• Automated telephone communication systems for preventive healthcare and management of long-term conditions

      Posadzki, Pawel; Mastellos, Nikolaos; Ryan, Rebecca; Gunn, Laura H.; Felix, Lambert M.; Pappas, Yannis; Gagnon, Marie‐Pierre; Julious, Steven A.; Xiang, Liming; Oldenburg, Brian; et al. (Wiley, 2016-12-14)
      Background: Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. Objectives: To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. Search methods: We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Selection criteria: Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. Data collection and analysis: We used standard Cochrane methods to select and extract data and to appraise eligible studies. Main results: We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. Authors' conclusions: ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
    • British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing careers

      Quereshi, Irtiza; Ali, Nasreen; Randhawa, Gurch; University of Bedfordshire (Wiley, 2020-04-06)
      To ascertain British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing education and careers. There is a shortage of men from Black, Asian and Minority Ethnic groups in the National Health Service nursing workforce. There is a dearth of evidence on the views of British south Asian men on this subject. A qualitative interpretative intersectional approach was used to carry out one to one interviews (n=5) with British South Asian male nurses using a semi-structured topic guide. Interviews took place between July 2018 and February 2019, across England. A Framework Analysis approach was used to analyse the interview transcripts. The main themes emerging as barriers were: poor pay and conditions, negative immediate, extended family, community views and a lack of knowledge and awareness of the nursing profession. The main themes emerging as enablers were: personal circumstances (including role models) and ethnicity (including the role of religion and masculinity). Findings suggest that the intersection between ethnicity and gender presents as an important enabler, as well as inhibitor, for British South Asian men. Nursing careers and salient barriers exist at a systemic level and include institutional racism. Review policies and practice on unconscious bias and institutional racism in the recruitment, retention and progression of British South Asian men. Provide continuous professional development including mentoring support to help career progression for these men. Develop culturally specific interventions to reduce the stigma associated with the nursing profession in the British South Asian community. Consider places of worship as venues for delivery of these interventions when promoting nursing. AIM BACKGROUND METHODS RESULTS CONCLUSION IMPLICATIONS FOR NURSING MANAGEMENT
    • Children, organ donation, and Islam: a report of an engagement day of Islamic scholars, young Muslims and pediatric transplant and donation professionals

      Aktas, Mikail; Randhawa, Gurch; Brierley, Joe; ; University of Newcastle; University of Bedfordshire; Great Ormond St Hospital for Sick Children (Wiley, 2020-03-02)
      Meeting report
    • ‘Coaching and Peer Assisted Learning’ (C‐PAL) ‐ the mental health nursing student experience: a qualitative evaluation

      Wareing, Mark; Green, Helen; Burden, Barbara; Burns, Sally; Beckwith, Mary A.R.; Mhlanga, Fortune; Mann, Bob; University of Bedfordshire; Oxford Health NHS Foundation Trust (Wiley, 2018-08-08)
      Introduction: This paper presents findings from a study that evaluated mental health nursing students’ experience of a team mentoring model called Coaching and Peer Assisted Learning (C-PAL). At present there are no published research studies into the effectiveness of team mentorship utilised by nursing students within inpatient mental health settings. Aim: The study utilised an interpretist methodology where the focus was on individuals in their social world. Method: Two focus groups were held with fifteen students who had experienced C-PAL in four in-patient wards. Findings: Students’ overall experience of piloting C-PAL was positive. Learning opportunities (Theme 3) appeared to be dependent on the quality of peer support (Theme 5) which in turn, enhanced the learner experience and increased the level of student confidence (Theme 6). Less positive experiences included inadequate preparation (Theme 1), poor understanding of the model and competition for learning experiences. Implications for practice: We tentatively suggest that team mentorship models such as C-PAL may be suitable for acute in-patient mental health settings. The success of C-PAL depends upon the preparation of nursing staff, mentors (Theme 4), coaches and students in relation to role expectations, shift rostering (Theme 2) and the implementation of ‘huddling’ to promote opportunistic learning.
    • Does intentional asphyxiation by strangulation have addictive properties?

