EMPATHICA - Expectation Management for Patients in Primary Care: Developing and Feasibility Testing a New Digital Intervention for Practitioners

This research aimed to enable primary care practitioners to enhance the effectiveness of therapies for Osteoarthritis pain through the development of a brief digital intervention: “Expectation Management for Patients with Osteoarthritis” (EmpathicO).

Osteoarthritis pain is common, costly, and challenging to manage in busy primary care settings. While various drug-based and non-drug-based treatments are recommended, patients still experience pain, poor quality-of-life, and drug side effects. Regardless of which treatment patients receive, excellent practitioner-patient communication can significantly reduce patients’ pain while improving quality of life and satisfaction with care. We recently showed that patients experience less pain after consulting practitioners who show empathy and encourage optimism about treatment. Yet practitioners vary widely in how much they show empathy.

We developed an online training package to teach practitioners (GPs, physiotherapists, and nurses) how to show more empathy and encourage patients to have positive yet realistic expectations.

Our research questions were:

What strategies should we teach practitioners to use so that they will show more empathy and encourage patients to have realistic and positive expectations?
What are patients’ and practitioners’ concerns and priorities, to address in our training?
How can we make our training engaging and relevant for practitioners so that they use it?

To answer these questions, we:

Reviewed existing trials to confirm what strategies enhance practitioner engagement.
Reviewed existing qualitative studies to identify patients’ and practitioners’ priorities and concerns.
Interviewed practitioners so we can make our training engaging and persuasive.

To design our training, we made a plan and used published evidence about how to help people change their behaviour. To produce our training package, we tested prototypes with patients and practitioners and made improvements. This development work was published 2021 (Smith et al DOI: 10.3389/fpain.2021.721222 - attached below)
Finally, we will conducted a small feasibility trial (named the ‘Talking in Primary Care (TIP) study’) to help us design a large, fundable, clinical trial.
If successful, our training package should enable practitioners to improve the long-term effectiveness of all drug and non-drug therapies for osteoarthritis pain, reduce patients’ pain and improve quality of life.

The feasibility TIP study helped us understand patients’ experiences of appointments with healthcare professionals from their GP practice. Due to the COVID-19 pandemic, the study was adapted to fit in with remote GP consultations:
The two parts of the TIP feasibility study were:
1. Healthcare professionals undertook the online training and provided interview feedback on their experience.
2. Patients who had recently had an appointment at their GP surgery (either face-to-face or remotely) were invited to complete a 2-part online survey about their experiences of the appointment and their general health and wellbeing. Some of these participants were invited to take part in a telephone interview to give more information about the appointment and their experience of completing the survey.

Due to the changes required due to the pandemic, we were able to recruit more patients to the study and gain valuable knowledge on how empathy and optimism differ in both remote and face-to-face appointments.

The NIHR School of Primary Care Research has since funded a full trial which is ongoing – please see the TIP2 Project page: Tip Study 2 | University of Southampton

Study Team:
Co-Lead Investigators: Prof Felicity Bishop and Prof Hazel Everitt
Co-investigators: Prof Paul Little, Professor Jeremy Howick, Dr Leanne Morrison, Dr Jane Vennik, Professor Lucy Yardley, Dr Kirsten Smith, Stephanie Hughes, Dr Christian Mallen, Dr Mohana Ratnapalan, Dr Emily Lyness, Dr Hajira Dambha-Miller
PPI co-applicant: Mrs Jennifer Bostock.