Effectiveness of literature-based initiatives to enhance empathy in healthcare populations: A systematic review and meta-analysis

Abstract

Background: Empathy is a core component of effective healthcare, improving patient outcomes and supporting practitioner wellbeing. While various educational strategies aim to foster empathy, the specific impact of literary arts-based interventions, such as shared reading, textual analysis, and creative writing, remains underexplored. This systematic review and meta-analysis will evaluate the effectiveness of these interventions in enhancing empathy among healthcare students and professionals. Methods: The review will synthesise studies measuring changes in clinical empathy and identify which intervention components (e.g., duration, format, participant type) are most effective. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quantitative studies examining the impact on empathy of literary arts-based interventions for healthcare student and professional populations will be included. A librarian-guided search strategy will cover databases including Ovid Medline, Scopus, Cinahl Complete, LION, MLA, and APA PsycInfo. Two reviewers will screen abstracts and extract data, which will be informed by the TIDieR framework, capturing intervention details, demographics, Version 1 methodology, outcomes, and risk of bias. The main outcome will be changes in empathy scores. Heterogeneity will be assessed using the I2 statistics and Cochran's Q score. Risk of bias will be assessed using ROBINS-I, and evidence quality evaluated using GRADE. Where meta-analysis is not feasible, a structured narrative synthesis will be provided. Discussion: This review will offer timely insights into the role of literary arts in empathy development, informing future research and curriculum design in healthcare education.