title: The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure.
abstract: BACKGROUND
  Empathy is a key aspect of the clinical encounter but there is a lack of patient-assessed measures suitable for general clinical settings.
  
  
  OBJECTIVE
  Our aim was to develop a consultation process measure based on a broad definition of empathy, which is meaningful to patients irrespective of their socio-economic background.
  
  
  METHODS
  Qualitative and quantitative approaches were used to develop and validate the new measure, which we have called the consultation and relational empathy (CARE) measure. Concurrent validity was assessed by correlational analysis against other validated measures in a series of three pilot studies in general practice (in areas of high or low socio-economic deprivation). Face and content validity was investigated by 43 interviews with patients from both types of areas, and by feedback from GPs and expert researchers in the field.
  
  
  RESULTS
  The initial version of the new measure (pilot 1; high deprivation practice) correlated strongly (r = 0.85) with the Reynolds empathy measure (RES) and the Barrett-Lennard empathy subscale (BLESS) (r = 0.63), but had a highly skewed distribution (skew -1.879, kurtosis 3.563). Statistical analysis, and feedback from the 20 patients interviewed, the GPs and the expert researchers, led to a number of modifications. The revised, second version of the CARE measure, tested in an area of low deprivation (pilot 2) also correlated strongly with the established empathy measures (r = 0.84 versus RES and r = 0.77 versus BLESS) but had a less skewed distribution (skew -0.634, kurtosis -0.067). Internal reliability of the revised version was high (Cronbach's alpha 0.92). Patient feedback at interview (n = 13) led to only minor modification. The final version of the CARE measure, tested in pilot 3 (high deprivation practice) confirmed the validation with the other empathy measures (r = 0.85 versus RES and r = 0.84 versus BLESS) and the face validity (feedback from 10 patients).
  
  
  CONCLUSIONS
  These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.
authors.affiliation: General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK. stewmercer@blueyonder.co.uk
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: David
authors.initials: D
authors.lastname: Heaney
authors.forename: Graham Cm
authors.initials: GC
authors.lastname: Watt
mesh_terms: D000328:Adult; D000368:Aged; D004645:Empathy; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011204:Poverty Areas; D012606:Scotland; D012923:Social Class; D011795:Surveys and Questionnaires / Q000592:standards*