Interventions to Enhance Empathy and Person-Centered Care for Individuals With Dementia: A Systematic Review
Abstract
Empathy, or the ability to imagine what someone else may be feeling or thinking, is a crucial component of meaningful care provision, including person-centered care (PCC), and has been shown to enhance care provider and patient well-being. The purpose of the current review was to examine the impact of interventions focused on improving the ability of health care providers or students to experience and/or communicate with empathy. Of 1,427 publications reviewed, 18 articles met inclusion criteria. All studies incorporated empathy or empathic communication competencies in their training or intended variables of change. PCC concepts were used in guiding the development of most interventions. Some interventions significantly improved participant empathy, attitudes toward patients with dementia, and certain verbal and nonverbal communication skills. Current study reports on improved positive interpersonal communication skills by nursing assistants are promising. Future study to improve therapeutic communication and delivery of dementia care with empathy using enhanced study design and measurement are needed. [Research in Gerontological Nursing, 13(3), 158–168.]
- Adefila A., Graham S., Clouder D. L., Bluteau P., Ball S. (2016). myShoes: The future of experiential dementia training?The Journal of Mental Health Training, Education and Practice, 11(2), 91–101 https://doi.org/10.1108/JMHTEP-10-2015-0048
10.1108/JMHTEP-10-2015-0048 Crossref, Google Scholar - American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15–18 https://doi.org/10.1111/jgs.13866 PMID:
10.1111/jgs.13866 Crossref Medline, Google Scholar - Bangerter L. R., Heid A. R., Abbott K., Van Haitsma K. (2017). Honoring the everyday preferences of nursing home residents: Perceived choice and satisfaction with care. The Gerontologist, 57(3), 479–486 https://doi.org/10.1093/geront/gnv697 PMID:
26874190 Medline, Google Scholar - Beer L. E., Hutchinson S. R., Skala-Cordes K. K. (2012). Communicating with patients who have advanced dementia: Training nurse aide students. Gerontology & Geriatrics Education, 33(4), 402–420 https://doi.org/10.1080/02701960.2012.702165 PMID:
10.1080/02701960.2012.702165 Crossref, Google Scholar - Broughton M., Smith E. R., Baker R., Angwin A. J., Pachana N. A., Copland D. A., Chenery H. J. (2011). Evaluation of a caregiver education program to support memory and communication in dementia: A controlled pretest-posttest study with nursing home staff. International Journal of Nursing Studies, 48(11), 1436–1444 https://doi.org/10.1016/j.ijnurstu.2011.05.007 PMID:
10.1016/j.ijnurstu.2011.05.007 21669432 Crossref Medline, Google Scholar - Burgio L. D., Allen-Burge R., Roth D. L., Bourgeois M. S., Dijkstra K., Gerstle J., Bankester L. (2001). Come talk with me: Improving communication between nursing assistants and nursing home residents during care routines. The Gerontologist, 41(4), 449–460 https://doi.org/10.1093/geront/41.4.449 PMID:
10.1093/geront/41.4.449 11490043 Crossref Medline, Google Scholar - Centers for Medicare & Medicaid Services. (2012). Hand in hand: A training series for nursing homes. Retrieved from https://surveyortraining.cms.hhs.gov/pubs/HandinHand.aspx Google Scholar
- Cervero R. M. (1985). Continuing professional education and behavioral change: A model for research and evaluation. Journal of Continuing Education in Nursing, 16(3), 85–88 PMID:
3923067 Abstract, Google Scholar - Cockbain B. C., Thompson S., Salisbury H., Mitter P., Martos L. (2015). A collaborative strategy to improve geriatric medical education. Age and Ageing, 44(6), 1036–1039 https://doi.org/10.1093/ageing/afv100 PMID:
10.1093/ageing/afv100 26265672 Crossref Medline, Google Scholar - Conway E. R., Chenery H. J. (2016). Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: A controlled pretest-post-test study. Journal of Clinical Nursing, 25(7–8), 1145–1155 https://doi.org/10.1111/jocn.13134 PMID:
10.1111/jocn.13134 26821868 Crossref Medline, Google Scholar - (Eds.). (2011). Empathy: Philosophical and psychological perspectives. Oxford, UK: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199539956.001.0001 Google Scholar
- Dambha-Miller H., Feldman A. L., Kinmonth A. L., Griffin S. J. (2019). Association between primary care practitioner empathy and risk of cardiovascular events and all-cause mortality among patients with type 2 diabetes: A population-based prospective cohort study. Annals of Family Medicine, 17(4), 311–318.
