What Is the State of Compassion Education? A Systematic Review of Compassion Training in Health Care

Predictors of Palliative Care Self-efficacy Among Health Care Professionals in Vietnam: A Cross-sectional Study

This study aimed to investigate predictors of palliative care self-efficacy among Vietnamese health care professionals. An online descriptive cross-sectional survey was conducted at 1 hospital in Vietnam. Participants completed survey questionnaires including demographics, professional experience, Palliative Care Self-Efficacy, Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying-Form B, Santa Clara Brief Compassion Scale, and Self-Compassion Scale-Short Form. After data collection, descriptive statistics and stepwise regression were applied for data analysis. A total of 128 nurses and 42 physicians completed the survey. The mean score for palliative care self-efficacy was 27.6 ± 10.6 out of 48. The results indicated that compassion for others, self-compassion, and palliative care knowledge explained 17.8% of health care professionals' self-efficacy levels. This study supports the positive relationship between self-efficacy, compassion for others, and self-compassion among health care professionals, underscoring the need for incorporating compassion training into the curriculum and the training program.

Demoralization Syndrome in End-Of-Life Cancer Patients: A Qualitative Study

ObjectivesIn our previous study we analyzed the prevalence of demoralization in a sample of 235 end-of-life cancer patients using the Demoralization Scale (DS). The findings revealed that 50.2% of the participants reported experiencing a moderate level of demoralization. The main sub-dimensions observed from the original DS were Helplessness, Disheartenment, and Sense of Failure, which we have categorized as "Emotional Distress and Inability to Cope". The aim of this study was to qualitatively investigate the subjective experience of this factor among a group of terminal cancer patients.MethodA sample of 30 patients was interviewed using seven open-ended questions, divided into 3 categories: helplessness, disheartenment and sense of failure. Content analysis was performed.ResultsFaith and prayer, social support and preserving autonomy were the principal coping strategies used by the sample and have been classed as sources of hope. Sadness, anger, death anxiety, fear, and sickness were the most commonly expressed emotions. Faith, social support, autonomy, and fighting spirit were identified as the primary coping strategies.ConclusionsThis study allowed a better understanding of the patient's subjective experience of the demoralization sub-dimension. The deepening of the topic can increase personalized clinical interventions, according to the patient's needs.

The relationship between compassion competence, caring behaviours, and professional commitment among nursing students: a cross-sectional study

BACKGROUND AND OBJECTIVE

compassion plays a crucial role in providing high-quality healthcare. In recent years, there has been a growing emphasis on compassion and compassion competence within the nursing and healthcare professions. Training and developing compassion competence in nursing students is an essential aspect of the educational process to ensure these skills are effectively applied in clinical interactions. This study aims to assess the level of compassion competence among nursing students and explore its relationship with caring behaviours and professional commitment.

METHODOLOGY

This cross-sectional study was conducted on nursing students at Tabriz Faculty of Nursing and Midwifery from Sep to Dec 2023. A total of 200 nursing students were selected by random sampling method using Random Number Generator software. Data were collected by Compassion Competence Scale, Caring behaviours Scale, and Professional Commitment Scale. Data analysis was done by SPSS ver. 26 software.

FINDINGS

The results indicated that the mean total score of compassion competence was 4.02 ± 0.50 out of 5. The higher mean score (4.16 ± 0.63) belonged to the sensitivity domain and the lower score (3.84 ± 0.66) belonged to the insight domain. Furthermore, the mean score for caring behaviours was 121.03 ± 14.88 from a maximum possible score of 144, and the average score for professional commitment was 71.12 ± 13.13 out of 104. The results showed a significant positive relationship between students' compassion competence and caring behaviours (r = 0.70, p < 0.001), compassion competence and professional commitment (r = 0.41, p < 0.001) and between caring behaviours and professional commitment (r = 0.48, p < 0.001).

CONCLUSION

The findings highlight the essential role of developing compassion within nursing education. By strengthening students' compassion skills, educational institutions can enhance patient care quality and promote professional commitment among future nurses. Employing compassion focused strategies to nurture this competence in nursing students will result in a more empathetic and committed nursing workforce, benefiting both healthcare providers and patients.

