| Summary: | <h4>Background</h4> <p>Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised.</p> <h4>Objectives</h4> <p>To estimate the effects of empathy and expectations interventions for any clinical condition.</p> <h4>Design</h4> <p>Systematic review and meta-analysis of randomised trials.</p> <h4>Data sources</h4> <p>Six databases from inception to August 2017.</p> <h4>Study selection</h4> <p>Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older.</p> <h4>Review methods</h4> <p>Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis.</p> <h4>Results</h4> <p>We identified 28 eligible (n=6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n=2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference -0.43 [95% confidence interval -0.65 to -0.21]); 11 (n=1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.05]). Within 11 trials (n=2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons.</p> <h4>Conclusions</h4> <p>Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain.</p>
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