Objectives To examine primary care practitioners’ experiences and use of EMPathicO e-learning to enhance communication of clinical empathy and realistic optimism.

Design Mixed methods evaluation incorporating thematic analysis of qualitative interviews and quantitative analysis of EMPathicO usage patterns and practitioner survey data.

Setting Cluster randomised controlled trial of EMPathicO in general practices in England and Wales.

Participants Primary care practitioners allocated to the intervention arm.

Analysis Thematic analysis of qualitative data explored experiences of undertaking EMPathicO and implementing change in subsequent consultations. Descriptive quantitative analysis of EMPathicO usage and practitioner-reported survey data examined practitioner engagement with the e-learning. These parallel analyses were integrated using a triangulation protocol to explore convergence, complementarity and dissonance between the datasets.

Results 23 interviews (16 initial and 7 follow up) across 14 GP practices were undertaken with 11 GPs, 1 nurse practitioner, 3 physiotherapists and 1 physician associate, purposively sampled for diversity from the 115 participants randomised to receive EMPathicO in the trial. Interviewees were positive about EMPathicO, perceiving it as convenient and manageable (approx. 75 minutes online), informative, important, and relevant to their consultations. Over 95% of the 115 EMPathicO practitioners completed the e-learning modules, set goals and felt motivated to adopt EMPathicO communication skills following the e-learning. Interviewees appreciated the autonomy of setting personal goals; found their chosen empathy and optimism goals feasible to incorporate into everyday practice without lengthening consultations and felt such changes led to more positive interactions that were mutually beneficial for practitioners and patients. Aside from their own personal benefit some felt EMPathicO would be particularly helpful if integrated into existing training programmes. One interviewee described how they did not adopt the EMPathicO communication skills (despite feeling positive towards the e-learning overall) due to nearing retirement and another described not using specific tools within the e-learning (e.g. goal setting) because they did not fit with their preferred learning style. Additional content on communicating clinical empathy and realistic optimism flexibly in some situations (e.g., remote consultations especially telephone due to limitations on non-verbal communication) would be welcomed.

Conclusions Practitioners across the multidisciplinary primary care team found completing EMPathicO to be a positive experience, manageable in the current pressurised clinical context and worthwhile, perceiving it to enhance their communication skills. They felt it benefitted both them and their patients and could also be particularly helpful within GP training and medical education settings. These important findings would have been missed if the mixed methods evaluation had not been incorporated into the trial. If widely disseminated, EMPathicO is likely to be well-received by primary care practitioners and straightforward to integrate into everyday practice.

What is already known

Effective practitioner-patient communication, including clinical empathy can help enhance healthcare interactions, patient outcomes and self-management and improve practitioner job satisfaction and reduce burnout.

Existing clinical empathy training can be too lengthy for busy primary care clinicians, is commonly delivered face to face limiting accessibility, and has not usually been offered across the multidisciplinary team.

EMPathicO is rigorously developed, evidence-based brief communication skills e-learning to enhance communication of clinical empathy and realistic optimism.

What this study adds

Primary care practitioners across the multidisciplinary team valued EMPathicO, finding it relevant, accessible, manageable in the context of busy clinical practice and a positive worthwhile experience.

Practitioners felt motivated to adopt EMPathicO communication skills and most reported doing so, perceiving benefits for themselves and their interactions with patients, without lengthening consultation length.

If widely disseminated, EMPathicO is likely to be very well-received by primary care practitioners and straightforward to integrate into everyday practice.

The authors declare the following competing interests: FLB (research grant from NIHR School for Primary Care Research paid to institution; speakers honoraria from Stoneygate Centre for Empathic Healthcare and New Scientist), TB (research grant from NIHR School for Primary Care Research paid to institution), KG (research grant from NIHR School for Primary Care Research paid to institution; ModRUM license holder), NC (research grant from NIHR School for Primary Care Research paid to institution), RDH (none declared), ET (research grant from NIHR School for Primary Care Research paid to institution), AH (research grant from NIHR School for Primary Care Research paid to institution), MER (research grant from NIHR School for Primary Care Research paid to institution), MJR (research grant from NIHR School for Primary Care Research paid to institution; other research funding from NIHR SPCR, HTA, and PGfAR paid to institution; NIHR Research Professorship; on TSC/DMC for ERICA, BabyBathe and ASYMPTOMATIC trials), CM (research grant from NIHR School for Primary Care Research paid to institution; other funding from NIHR, MRC, NHS paid to institution; is the Director of the NIHR SPCR), LC (research grant from NIHR School for Primary Care Research paid to institution; paid role as Chief Medical Officer, NHS Shropshire, Telford and Wrekin; Salaried GP at Brook Medical Centre, Stoke-on-Trent; Senior Lecturer in General Practice Research, Keele University), JB (research grant from NIHR School for Primary Care Research), BS (research grant from NIHR School for Primary Care Research paid to institution; other research funding from NIHR paid to institution; member of NIHR HTA Commissioning Panel 15/09/2020 to present), LM (research grant from NIHR School for Primary Care Research paid to institution), SP (research grant from NIHR School for Primary Care Research paid to institution), JV (none declared), HA (research grant from NIHR School for Primary Care Research paid to institution; other research funding from NIHR, Research Council of Norway, University of Warwick/eConsult Ltd paid to institution; honoraria from Imperial College London, UCL, North West Cancer Research; received support for travel from NIHR, RCGP, University of Birmingham; advisory board member/chair for NIHR159467, NIHR160384, BRACE rapid evaluation centre, HED-LINE study, EPaCCS study; is Vice Chair of the Scientific Foundation Board, Royal College of General Practitioners), JH (research grant from NIHR School for Primary Care Research paid to institution), GML (none declared), JN (none declared), NI (none declared), PHL (none declared), PL (research grant from NIHR School for Primary Care Research paid to institution), HAE (research grant from NIHR School for Primary Care Research paid to institution; is Deputy Academic Capacity Development Lead for the NIHR SPCR and sits on the NIHR SPCR Board and Exec; works clinically as a GP at New Horizons Medical Partnership in Southampton as part of Professor of Primary Care Research post at the University of Southampton; Co-Authors the Oxford Handbook of General Practice published by Oxford University Press).

Funding: This project was funded by the National Institute for Health Research (NIHR) School for Primary Care Research grant (project reference 563). The Primary Care Research Centre, University of Southampton is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. Service support costs will be paid by the CRN. CDM is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands and the NIHR School for Primary Care Research. The EMPathicO e-learning package was developed using LifeGuide software, which was partly funded by the National Institute for Health Research Southampton Biomedical Research Centre (BRC). NIHR Local Clinical Research Networks (CRNs) supported practice recruitment. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study sponsor (University of Southampton) and funders had no role in study design; collection, management, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication. The researchers are independent from the funders and all authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

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South Central - Hampshire B Research Ethics Committee gave ethical approval for this work (ref: 22/SC/0145)

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