Conceptualisation of Empathy in Interactions Between Healthcare Professionals and People With Fibromyalgia Syndrome: A Mixed-Methods Study.

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, 'Empathy is about truly connecting-the dominant healthcare professional view', included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, 'Empathy cannot be taught; it is something that you have', focussed on behavioural, outcome-oriented aspects; Factor 3, 'Empathy requires communication that goes both ways', prioritised behavioural and cognitive aspects; and Factor 4, 'Lack of empathy makes patients feel abandoned-the dominant patient view', reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically informed healthcare for FMS.