Cultivating compassion in care: evaluating a compassion-training intervention and exploring barriers to compassionate care in postgraduate medical education in Pakistan: a mixed-methods study

BACKGROUND

Compassionate patient care is essential for improving patient outcomes and enhancing healthcare experience. However, in lower-middle-income countries (LMICs) like Pakistan, systemic barriers and a lack of structured curricula hinder its consistent delivery. This study evaluates a targeted compassion-training intervention for residents in a tertiary care hospital and explores barriers to its implementation. Given shared challenges like resource constraints, high patient loads, and gaps in formal training, these findings have broader implications for integrating structured compassion-based education across LMICs.

METHODS

This quasi-experimental mixed-methods study was conducted with first-year residents over a one-year period (November 2023 - October 2024). A 4-hour compassion-training session was delivered to develop compassion as a clinical competency. Quantitative data on satisfaction and self-reported compassion competence were collected using the Sinclair Compassion Questionnaire-Healthcare Provider Competence Self-Assessment (SCQ-HCPCSA) and analyzed via paired t-tests. Qualitative data from focused group discussions (FGDs) exploring barriers and facilitators underwent thematic analysis.

RESULTS

204 residents participated. Baseline compassion competence was 4.03 ± 0.54, with no demographic variations (p > 0.05). Participants rated sessions highly for interest (4.54 ± 0.65), relevance (4.50 ± 0.82), and interactivity (4.68 ± 0.61). Post-training, compassion competence significantly improved to 4.58 ± 0.47 (p < 0.001), with all SCQ-HCPCSA items showing significant improvements (p < 0.001). Qualitative findings revealed key barriers to practicing compassionate care, including time constraints, high workloads, and compassion fatigue, particularly in high-pressure specialties like surgery and intensive care. Institutional factors like documentation inefficiencies, financial pressures, and hierarchical workplace culture also limit compassionate care delivery. Culturally specific challenges emerged, including language barriers, differences in patient expectations, and perceptions of compassion as a transactional service in a largely out-of-pocket healthcare system. Facilitators of compassionate care included interdisciplinary collaboration, supportive senior staff, and effective communication strategies.

CONCLUSIONS

Targeted compassion-training interventions can enhance compassionate care among physicians. To ensure long-term impact, postgraduate medical education programs should formally integrate structured curricula, alongside institutional policy reforms that reduce administrative burdens and promote interdisciplinary collaboration. Future studies should explore long-term retention of training effects and assess scalability of similar curricula across diverse healthcare settings, particularly in other lower-middle-income countries.

TRIAL REGISTRATION

Not applicable.

Enhancing compassion in medical education - a comparative study of the efficacy of clinical clerkships versus simulation-based training methodologies

BACKGROUND

Compassionate behavior plays a crucial role in medicine by fostering patient-doctor relationships, enhancing adherence, and improving care quality. While partly innate, compassion can be significantly enhanced through structured educational interventions. Despite recent efforts to integrate compassion into medical curricula, methodological challenges persist, especially in understanding how different environments influence skill expression and development. This study aims to assess the effectiveness of traditional clinical clerkships versus simulation-based training in cultivating compassion skills among medical students.

METHODS

This retrospective longitudinal study evaluated the professional behavior and cognitive skills of 133 medical students at Humanitas University, Milan, Italy, over a three-year period from 2021 to 2024. The curriculum emphasizes problem-based learning and professional development through hospital clerkships and simulation-based training. Compassion was assessed quarterly using a standardized scorecard and continuously evaluated via a learning management system, simulation scenarios and objective structured clinical examinations (OSCEs).

RESULTS

In the initial assessment, compassion scores showed no significant difference between the two settings (clerkship: 3.25 ± 0.73, simulation: 3.30 ± 0.69, p = 0.45). Over subsequent evaluations taking place in the following two years, the differences remained non-significant (p = 0.39, p = 0.22) until a notable divergence was observed in later assessments, particularly in the final evaluation at the end of 5th year study (clerkship: 3.54 ± 0.78, simulation: 3.23 ± 1.18, p = 0.023). Clerkship students demonstrated a significant increase in compassion scores over time (+ 0.29, p = 0.023), benefiting from immersive patient interactions that deepened their compassionate behavior. In contrast, simulation scores peaked slightly but not significantly in Year 4 before returning to initial levels (-0.07, 95% CI [-0.24, 0.11]), highlighting the challenge of sustaining compassionate behaviors without ongoing real-world practice.

