Wenchan Wu (1), Norshafarina SK (2), Shoo Thien Lee (3), Ke-Xin Yu (4)
The Background–Affect–Trouble–Handling–Empathy (BATHE) technique is a structured, empathy-oriented consultation model increasingly applied in primary and inpatient healthcare settings. This study aimed to comprehensively review the evidence and application of BATHE technique in healthcare setting. This narrative review, through a targeted literature search strategy, synthesized evidence from 33 peer-reviewed studies. Of these, 17 studies explored the use of BATHE technology in patient-physician consultation cases and training methods, while the remaining 16 focused on its clinical application in improving patient satisfaction, empowerment, self-management, and reducing preoperative anxiety. Randomized controlled trials (RCT) from Nigeria, India, and South Korea showed that BATHE-based interventions improved patient satisfaction by 15–30% compared to standard care. A Turkish study in Type 2 diabetes patients reported significantly higher Diabetes Empowerment Scale scores in the intervention group (Δ = 10.6 vs. 5.6, p < 0.001). UK-based qualitative studies highlighted enhanced patient self-management and awareness. Preoperative trials (n = 463) indicated reduced anxiety scores (STAI) by 3–4 points. However, fidelity studies revealed implementation inconsistencies, including step omissions and deviation from the BATHE sequence, with time constraints being a major barrier in clinical practice. BATHE demonstrates short-term efficacy in enhancing patient experience, empowerment, and emotional well‑being across cultures. However, its long-term impact on physiological and behavioral outcomes remains untested. Future research should include large-scale, longitudinal RCTs linking BATHE to hard clinical endpoints and explore how to incorporate BATHE technique into physicians' routine practice to further patient satisfaction and patient care quality.
Akafa, T. A., Akinwale, M. L., & Ogwuche, E. (2021). BATHE Consultation Model and Patients’ Satisfaction: A Randomized Controlled Clinical Trial among Adults with Chronic Illness in a Tertiary Health Facility in North-Central Nigeria. West African Journal of Medicine, Vol. 38(10).
Akturan, S., Kaya, Ç. A., Ünalan, P. C., & Akman, M. (2017). The effect of the BATHE interview technique on the empowerment of diabetic patients in primary care: A cluster randomised controlled study. Primary Care Diabetes, 11(2). https://doi.org/10.1016/j.pcd.2016.12.003
Alves-Nogueira, A. C., Góis, A. C., Pereira, M., Canavarro, M. C., Melo, C., & Carona, C. (2024). The Associations Between Physician-Patient Communication and Adjustment Outcomes of Patients and Physicians: A Systematic Review and Meta-Analysis of Correlations. Health Communication, 39(9), 1781–1794. https://doi.org/10.1080/10410236.2023.2243043
Ayvat, P., Arslan Yurtlu, D., Özgürbüz, U., Güntürkün, F., Katircioğlu, K., & Kizilkaya, M. (2020). Does preoperative anxiety decrease with bathe method? A prospective randomized study. Noropsikiyatri Arsivi, 57(2). https://doi.org/10.29399/npa.24853
Barnes, R. K., Cramer, H., Thomas, C., Sanderson, E., Hollinghurst, S., Metcalfe, C., Jackson, S., Record, C., Thorley, H., & Kessler, D. (2019). A consultation-level intervention to improve care of frequently attending patients: A cluster randomised controlled feasibility trial. BJGP Open, 3(1). https://doi.org/10.3399/bjgpopen18X101623
Barnes, R. K., Jepson, M., Thomas, C., Jackson, S., Metcalfe, C., Kessler, D., & Cramer, H. (2018). Using conversation analytic methods to assess fidelity to a talk-based healthcare intervention for frequently attending patients. Social Science and Medicine, 206. https://doi.org/10.1016/j.socscimed.2018.04.008
Cahill, A., Martin, M., Beachy, B., Bauman, D., & Howard-Young, J. (2024). The contextual interview: a cross-cutting patient-interviewing approach for social context. Medical Education Online, 29(1). https://doi.org/10.1080/10872981.2023.2295049,
Chengappa, N., Rajkumar Honest, P. C., David, K., Pricilla, R. A., Rahman, S. M. F., & Rebecca, G. (2020). Effect of BATHE interview technique on patient satisfaction in an ambulatory family medicine centre in South India. Family Medicine and Community Health, 8(4). https://doi.org/10.1136/fmch-2020-000327
Demaria, S., Demaria, A. P., Silvay, G., & Flynn, B. C. (2011). Use of the BATHE method in the preanesthetic clinic visit. Anesthesia and Analgesia, 113(5), 1020–1026. https://doi.org/10.1213/ANE.0B013E318229497B
Fakhro, E., & Al-Jalahma, M. (2002). The BATHE technique A method of supportive psychotherapy in primary care. In Journal of the Bahrain Medical Society (Vol. 14, Issue 4).