      Chater, Angel M.; University of Bedfordshire (Wiley, 2020-09-04)
      Background and aims Intentional asphyxiation leads to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone. This article raises the question as to whether it could usefully be regarded as having addictive properties. Methods and results A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with co‐morbidities. There does not appear to be strong evidence of seeking support for cessation of the practice. Discussion Intentional asphyxiation behaviours may have addictive properties and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it.
    • Ethnic differences in body fat deposition and liver fat content in two UK-based cohorts

      Alenaini, Wareed; Parkinson, James R.; McCarthy, John; Goldstone, Anthony P.; Wilman, Henry R.; Banerjee, Rajarshi; Yaghootkar, Hanieh; Bell, Jimmy D.; Thomas, E. Louise; University of Westminster; et al. (Wiley, 2020-09-16)
      Objective: Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK-based populations. Methods: Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro-Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques. Results: The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort. Conclusions: Our data, consistent across two independent UK-based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.
    • Ethnic differences in the prevalence of frailty in the United Kingdom assessed using the electronic Frailty Index

      Pradhananga, Shraddha; Regmi, Krishna; Razzaq, Nasrin; Ettefaghian, Alireza; Dey, Aparajit Ballav; Hewson, David (Wiley, 2019-09-13)
      Objective: There have been few studies in which the prevalence of frailty of different ethnic groups has been assessed in multiethnic countries. The aim of this study was to evaluate the prevalence of frailty in different ethnic groups in the United Kingdom. Methods: Anonymized electronic health records (EHR) of 13 510 people aged 65 years and over were extracted from the database of a network of general practitioners, covering 16 clinical commissioning groups in London. Frailty was determined using the electronic Frailty Index (eFI), which was automatically calculated using EHR data. The eFI was used as a categorical variable with fit and mild frailty grouped together, and moderate and severe frailty grouped as frail. Results: The overall prevalence of frailty was 18.1% (95% confidence interval [CI], 17.4%‐18.9%). The prevalence of frailty increased with age (odds ratio [OR], 1.11; 95% CI, 1.10‐1.12) and body mass index (BMI; OR, 1.05; 95% CI, 1.04‐1.06). The highest prevalence of frailty was observed for Bangladeshis, with 32.9% classified as frail (95% CI, 29.2‐36.7); and the lowest prevalence of 14.0% (95% CI, 12.6‐15.5) was observed for the Black ethnic group. Stepwise logistic regression retained ethnicity, age, and BMI as predictors of frailty. Conclusion: This pilot study identified differences in the prevalence of frailty between ethnic groups in a sample of older people living in London. Additional studies are warranted to determine the causes of such differences, including migration and socioeconomic status. It would be worthwhile carrying out a validation study of the eFI in different ethnic populations.
    • Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: a systematic review

      Mistry, Sabuj Kanti; Das Gupta, Rajat; Alam, Sabiha; Kaur, Kuljeet; Shamim, Abu Ahmed; Puthussery, Shuby; BRAC University, Dhaka; University of New South Wales; University of Dhaka; University of Bedfordshire (Wiley, 2021-07-03)
      Introduction The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. Methods A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. Results Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. Conclusion Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.
    • IFITM proteins drive type 2 T helper cell differentiation and exacerbate allergic airway inflammation

      Yánez, Diana C.; Sahni, Hemant; Ross, Susan; Solanki, Anisha; Lau, Ching-In; Papaioannou, Eleftheria; Barbarulo, Alessandro; Powell, Rebecca; Lange, Ulrike C.; Adams, David J.; et al. (Wiley, 2018-10-26)
      T cells differentiated more efficiently to Th1, whereas Th2 differentiation was inhibited. Ifitm-family-deficient mice, but not Ifitm3-deficient mice, were less susceptible than WT to induction of allergic airways disease, with a weaker Th2 response and less severe disease and lower Il4 but higher Ifng expression and IL-27 secretion. Thus, the Ifitm family is important in adaptive immunity, influencing Th1/Th2 polarization, and Th2 immunopathology.
    • The impact of COVID-19 on health behaviour, well-being, and long-term physical health.