CONCLUSION

This study emphasizes the crucial role of deliberate curriculum design in medical education. While simulation-based training offers controlled environments, it incompletely replicates the emotional depth of real patient interactions crucial for sustaining compassion. Integrating compassion-focused training into medical curricula is essential for nurturing compassionate healthcare professionals, urging immediate action to enhance compassion in medical education.

TRIAL REGISTRATION

Not applicable. No health intervention has been proposed, and it's a purely retrospective analysis on an educational methodology.

Beyond base pairs: Using simulation to build genomic competency in pediatric nurse practitioners

Genomics is a lifespan competency that has relevance for pediatric nursing practice. Identifying individuals who could benefit from genomic healthcare can enable timely diagnosis and treatment to improve health and wellbeing outcomes. Nurse practitioners (NPs) must have genomic competency to provide high quality, comprehensive pediatric care and support families through the continuum of care. To date, integrating genomics into nursing curricula has been inconsistent and piecemeal. We describe the structure, process, and initial outcomes of a novel genomic nursing simulation for pediatric NP students that uses Turner syndrome and Fragile X as exemplar cases.

Having a More Compassionate Doctor Does Not Mean Patients Will Feel More Cared for: An Empirical Study

BACKGROUND

Compassion is central to healthcare. It is valued by both patients and physicians and predicts better outcomes for patients, physicians, and healthcare organisations. Whilst most studies to date have focused on providers' expression of compassion, the current report was designed to focus on the patient, specifically identifying patient and physician variables predicting the patient experience of compassion from physicians.

OBJECTIVES

To identify the predictors of patient experience of compassion.

DESIGN

An anonymous cross-sectional online survey study conducted in Aotearoa New Zealand.

PARTICIPANTS

One thousand sixty-five patients were recruited from the community, followed by the recruitment of 219 physicians based on patients' referrals.

MAIN MEASURE

Patient experience of physician compassion.

KEY RESULTS

Patient-level predictors only explained 1.7% and physician-level 2.9% of the variance in patient experience of compassion (PEC). Patient age (β = 0.08, p < 0.05) and being diagnosed with serious chronic illness (β = 0.08, p < 0.05) predicted reports of greater compassion from physicians, whereas better self-reported health (β = - 0.12, p < 0.01) predicted less. Patients reported experiencing greater compassion when physicians were younger (β = - 0.15, p < 0.05), but physician trait compassion was unrelated (p > 0.05) and reports of physician behaviours that should signal compassion were only marginally significant (p = 0.06).

CONCLUSIONS

Our data highlight how little is known about the patient experience of compassion and imply that the patient experience of compassion may or may not be related to physician compassion. Consequently, we need to supplement our ongoing study of the origins and determinants of compassion in healthcare providers with an equally systematic, rigorous, and empirically based study of the patient experience of compassion from providers.

Teaching empathy and compassion to healthcare providers in palliative care: a scoping review

Empathy and compassion are core competencies that healthcare providers (HCPs) require when caring for patients and families with life-threatening illnesses like cancer. These constructs are often challenging to define and generalise and are often used interchangeably. Medical education has evolved from the traditional curriculum-based approach to a more eclectic competency-based approach. The purpose of this review is to explore the current evidence on teaching compassionate care for palliative care issues in cancer settings in lower-middle-income countries. A preliminary search of the Scopus database from 2,000 until now identified 1,502 records, of which 54 peer-reviewed articles were included in this review. Training in compassion and empathy was delivered in three formats: online, face-to-face and blended learning or hybrid. The training modalities were didactic, experiential and reflective, with many educational interventions using a multimodal approach. The educational interventions reported a positive outcome and improvement in empathetic and compassionate behaviours. However, they were limited due to inadequately defined constructs, use of self-reported outcome measures and difficulty in ascertaining if these skills were retained long-term and were translated into the clinical settings. Given that compassion and empathy are multidimensional constructs, it is imperative that educational interventions be multimodal and learner-centred, focusing on developing the knowledge, attitudes, skills and behaviours of the HCP in providing compassionate care while aiming for conceptual clarity regarding definition and more robust validated outcome measures.

