title: Analyzing the "nature" and "specific effectiveness" of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda.
abstract: OBJECTIVE
  To establish sound empirical evidence that clinical empathy (abbreviated as CE) is a core element in the clinician-patient relationship with profound therapeutic potential, a substantial theoretical-based understanding of CE in medical care and medical education is still required. The two aims of the present paper are, therefore, (1) to give a multidisciplinary overview of the "nature" and "specific effectiveness" of CE, and (2) to use this base as a means of deriving relevant questions for a theory-based research agenda.
  
  
  METHODS
  We made an effort to identify current and past literature about conceptual and empirical work focusing on empathy and CE, which derives from a multiplicity of disciplines. We review the material in a structured fashion.
  
  
  RESULTS
  We describe the "nature" of empathy by briefly summarizing concepts and models from sociology, psychology, social psychology, education, (social-)epidemiology, and neurosciences. To explain the "specific effectiveness" of CE for patients, we develop the "Effect model of empathic communication in the clinical encounter", which demonstrates how an empathically communicating clinician can achieve improved patient outcomes. Both parts of theoretical findings are synthesized in a theory-based research agenda with the following key hypotheses: (1) CE is a determinant of quality in medical care, (2) clinicians biographical experiences influence their empathic behavior, and (3) CE is affected by situational factors.
  
  
  CONCLUSIONS
  The main conclusions of our review are twofold. First of all, CE seems to be a fundamental determinant of quality in medical care, because it enables the clinician to fulfill key medical tasks more accurately, thereby achieving enhanced patient health outcomes. Second, the integration of biographical experiences and situational factors as determinants of CE in medical care and medical education appears to be crucial to develop and promote CE and ultimately ensuring high-quality patient care.
  
  
  CONCLUSIONS
  Due to the complexity and multidimensionality of CE, evidence-based investigations of the derived hypotheses require both well-designed qualitative and quantitative studies as well as an interdisciplinary research approach.
authors.affiliation: Center for Health Services Research Cologne (ZVFK), Medical Department of the University of Cologne, Germany. Melanie.Neumann@uk-koeln.de
authors.forename: Melanie
authors.initials: M
authors.lastname: Neumann
authors.forename: Jozien
authors.initials: J
authors.lastname: Bensing
authors.forename: Stewart
authors.initials: S
authors.lastname: Mercer
authors.forename: Nicole
authors.initials: N
authors.lastname: Ernstmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Ommen
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
mesh_terms: D000339:Affect; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003071:Cognition; D003142:Communication; D004645:Empathy; D055317:Evidence-Based Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017145:Models, Educational; D008960:Models, Psychological; D008962:Models, Theoretical; D009482:Neurophysiology; D010348:Patient Care Team / Q000458:organization & administration; D024382:Professional Role / Q000523:psychology; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012106:Research / Q000458:organization & administration*; D012107:Research Design; D012944:Social Support