GPs are losing the ability to read a patient’s face, hear the catch in their voice, or see them flinch during a digital consultation, and no one has told them how to compensate. This matters because clinical empathy—understanding a patient’s perspective, responding emotionally, and acting on it—improves pain, anxiety, and practitioner wellbeing. Yet empathy is already delivered inconsistently in face-to-face care, especially for marginalised groups, and digital consultations strip away non-verbal cues like eye contact and facial expressions. There are currently no guidelines or training to help GPs express empathy over the phone, by video, or via chat messaging. If this research succeeds, it will produce the first evidence-based recommendations for how GPs can express empathy across different patient needs and digital contexts. Within two to three years, those recommendations could be implemented nationally through NHS England, improving patient outcomes and practitioner wellbeing. The findings could also inform digital consultations in other NHS settings, from hospitals to community services.
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Research question How can clinical empathy be effectively expressed during digital consultations across different contexts and for different people? Background Clinical empathy involves a healthcare professionals understanding patients perspectives, responding emotionally, and taking action. It strengthens therapeutic relationships, improves patient outcomes (e.g. pain, anxiety), and practitioner wellbeing. However, empathy is inconsistently delivered in face-to-face consultations and particularly lacking for marginalised populations, which can lead to serious harm. Digital consultations (e.g. telephone calls, video calls, chat messaging) are increasingly used in primary care. These pose additional obstacles to empathy by removing some non-verbal communication (e.g. eye contact, facial expressions) and introducing barriers (e.g. calls at inconvenient times, technical difficulties). Cultural differences also influence comfort with digital consultations. There are no guidelines or training to help GPs express empathy during digital consultations. Addressing this gap is essential given NHS England s prioritisation of digital-first healthcare and the impact of empathy on patient and practitioner outcomes. Aims Develop a programme theory and recommendations enabling GPs to deliver clinical empathy across varied patient needs during digital consultations. Objectives Undertake a realist review to explain how GPs can express empathy in digital consultations across different contexts and people. Produce evidence-based recommendations to improve digital consultation experiences for all NHS primary care patients. Methods A realist review (a theory-driven evidence review to understand how and why health systems/programmes work in different contexts) will explore how empathy in digital consultations functions, including context- and person-specific barriers and facilitators impacting outcomes. A Content Expert Group (~12-15 GPs plus ~10-13 other stakeholders, i.e. public contributors, empathy experts, implementation-focussed stakeholders) will guide the review: Develop initial programme theory. Conduct evidence search using established methods. Select, extract, and organise data. Synthesise evidence to refine programme theory. Conduct final literature searchers and consultations on programme theory. Finalise programme theory, generate recommendations on expressing empathy during digital consultations across different contexts. Delivery timelines Pre-funding: Recruit Research Associate. Months 1-2: Form/expand Content Expert Group and Patient Advisory Group; start Step 1. Months 3-4: Finish Step 1; start Steps 2-3. Months 5-11: Complete Steps 2-5; start Step 6. Months 12-15: Complete Step 6; produce outputs. Post-funding: Finalise/submit grant application. Main outputs Evidence-based programme theory and recommendations. Peer-reviewed paper. Grant application to develop and test an intervention based on findings. Dissemination Progress and findings will be shared with the public and NHS via: Dissemination to all participants and other stakeholders. Social media in accessible language. NHS management/Decision-makers: Share outputs, with ICBs and other bodies, designed for easy dissemination to their practices (including infographic and video). Anticipated Impact Immediately following the grant, GPs can use the recommendations and anticipate improved wellbeing and better outcomes for their patients. Within 2-3 years, recommendations can be implemented nationally to improve empathy (and patient outcomes and practitioner wellbeing). This will be achieved through future research, using findings to design, test, and implement an intervention for GPs, then working with NHS England to ensure widespread adoption. Findings could also inform digital consultations in other NHS settings.
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