Mechanisms of change in compassion-based programs for medical students

Medical practice exposes physicians to numerous stressors, leading to high rates of psychological distress and burnout, a problem that begins during medical school. Scientific evidence suggests that promoting compassion among physicians could improve their well-being and promote patient-centered care. However, the mechanisms underlying these benefits remain unclear. This study aimed to examine the mediators and moderators of changes in psychological distress and well-being following Compassion Cultivation Training (CCT) among medical students. A randomized controlled trial with 40 medical students assigned to an 8-week CCT program or a waitlist control group was conducted. Participants were assessed at pre-intervention, post-intervention, and a 2-month follow-up on measures of psychological distress, well-being, mindfulness, compassion, emotion regulation, and burnout. Results indicated that CCT led to significant reductions in stress and anxiety immediately after the program, mediated by improvements in emotion regulation and mindfulness skills. Gender moderated changes in stress, anxiety, depression, and well-being at post-intervention, with women benefiting more than men, though these differences were not sustained at follow-up. In conclusion, this study contributes to the growing body of literature on the benefits of compassion training in healthcare and provides insights into the mechanisms through which compassion could support physicians and medical students.

The impact of compassion-based interventions on perioperative anxiety and depression: A systematic review and meta-analysis

BACKGROUND

The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients.

METHODS

A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information.

RESULTS

The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations.

LIMITATIONS

Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis.

CONCLUSIONS

Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences.

Healthcare compassion interventions co-design and feasibility inquiry with clinicians and healthcare leaders in Aotearoa/New Zealand

Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power.

Compassion in Italian palliative care: Investigating healthcre professionals' perspectives using focus groups

Compassion, a complex response aimed at alleviating suffering, plays a crucial role in healthcare professionals' (HCPs) patient care, especially in palliative settings. This study explored compassion in Italian palliative care HCPs using focus groups. A total of 52 palliative care HCPs participated in this study across five focus groups. The transcripts of the discussions were subjected to content analysis. Compassion emerged as "being with someone," a relational dimension deeply influenced by various factors, including patients, caregivers, work environment, and HCPs themselves. While often perceived as innate, the participants expressed their potential to be nurtured through training and group discussions. Compassion is integral to the HCP-patient relationship, shaped by multifaceted aspects. These findings emphasize the importance of cultivating and enhancing compassion through training and group discussions.

The Mediation Impact of Compassion Competence on the Link Between Mindfulness and Job Burnout in Nurses: A Cross-Sectional Study

AIMS

This study explores the link between mindfulness, compassion competence and job burnout among nurses, and analyses the mediating role that compassion competence plays in this relationship.

BACKGROUND

Understanding nurses' mindfulness, compassion competence and job burnout is important, which could help devise interventions to relieve burnout in clinical nurses.

METHODS

This study adopts convenience sampling method and descriptive design quantitative research. A cross-sectional study of 513 nurses was conducted from June to October 2023 in mainland China. The Socio-demographic Questionnaire, Mindful Attention Awareness Scale, Maslach Burnout Inventory-Human Service Survey and Compassion Competence Scale for the Nurses were utilised to gather basic demographic information on nurses and to evaluate their level of mindfulness, compassion competence and job burnout. Descriptive statistics, Spearman's correlation analyses and structural equation model were used to analyse the data.

RESULTS

Five hundred and thirteen valid questionnaires were gathered. Spearman's correlation analysis revealed a strong negative link between mindfulness and job burnout, and between compassion competence and burnout, and a significant positive correlation between mindfulness and compassion competence. The results of the mediation analysis revealed that the relationship between mindfulness and job burnout was partially mediated by compassion competence, and the mediating effect accounted for 18.6% of the total effect.

