Rapid Assessment of Therapeutic Empathy (RATE): Development of a universal single-item empathy scale and validation of the patient-reported version
5 affiliations
- 1Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom
- 2School of Healthcare, University of Leicester, George Davies Centre, Leicester, United Kingdom
- 3Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- 4Division of Epidemiology and Public Health, School of Medical Sciences, University of Leicester, Leicester, United Kingdom
- 5School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom
Abstract
Background: Therapeutic empathy improves patient and practitioner outcomes, yet existing measures are often lengthy, conceptually inconsistent, and difficult to compare across respondent groups. Brief, universal measures (usable by patients, practitioners, students, and observers) are lacking. We developed a universal single-item scale – the Rapid Assessment of Therapeutic Empathy (RATE) scale – and conducted psychometric testing of the patient-reported version. Methods: We used a three-phase approach: (1) item development; (2) pre-testing the scale by obtaining expert panel feedback (n = 9) and conducting cognitive interviews with stakeholders (n = 35); and (3) scale validation in an international patient sample (n = 521) assessing convergent, discriminant, and known-groups validity. Validation involved assessing correlations with the Consultation and Relational Empathy (CARE) measure and clinical neutrality measure, and by assessing differences in scores by patient ethnicity. Results: We developed two versions (pictorial and text-based) of each scale. Expert feedback and cognitive interviews confirmed content and face validity. Pictorial and text-based versions showed high convergent validity with the CARE measure (r = 0.761 and r = 0.838, both p < 0.001), and discriminant validity with a clinical neutrality measure (r = 0.131 and r = 0.139, p = 0.003 and p = 0.001, respectively). Correlations with the CARE measure remained high (r > 0.70) and statistically significant (p < 0.001) across patient gender, ethnicity, and practitioner type. Ethnic minority patients rated practitioner empathy lower than White patients (pictorial p = 0.057; text-based p = 0.033), demonstrating known-groups validity. Patients rated doctors’ empathy higher than other healthcare practitioners’ (p = 0.001 for both pictorial and text-based); there were no significant differences in empathy scores by patient gender. Conclusions: We developed the first universal single-item therapeutic empathy measure and demonstrated validity. The RATE scale is brief, accessible, and applicable to clinical practice, education, and research. Further research should validate practitioner-, student-, and observer-reported versions, and assess predictive and cross-cultural validity. This robust tool can support patient-reported routine measurement of therapeutic empathy and contribute to improving patient and practitioner outcomes.
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BibTeX
@article{bennettweston2026rapid,
title = {{Rapid Assessment of Therapeutic Empathy (RATE): Development of a universal single-item empathy scale and validation of the patient-reported version}},
author = {Amber Bennett-Weston and John Maltby and Kamlesh Khunti and Char Leung and Daya Narwal and Patience Otoo and Benita Iyadi-Wilson and Jeremy Howick},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0346994},
url = {https://doi.org/10.1371/journal.pone.0346994},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rapid Assessment of Therapeutic Empathy (RATE): Development of a universal single-item empathy scale and validation of the patient-reported version
AU - Amber Bennett-Weston
AU - John Maltby
AU - Kamlesh Khunti
AU - Char Leung
AU - Daya Narwal
AU - Patience Otoo
AU - Benita Iyadi-Wilson
AU - Jeremy Howick
PY - 2026
DA - 2026/09/09
JO - PLOS One
DO - 10.1371/journal.pone.0346994
UR - https://doi.org/10.1371/journal.pone.0346994
AB - Background: Therapeutic empathy improves patient and practitioner outcomes, yet existing measures are often lengthy, conceptually inconsistent, and difficult to compare across respondent groups. Brief, universal measures (usable by patients, practitioners, students, and observers) are lacking. We developed a universal single-item scale – the Rapid Assessment of Therapeutic Empathy (RATE) scale – and conducted psychometric testing of the patient-reported version. Methods: We used a three-phase approach: (1) item development; (2) pre-testing the scale by obtaining expert panel feedback (n = 9) and conducting cognitive interviews with stakeholders (n = 35); and (3) scale validation in an international patient sample (n = 521) assessing convergent, discriminant, and known-groups validity. Validation involved assessing correlations with the Consultation and Relational Empathy (CARE) measure and clinical neutrality measure, and by assessing differences in scores by patient ethnicity. Results: We developed two versions (pictorial and text-based) of each scale. Expert feedback and cognitive interviews confirmed content and face validity. Pictorial and text-based versions showed high convergent validity with the CARE measure (r = 0.761 and r = 0.838, both p < 0.001), and discriminant validity with a clinical neutrality measure (r = 0.131 and r = 0.139, p = 0.003 and p = 0.001, respectively). Correlations with the CARE measure remained high (r > 0.70) and statistically significant (p < 0.001) across patient gender, ethnicity, and practitioner type. Ethnic minority patients rated practitioner empathy lower than White patients (pictorial p = 0.057; text-based p = 0.033), demonstrating known-groups validity. Patients rated doctors’ empathy higher than other healthcare practitioners’ (p = 0.001 for both pictorial and text-based); there were no significant differences in empathy scores by patient gender. Conclusions: We developed the first universal single-item therapeutic empathy measure and demonstrated validity. The RATE scale is brief, accessible, and applicable to clinical practice, education, and research. Further research should validate practitioner-, student-, and observer-reported versions, and assess predictive and cross-cultural validity. This robust tool can support patient-reported routine measurement of therapeutic empathy and contribute to improving patient and practitioner outcomes.
SN - 1932-6203
ER -