Flavin, J. A., Barker, E., Pruchnicki, M. C., Sevin, A. M., Green, C. G., & Porter, K. (2015). Transdisciplinary educational strategy for improving prescribing skills in family nurse practitioner students. Journal of Interprofessional Education & Practice, 1(2). https://doi.org/10.1016/j.xjep.2015.07.006
Gerger, H., Munder, T., Kreuzer, N., Locher, C., & Blease, C. (2024). Lay Perspectives on Empathy in Patient-Physician Communication: An Online Experimental Study. Health Communication, 39(6), 1246–1255. https://doi.org/10.1080/10410236.2023.2210380
KARAKOYUN, İ., İŞBİR, A. C., GÜNDOĞDU, O., AVCI, O., ÖZDEMİR KOL, İ., GÜRSOY, S., & KAYGUSUZ, K. (2021). The Effect of BATHE Method on Preoperative Anxiety, Patient Satisfaction and Individual Anesthesia Concerns: Randomized, Placebo-Controlled, Clinical Trial. Turkiye Klinikleri Journal of Anesthesiology Reanimation, 19(3), 114. https://doi.org/10.5336/ANESTHE.2021-85696
Kim, J. H., Park, Y. N., Park, E. W., Cheong, Y. S., & Choi, E. Y. (2012). Effects of BATHE interview protocol on patient satisfaction. Korean Journal of Family Medicine, 33(6). https://doi.org/10.4082/kjfm.2012.33.6.366
Lambrinou, E., Hansen, T. B., & Beulens, J. W. J. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European Journal of Preventive Cardiology, 26(2_suppl), 55–63. https://doi.org/10.1177/2047487319885455,
Leaman, T. L. (1999). Anxiety disorders. Primary Care - Clinics in Office Practice, 26(2). https://doi.org/10.1016/S0095-4543(08)70002-2
Leiblum, S. R., Schnall, E., Seehuus, M., & DeMaria, A. (2008). To BATHE or not to BATHE: Patient satisfaction with visits to their family physician. Family Medicine, 40(6).
Lieberman, J. A., & Stuart, M. R. (1999). The BATHE method: Incorporating counseling and psychotherapy into the everyday management of patients. Primary Care Companion to the Journal of Clinical Psychiatry, 1(2). https://doi.org/10.4088/pcc.v01n0202
Mcculloch, J., Ramesar, S., & Peterson, H. (1998). Psychotherapy in primary care: The bathe technique. American Family Physician, 57(9).
Milstein, J. M., Raingruber, B. J., Bennett, S. H., Kon, A. A., Winn, C. A., & Paterniti, D. A. (2009). Burnout assessment in house officers: Evaluation of an intervention to reduce stress. Medical Teacher, 31(4), 338–341. https://doi.org/10.1080/01421590802208552
Nash, W., Erondu, M., & Childress, A. (2023). Expanding Narrative Medicine through the Collaborative Construction and Compelling Performance of Stories. The Journal of Medical Humanities, 44(2), 207. https://doi.org/10.1007/S10912-022-09779-6
Pace, E. J., Somerville, N. J., Enyioha, C., Allen, J. P., Lemon, L. C., & Allen, C. W. (2017). Effects of a brief psychosocial intervention on inpatient satisfaction: A randomized controlled trial. Family Medicine, 49(9).
Peyrot, M., & Rubin, R. R. (2007). Behavioral and Psychosocial Interventions in DiabetesA conceptual review. Diabetes Care, 30(10), 2433–2440. https://doi.org/10.2337/DC07-1222
Poon, V. H. K. (1997). Short counseling techniques for busy family doctors. Canadian Family Physician, 43(APR.).
Searight, H. R. (2007). Efficient counseling techniques for the primary care physician. Primary Care, 34(3), 551–570. https://doi.org/10.1016/J.POP.2007.05.012
Searight, H. R. (2009). Realistic approaches to counseling in the office setting. In American Family Physician (Vol. 79, Issue 4).
Searight, H. R. (2018). Counseling patients in primary care: Evidence-based strategies. American Family Physician, 98(12).
Stuart, M., & Lieberman, J. (2018). The Fifteen Minute Hour : Efficient and Effective Patient-Centered Consultation Skills, Sixth Edition. https://doi.org/10.1201/9781351017916
Thomas, C., Cramer, H., Jackson, S., Kessler, D., Metcalfe, C., Record, C., & Barnes, R. K. (2019). Acceptability of the BATHE technique amongst GPs and frequently attending patients in primary care: A nested qualitative study. BMC Family Practice, 20(1). https://doi.org/10.1186/s12875-019-1011-y
Unal, O., Akbolat, M., & Amarat, M. (2018). The influence of patient-physician communication on physician loyalty and hospital loyalty of the patient. Pakistan Journal of Medical Sciences, 34(4), 999–1003. https://doi.org/10.12669/PJMS.344.15136
Vine, M., Vamos, S. D., Vine, M. E., Gordon, I. D., & Alaimo, D. F. (2024). The Role of Health Literacy in Patient-Physician Communication: A Scoping ReviewIF 0.5ESCIJCR Q4. Ingentaconnect.Com, 11(4), 1624–1654. https://doi.org/10.14485/HBPR.11.4.2
Zhang, X., Li, L., Zhang, Q., Le, L. H., & Wu, Y. (2024). Physician Empathy in Doctor-Patient Communication: A Systematic Review. Health Communication, 39(5), 1027–1037. https://doi.org/10.1080/10410236.2023.2201735;CTYPE:STRING:JOURNAL