CONCLUSION

Compassion competence performed as a partial mediator between mindfulness and job burnout among nurses. Nursing managers could enhance nurses' mindfulness level and compassion competence through Mindfulness interventions and Compassion training to reduce their burnout.

RELEVANCE TO CLINICAL PRACTICE

This study offers a fresh viewpoint on enhancing clinical nurses' compassion competence and reducing job burnout. Healthcare organisations and medical institutions can mitigate nurses' job burnout by improving their mindfulness levels and compassion competence.

REPORTING METHOD

The study used the STROBE checklist for reporting.

PATIENT OR PUBLIC CONTRIBUTION

All participants were nurses who completed an electronic questionnaire related to this study.

A call to action: Re-activating the latent human factor for achieving the UN SDGs-cultivating courageous partnerships and compassionate human systems

The raison d'être for psychotherapy1 is to address individual suffering and distress. The sustainable development goals address suffering and distress on a global scale in the context of threats to the survival of our communities and planet.

OBJECTIVE

We propose scaling up therapeutic principles for collective impact and nurturing therapist commitment beyond the therapy room, to activate and sustain compassion-in-action at the community system level.

DESIGN

The SDGs represent the strength of collective human concern and action coming together. At the half-way point, we are falling dangerously short of our targets, requiring an urgent response. The tenet of this paper is that the weakest link in our journey is not technical capability or finances, or even the impact of multiple intersecting crises, but our ability to collaborate for sustained action-it is the human factor-hence, we need a psychologically informed response.

METHOD

Notably, least 'visible' is SDG17, the umbrella goal designated means of implementation, through partnership. Partnership has been treated as a transactional element of SDG projects, rather than the vital heartbeat connecting daily actions to the 2030 vision. Partnership is about investing in relationships and a commitment to working together with a common purpose-the bailiwick of psychological therapists.

RESULTS

We propose an architecture to support the development of courageous partnerships and compassionate systems.

CONCLUSION

Compassion uniquely potentiates global action on wicked problems.

Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study

BACKGROUND

Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally.

OBJECTIVE

The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine.

METHODS

We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically.

RESULTS

A total of 19 participants were interviewed-8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care.

CONCLUSIONS

Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings.

Developing care behaviors and ethical attitude in nursing education

AIM

This study aims to determine the effect of education based on the Theory of Human Caring on nursing students' caring behaviors and ethical attitudes.

BACKGROUND

It is crucial to plan nursing education holistically, addressing cognitive, psychomotor and affective domains for the comprehensive development of caring behaviors and ethical attitudes.

DESIGN

This study employed a convergent mixed-methods approach with randomized pretest-posttest comparisons and qualitative analysis.

METHODS

This study was conducted with third-year nursing students at a state university in Ankara, Turkey, in 2021. It comprised a total of 95 participants, with 47 students in the case group and 48 students in the video group. Theoretical education based on the Theory of Human Caring was simultaneously provided to both groups. Following this, one group received practical training using a video-supported teaching method, while the other group received it through a case analysis method. The research used the 'Descriptive Characteristics Form', 'Caring Nurse Patient Interaction Scale (CNPIS)', 'Scale for Attitudes of Ethical Principles (SAEP)' and 'Student Opinion Form on Care Behaviors Education' to collect data. Quantitative data were analyzed using t-tests, Mann-Whitney U tests, Wilcoxon paired two-sample tests and Linear Regression Analysis, with a significance level of p<0.05. Qualitative data were evaluated through document analysis. Permissions were obtained before the research.

RESULTS

After the education provided, significant differences were found between the pre-test and post-test scores of both groups (p<0.05). It was determined that there was a statistically significant, positive and generally moderate relationship between the caring behaviors and ethical attitudes of the students. Additionally, participating students reported that they were satisfied with the education provided, stating that the teaching methods increased their motivation and positively influenced their perspectives on caring and its ethical dimensions.

CONCLUSIONS

The research findings show significant improvements in nursing students' care behaviors and ethical attitudes following education based on the Human Care Theory, with both case analysis and video-supported teaching methods yielding notable results. Integration of care theories into the nursing undergraduate curriculum, alongside the use of holistic teaching methods, is recommended, along with further randomized controlled trials to assess teaching effectiveness.