10.1370/afm.2421 31285208 Crossref Medline, Google Scholar - Davis M. H. (1980). A multidimensional approach to individual differences in empathy. Catalog of Selected Documents in Psychology, 10, 85. Google Scholar
- Davis M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113–126 https://doi.org/10.1037/0022-3514.44.1.113
10.1037/0022-3514.44.1.113 Crossref, Google Scholar - de Abreu I. D., Hinojosa-Lindsey M., Asghar-Ali A. A. (2017). A simulation exercise to raise learners' awareness of the physical and cognitive changes in older adults. Academic Psychiatry, 41(5), 684–687 https://doi.org/10.1007/s40596-017-0775-4 PMID:
10.1007/s40596-017-0775-4 28836181 Crossref Medline, Google Scholar - Decety J., Fotopoulou A. (2015). Why empathy has a beneficial impact on others in medicine: Unifying theories. Frontiers in Behavioral Neuroscience, 8, 457 https://doi.org/10.3389/fnbeh.2014.00457 PMID:
10.3389/fnbeh.2014.00457 25642175 Crossref Medline, Google Scholar - Effective Public Health Practice Project. (1998). Quality assessment tool for quantitative studies. Retrieved from https://merst.ca/ephpp Google Scholar
- Eritz H., Hadjistavropoulos T., Williams J., Kroeker K., Martin R. R. M., Lix L. M., Hunter P. V. (2016). A life history intervention for individuals with dementia: A randomised controlled trial examining nursing staff empathy, perceived patient personhood and aggressive behaviours. Ageing & Society, 36(10), 2061–2089 https://doi.org/10.1017/S0144686X15000902
10.1017/S0144686X15000902 Crossref, Google Scholar - Fazio S., Pace D., Flinner J., Kallmyer B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(Suppl. 1), S10–S19 https://doi.org/10.1093/geront/gnx122
10.1093/geront/gnx122 29361064 Crossref Medline, Google Scholar - Fields S. K., Mahan P., Tillman P., Harris J., Maxwell K., Hojat M. (2011). Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: Health provider— student version. Journal of Interprofessional Care, 25(4), 287–293 https://doi.org/10.3109/13561820.2011.566648 PMID:
10.3109/13561820.2011.566648 21554061 Crossref Medline, Google Scholar - Fritsch T., Kwak J., Grant S., Lang J., Montgomery R. R., Basting A. D. (2009). Impact of TimeSlips, a creative expression intervention program, on nursing home residents with dementia and their caregivers. The Gerontologist, 49(1), 117–127 https://doi.org/10.1093/geront/gnp008 PMID:
10.1093/geront/gnp008 19363009 Crossref Medline, Google Scholar - George D. R., Stuckey H. L., Whitehead M. M. (2014). How a creative story-telling intervention can improve medical student attitude towards persons with dementia: A mixed methods study. Dementia (London), 13(3), 318–329 https://doi.org/10.1177/1471301212468732 PMID:
10.1177/1471301212468732 Crossref, Google Scholar - Hattink B., Meiland F., van der Roest H., Kevern P., Abiuso F., Bengtsson J., Dröes R. M. (2015). Web-based STAR E-Learning Course increases empathy and understanding in dementia caregivers: Results from a randomized controlled trial in the Netherlands and the United Kingdom. Journal of Medical Internet Research, 17(10), e241 https://doi.org/10.2196/jmir.4025 PMID:
10.2196/jmir.4025 26519106 Crossref Medline, Google Scholar - (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (version 5.1.0). Retrieved from https://training.cochrane.org/handbook Google Scholar
- Hojat M., Mangione S., Kane G. C., Gonnella J. S. (2005). Relationships between scores of the Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI). Medical Teacher, 27(7), 625–628 https://doi.org/10.1080/01421590500069744 PMID:
10.1080/01421590500069744 16332555 Crossref Medline, Google Scholar - Hojat M., Mangione S., Nasca T. J., Cohen M. J. M., Gonnella J. S., Erdmann J. B., Magee M. (2001). The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educational and Psychological Measurement, 61(2), 349–365 https://doi.org/10.1177/00131640121971158
10.1177/00131640121971158 Crossref, Google Scholar - Hojat M., Shannon S. C., DeSantis J., Speicher M. R., Bragan L., Calabrese L. H. (2019). Empathy in medicine national norms for the Jefferson Scale of Empathy: A nationwide project in osteopathic medical education and empathy (POMEE). The Journal of the American Osteopathic Association, 119(8), 520–532 https://doi.org/10.7556/jaoa.2019.091 PMID:
10.7556/jaoa.2019.091 31355891 Crossref Medline, Google Scholar - Hunter P. V., Hadjistavropoulos T., Smythe W. E., Malloy D. C., Kaasalainen S., Williams J. (2013). The Personhood in Dementia Questionnaire (PDQ): Establishing an association between beliefs about personhood and health providers' approaches to person-centred care. Journal of Aging Studies, 27(3), 276–287 https://doi.org/10.1016/j.jaging.2013.05.003 PMID:
10.1016/j.jaging.2013.05.003 23849425 Crossref Medline, Google Scholar - Kitwood T. (1997). Dementia reconsidered: The person comes first. Philadelphia, PA: Open University Press. Google Scholar
- Kogan A. C., Wilber K., Mosqueda L. (2016). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1–e7 https://doi.org/10.1111/jgs.13873 PMID:
10.1111/jgs.13873 Crossref, Google Scholar - Lam T. C. M., Kolomitro K., Alamparambil F. C. (2011). Empathy training: Methods, evaluation practices and validity. Journal of MultiDisciplinary Education, 7(16), 162–200. Google Scholar
- Levy-Storms L., Harris L. M., Chen X. (2016). Video-based intervention on and evaluation of nursing aides' therapeutic communication and residents' agitation during mealtime in a dementia care unit. Journal of Nutrition in Gerontology and Geriatrics, 35(4), 267–281 https://doi.org/10.1080/21551197.2016.1238430 PMID:
10.1080/21551197.2016.1238430 27897609 Crossref Medline, Google Scholar - Li J., Porock D. (2014). Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. International Journal of Nursing Studies, 51(10), 1395–1415 https://doi.org/10.1016/j.ijnurstu.2014.04.003 PMID:
10.1016/j.ijnurstu.2014.04.003 24815772 Crossref Medline, Google Scholar - Liberati A., Altman D. G., Tetzlaff J., Mulrow C., Gøtzsche P. C., Ioannidis J. P., Moher D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100 https://doi.org/10.1371/journal.pmed.1000100 PMID:
10.1371/journal.pmed.1000100 19621070 Crossref Medline, Google Scholar - Lintern T. (2001).Quality in dementia care: Evaluating staff attitudes and behaviour [PhD thesis]. Bangor University, Bangor, Wales. Google Scholar
- McCallion P., Toseland R. W., Lacey D., Banks S. (1999). Educating nursing assistants to communicate more effectively with nursing home residents with dementia. The Gerontologist, 39(5), 546–558 https://doi.org/10.1093/geront/39.5.546 PMID:
10.1093/geront/39.5.546 10568079 Crossref Medline, Google Scholar - Newhouse R. P., Dearholt S. L., Poe S. S., Pugh L. C., White K. M. (2007). Johns Hopkins nursing evidence-based practice: Model and guidelines. Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing. Google Scholar
- Passalacqua S. A., Harwood J. (2012). VIPS communication skills training for paraprofessional dementia caregivers: An intervention to increase person-centered dementia care. Clinical Gerontologist, 35(5), 425–445 https://doi.org/10.1080/07317115.2012.702655
10.1080/07317115.2012.702655 Crossref, Google Scholar - Post S. G. (2000). The moral challenge of Alzheimer's disease (2nd ed.). Baltimore, MD: The John Hopkins University Press. Google Scholar
- Riess H. (2015). The impact of clinical empathy on patients and clinicians: Understanding empathy's side effects. AJOB Neuroscience, 6(3), 51–53 https://doi.org/10.1080/21507740.2015.1052591
10.1080/21507740.2015.1052591 Crossref, Google Scholar - Riess H. (2017). The science of empathy. Journal of Patient Experience, 4(2), 74–77 https://doi.org/10.1177/2374373517699267 PMID:
10.1177/2374373517699267 28725865 Crossref Medline, Google Scholar - Ripich D. N., Wykle M., Niles S. (1995). Alzheimer's disease caregivers: The focused program. A communication skills training program helps nursing assistants to give better care to patients with disease. Geriatric Nursing, 16(1), 15–19 https://doi.org/10.1016/S0197-4572(05)80073-4 PMID:
10.1016/S0197-4572(05)80073-4 7859996 Crossref Medline, Google Scholar - Scales K., Zimmerman S., Miller S. J. (2018). Evidence-based nonpharmacological practices to address behavioral and psychological symptoms of dementia. The Gerontologist, 58(Suppl. 1), S88–S102 https://doi.org/10.1093/geront/gnx167 PMID:
10.1093/geront/gnx167 29361069 Crossref Medline, Google Scholar - Sprangers S., Dijkstra K., Romijn-Luijten A. (2015). Communication skills training in a nursing home: Effects of a brief intervention on residents and nursing aides. Clinical Interventions in Aging, 10, 311–319 https://doi.org/10.2147/CIA.S73053 PMID:
25653513 Medline, Google Scholar - Teri L., Huda P., Gibbons L., Young H., van Leynseele J. (2005). STAR: A dementia-specific training program for staff in assisted living residences. The Gerontologist, 45(5), 686–693 https://doi.org/10.1093/geront/45.5.686 PMID:
10.1093/geront/45.5.686 16199404 Crossref Medline, Google Scholar - Williams K. N., Perkhounkova Y., Herman R., Bossen A. (2017). A communication intervention to reduce resistiveness in dementia care: A cluster randomized controlled trial. The Gerontologist, 57(4), 707–718 https://doi.org/10.1093/geroni/igx004.4524 PMID:
27048705 Medline, Google Scholar

