Therapeutic empathy in remote consultations in general practice: a realist review protocol

Journal article

Introduction:
Remote consultations (video, telephone, text) have become integral to the delivery of primary care and are promoted by government initiatives. While many find these more convenient, they may also discriminate against those with lower digital literacy and present a barrier to empathy by removing some non-verbal communication. The aim of this realist review is to understand how therapeutic empathy can be effectively expressed during remote consultations in general practice across different situations and for different people.
Methods and analysis:
This realist review will follow the methodological framework proposed by Pawson and colleagues, which includes the following five steps: (1) identify existing theories to develop an initial programme theory; (2) systematically search bibliographic databases to identify relevant literature; (3) select, extract and organise data; (4) synthesise evidence to develop context-mechanism-outcome configurations; (5) refine and finalise programme theory. This iterative process will be guided by a Content Expert Group consisting of patients, carers, clinical staff working in general practice and representatives from national stakeholder groups. The final programme theory will inform the development of evidence-based recommendations to help clinical staff working in general practice express empathy during remote consultations.
Ethics and dissemination:
This review does not require ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences and through relevant professional associations and primary care networks in the UK.
PROSPERO registration number:
CRD420261306014.

Authors: Howick, J; Ma, K; Bennett-Weston, A; Ward, A; Roberts, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Open
• Volume: 16
• Issue: 5
• Article number: e119075
• Publication date: 2026-05-14
• Acceptance date: 2026-04-21
• DOI: 10.1136/bmjopen-2026-119075
• EISSN: 2044-6055
• Language: English