Compassionate care through the eyes of patients and physicians: An interview study

BACKGROUND

Although compassion is a crucial element of physicians' professional performance and high-quality care, research shows it often remains an unmet need of patients. Understanding patients' and physicians' perspectives on compassionate care may provide insights that can be used to foster physicians' ability to respond to patients' compassion needs. Therefore, this study aims to understand how both patients and physicians experience the concept and practice of compassionate care.

METHODS

We conducted semi-structured interviews with eight patients and ten resident physicians at a University Medical Center in the Netherlands. Using thematic analysis, we separately coded patient and resident transcripts to identify themes capturing their experiences of compassionate care. This study was part of a larger project to develop an educational intervention to improve compassion in residents.

RESULTS

For both patients and residents, we identified four themes encompassing compassionate care: being there, empathizing, actions to relieve patients' suffering, and connection. For residents, a fifth theme was professional fulfillment (resulting from compassionate care). Although patients and residents both emphasized the importance of compassionate care, patients did not always perceive the physician-patient encounter as compassionate. According to residents, high workloads and time pressures hindered their ability to provide compassionate care.

DISCUSSION AND CONCLUSION

Patients and residents have similar and varying understandings of compassionate care at the same time. Understanding these differences can aid compassion in medical practice. Based on the findings, three topics are suggested to improve compassion in residents: (1) train residents how to ask for patients' compassion needs, (2) address residents' limiting beliefs about the concept and practice of compassion, and (3) acknowledge the art and science of medicine cannot be separated.

More Than Maintaining Competence: A Qualitative Study of How Physicians Conceptualize and Engage in Lifelong Learning

Purpose

Physicians have a professional responsibility to engage in lifelong learning. Some of this lifelong learning is required to maintain licensure and certification. Yet, this conceptualization captures only a small portion of the content areas and learning processes that physicians need to engage with to ensure quality patient care. Additionally, purposes beyond regulatory requirements and professional obligations likely drive physicians lifelong learning, though these purposes have not been explored. Given the centrality of lifelong learning to quality patient care, our study explores how physicians conceptualize and engage in lifelong learning.

Method

We conducted a qualitative interview study using an interpretivist approach. In 2019, we recruited 34 academic physicians from one institution. We analyzed our data to identify themes related to conceptualization of purposes, content areas, and processes of lifelong learning and actual lifelong learning practices.

Results

We interpreted participants' descriptions and examples of lifelong learning as serving three purposes: maintaining competence, supporting personal growth and fulfillment, and engaging in professional stewardship. Much of participants' discussion of lifelong learning centered around keeping up to date with medical knowledge and clinical/procedural skills, though some also mentioned efforts to improve communication, leadership, and teamwork. Participants engaged in lifelong learning through contextual, social, and individual processes.

Discussion

Academic physicians engage in lifelong learning for reasons beyond maintaining competence. Medical knowledge and clinical/procedural skills receive most attention, though other areas are recognized as important. Our findings highlight opportunities for a broader, more comprehensive approach to lifelong learning that spans all areas of medical practice.

An evaluation of mindful clinical congruence in medical students after course-based teaching

Purpose

We questioned whether an intensive experiential core course would change medical students' intention to practice mindful clinical congruence. Our primary hypothesis was that we would see more of a change in the intention to practice mindful clinical congruence in those who had taken versus not yet taken our course.

Methods

From a class of 179 in second year we recruited 57 (32%) students who had been already divided into three groups that completed the course in successive periods. We measured mindful clinical congruence using a questionnaire developed and evaluated for validity. We also measured students' level of stress to determine if any effects we saw were related to stress reduction.

Results

Students who had just completed the course showed a greater intention to practice mindful clinical congruence than students who had not yet started the course. There was an apparent slight increase in perceived stress in those who had completed our course.

Conclusions

We can change students' intention to practice mindfully and congruently, which we believe will prevent a decline in compassion and ethical values in clerkship. The results did not appear to be explained by a decrease in stress in students who completed the course.

