industry representatives, medico-legal experts, psychologists and trial managers. Each participant was asked to rate their degree of agreement or disagreement with each statement on a 9-point Like...
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Supplemental material for Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis by Jeremy Howick, Andrew Moscrop, Alexander Mebius, Thomas R Fanshawe, George Lewith, Felicity L... more
Supplemental material for Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis by Jeremy Howick, Andrew Moscrop, Alexander Mebius, Thomas R Fanshawe, George Lewith, Felicity L Bishop, Patriek Mistiaen, Nia W Roberts, Eglė Dieninytė, Xiao-Yang Hu, Paul Aveyard and Igho J Onakpoya in Journal of the Royal Society of Medicine
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Research Interests: Psychology and Empathy
BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked... more
BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews. Purposefully sampled patients (n = 33) aged >45 years with hip or knee OA from GP practices in Wessex (Hampshire, Dorest, Wiltshire, and Somerset).MethodFifteen participants watched two filmed OA consultations with a GP, and 18 participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using ...