      McBride, Emily; Arden, Madelynne A.; Chater, Angel M.; Chilcot, Joseph; ; University College London; Sheffield Hallam University; University of Bedfordshire; King's College London (Wiley, 2021-03-31)
    • The importance of mealtime structure for reducing child food fussiness

      Powell, Faye; Farrow, Claire; Meyer, Caroline; Haycraft, Emma (Wiley, 2016-04-08)
      The aim of this study was to explore how the structure of mealtimes within the family setting is related to children's fussy eating behaviours. Seventy-five mothers of children aged between 2 and 4 years were observed during a typical mealtime at home. The mealtimes were coded to rate mealtime structure and environment as well as the child's eating behaviours (food refusal, difficulty to feed, eating speed, positive and negative vocalisations). Mealtime structure emerged as an important factor which significantly distinguished children with higher compared with lower levels of food fussiness. Children whose mothers ate with their child and ate the same food as their child were observed to refuse fewer foods and were easier to feed compared with children whose mothers did not. During mealtimes where no distractors were used (e.g. no TV, magazines or toys), or where children were allowed some input into food choice and portioning, children were also observed to demonstrate fewer fussy eating behaviours. Findings of this study suggest that it may be important for parents to strike a balance between structured mealtimes, where the family eats together and distractions are minimal, alongside allowing children some autonomy in terms of food choice and intake.
    • Life after prostate cancer: a systematic literature review and thematic synthesis of the post-treatment experiences of Black African and Black Caribbean men

      Bamidele, Olufikayo; McGarvey, Helen E.; Lagan, Briege M.; Ali, Nasreen; Chinegwundoh, Frank; Parahoo, K.; McCaughan, Ellis (Wiley, 2017-10-16)
      Evidence shows that there are significant ethnic variations in prostate cancer prevalence and outcomes. Specifically, Black African and Black Caribbean men may encounter different post-treatment experiences than Caucasian men due to their disproportionately higher risk of being diagnosed with advanced prostate cancer. But to date, no review of these experiences has been undertaken. This review synthesised findings from existing literature on the post-treatment experiences of Black African and Black Caribbean men with prostate cancer and identified pertinent issues which may be useful to inform practice and future research. Seven databases were systematically searched using developed search terms. Four qualitative studies were identified and critically appraised. Findings are summarised under four main themes: symptom experience, healthcare experience, marital and social relationships and coping strategies. Cultural definitions of masculinity influenced the meanings men gave to their post-treatment experiences. While men's experiences of healthcare varied, the provision of professional support to address their post-treatment distress was lacking. Men derived most support from wives, peers and church communities. A culturally sensitive approach which recognises diversity among Black African and Black Caribbean populations and treats individuals within their religious and socio-cultural contexts could potentially improve men's post-treatment experiences. Areas for further research were also identified.
    • The prescribing needs of community practitioner nurse prescribers: a qualitative investigation using the theoretical domains framework and COM-B.

      Chater, Angel M.; Williams, Jane; Courtenay, Molly; University of Bedfordshire; University College London; Cardiff University (Wiley, 2019-08-18)
      With several qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. A qualitative research design. Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. AIM DESIGN METHODS RESULTS CONCLUSION IMPACT
    • Public, patient and carers’ views on palliative and end‐of‐life care in India: a systematic review

      Ramasamy Venkatasalu, M.; Sirala Jagadeesh, N.; Elavally, B.; Pappas, Yannis; Mhlanga, F.; Pallipalayam Varatharajan, R. (Wiley, 2017-08-30)
      Aim To systematically review the existing evidence on the Indian public, patient and carers’ perspectives on palliative and end‐of‐life care. Background With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users’ (patients, family and public) perspectives is crucial in developing and sustaining successful community‐centred palliative nursing policies and service models especially in countries like India with diverse population. Methods An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. Results Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end‐of‐life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. Conclusions Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context‐specific palliative and end‐of‐life care practices in India – socioeconomic, cultural and religious factors – on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end‐of‐life care services, which are scant in India. Implications for nursing and health policy Nurses can be central in gathering the contextual evidence that advocate users’ perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family‐centred palliative and end‐of‐life care within curricula, whereas nursing practice may promote nurse‐led community models to address the patchy palliative and end‐of‐life service provision in India.
    • Understanding continuous professional development participation and choice of mid-career general dental practitioners

      Brown, T.; Wassif, Hoda; Health Education Yorkshire and Humber; University of Bedfordshire (Wiley, 2015-12-10)
      Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact Of CPD In Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development. OBJECTIVE METHOD RESULTS CONCLUSION
    • Why we should understand the patient experience: clinical empathy and medicines optimisation

      Jubraj, Barry; Barnett, Nina L.; Grimes, Lesley; Varia, Sneha; Chater, Angel M.; Auyeung, Vivian (Wiley, 2016-04-21)
      Objectives To critically discuss the need for pharmacists to underpin their consultations with appropriate ‘clinical empathy’ as part of effective medicines optimisation. Methods Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Key findings Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. Conclusions We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients’ relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care.