The initial validation of an Evidence-informed, competency-based, Applied Compassion Training (EnACT) program: a multimethod study

INTRODUCTION

Compassion is positively associated with improved patient outcomes, quality care ratings, and healthcare provider wellbeing. Supporting and cultivating healthcare providers' compassion through robust and meaningful educational initiatives has been impeded by a lack of conceptual clarity, inadequate content coverage across the domains of compassion, and the lack of validated evaluation tools. The EnACT program aims to address these gaps through an Evidence-informed, competency-based, Applied, Compassion Training program delivered to healthcare providers working in various clinical settings. In this study, we describe the development and initial validation of the program, which will inform and be further evaluated in a forthcoming Randomised Controlled feasibility Trial (RCfT).

METHOD

A multimethod design was used to explore learner needs, experiences, and outcomes associated with the program. Pre- and post-training surveys and qualitative interviews (1 month post training) were conducted among twenty-six healthcare provider learners working in acute care and hospice. Quantitative measures assessed professional fulfillment/burnout, self-confidence in providing compassion, learner satisfaction, and compassion competence. Qualitative interviews explored learners' experiences of the program, integration of learnings into their professional practice, and program recommendations.

RESULTS

Learners exhibited relatively high self-assessed compassion competence and professional fulfillment pre-training and low levels of burnout. Post-training, learners demonstrated high levels of compassion confidence and satisfaction with the training program. Despite high levels of reported compassion competence pre-training, a statistically significant increase in post-training compassion competence was noted. Thematic analysis identified five key themes associated with learners' overall experience of the training day and integration of the learnings and resources into their professional practice: (1) A beginner's mind: Learner baseline attitudes and assumptions about the necessity and feasibility of compassion training; (2) Learners' experiences of the training program; (3) Learner outcomes: integrating theory into practice; (4) Creating cultures of compassion; and (5) Learner feedback.

CONCLUSION

Findings suggest that the EnACT program is a feasible, rigorous, and effective training program for enhancing healthcare provider compassion. Its evidence-based, patient-informed, clinically relevant content; interactive in class exercises; learner toolkit; along with its contextualized approach aimed at improving the clinical culture learners practice holds promise for sustaining learnings and clinical impact over time-which will be further evaluated in a Randomized Controlled feasibility Trial (RCfT).

Compassion in health professionals: Development and validation of the Capacity for Compassion Scale

BACKGROUND

Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS).

DESIGN

A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity).

METHODS

The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation.

RESULTS

The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience.

CONCLUSIONS

The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field.

IMPACT

Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT PROBLEM DID THE STUDY ADDRESS?: Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. WHAT WERE THE MAIN FINDINGS?: A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

The pattern theory of compassion

Concepts of empathy, sympathy and compassion are often confused in a variety of literatures. This article proposes a pattern-theoretic approach to distinguishing compassion from empathy and sympathy. Drawing on psychology, Western philosophy, affective neuroscience, and contemplative science, we clarify the nature of compassion as a specific pattern of dynamically related factors that include physiological, cognitive, and affective processes, relational/intersubjective processes, and motivational/action tendencies. We also show that the dynamic nature of the compassion pattern is reflected in neuroscientific findings, as well as in compassion practice. The pattern theory of compassion allows us to make several clear distinctions between compassion, empathy, and sympathy.

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

BACKGROUND

The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

METHODS

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

RESULTS

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

DISCUSSION

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Adaptive Mentoring Networks and Compassionate Care: A Qualitative Exploration of Mentorship for Chronic Pain, Substance Use Disorders and Mental Health

This study undertook an exploration of how Adaptive Mentoring Networks focusing on chronic pain, substance use disorders and mental health were supporting primary care providers to engage in compassionate care. The study utilised the Cole-King & Gilbert Compassionate Care Framework to guide qualitative semi-structured interviews of participants in two Adaptive Mentoring Networks in Ontario, Canada. Fourteen physician participants were interviewed including five mentors (psychiatrists) and nine mentees (family physicians) in the Networks. The Cole-King & Gilbert Framework helped provide specific insights on how these mentoring networks were affecting the attributes of compassion such as motivation, distress-tolerance, non-judgement, empathy, sympathy, and sensitivity. The findings of this study focused on the role of compassionate provider communities and the development of skills and attitudes related to compassion that were both being supported in these networks. Adaptive Mentoring Networks can support primary care providers to offer compassionate care to patients with chronic pain, substance use disorders, and mental health challenges. This study also highlights how these networks had an impact on provider resiliency, and compassion fatigue. There is promising evidence these networks can support the "quadruple aim" for healthcare systems (improve patient and provider experience, health of populations and value for money) and play a role in addressing the healthcare provider burnout and associated health workforce crisis.

Intensive care nurses' compassion and patience levels and their attitude towards elderly people

Backgrounds

Intensive care nurses' attitudes towards the elderly and their emotional readiness before giving care can have an impact on the quality of care.

Aims

The objective of this study was to investigate intensive care nurses' compassion and patience levels and their attitude towards elderly people.

Methods

'Data Gathering Form', the 'Compassion Competence Scale', the 'Patience Scale and the University of California at Los Angeles Geriatrics Attitude (UCLA-GA) were used.

Results

A total of 212 intensive care nurses participated in the study. It was found that nurses whose time working in the intensive care unit and total professional experience were 6 years or more and those who were married and had children had higher levels of both compassion and patience. In addition, patience levels were significantly higher in nurses aged 29 or more. It was found that the nurses' sociodemographic and professional characteristics did not affect their UCLA-Geriatrics Attitudes total score.

Conclusion

It was found in the study that there was a significant positive correlation between the nurses' compassion and patience levels and their attitudes toward elderly people.

Measures of empathy and compassion: A scoping review

Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.

Compassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran

BACKGROUND

Compassionate care is the main indicator of the quality regarding nursing care. The importance of this care in the recovery process for the elderly hospitalized for COVID-19 has been under-researched in studies. Therefore, this study aimed to determine the compassionate care level of nurses to the elderly hospitalized in the COVID-19 wards of teaching hospitals in the south of Iran.

METHODS

This descriptive-analytical study was conducted on 212 nurses working in the COVID-19 wards of teaching hospitals in the south of Iran, who were selected through census in a cross-sectional study. The data were collected using the Tehranineshat et al. nurses' compassionate care questionnaire and then the data were analyzed using descriptive and analytical statistics along with SPSS software version 22.

RESULTS

The mean score of nurses' compassionate care was 130.18 ± 9.42, which was at a high level. The highest and lowest scores were related to professional performance (43.17 ± 2.799) and empathic communication dimension (27.76 ± 2.970). No significant relationship was found between variables such as gender, marital status, education, work experience, and job position with the compassionate care score (P > 0.05).

CONCLUSION

Nurses providing care for hospitalized elderly are recommended to consider all aspects of compassionate care, especially empathic communication, in their educational planning.

Patient's views of empathic and compassionate healthcare interactions: A scoping review

BACKGROUND

Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients.

OBJECTIVE

The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions.

METHOD

This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion.

RESULTS

Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare.

CONCLUSION

Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.

Physicians' Lived Experience of Breaking Bad News in Clinical Practice: Five Essentials of a Relational Process

The purpose of this study was to develop deeper knowledge about physicians' lived experiences of breaking bad news by identifying their common meanings and interrelatedness along with their potential alignment with process-oriented and relational aspects. Based on the methodology of descriptive phenomenology, in-depth interviews were conducted with 22 physicians from a wide variety of specialties. The participants were invited to freely reflect upon their experiences of breaking bad news by describing situations that had worked well and less well. Results showed that breaking bad news was fundamentally experienced as a relational process constituted by the five essentials of Becoming the bad messenger, Expecting the unpredictable, Being on stage, Professionally managing hope, and Mindfulness of the emotional relationship. In line with recent research, this study confirms that clinical communication involves much more than just delivering the message. However, it also contributes to existing knowledge by focusing on the phenomenology of physicians' experiences, which enables deeper understanding of the medical profession and the relational process of breaking bad news. As such, our findings are important to enable broader learning in, for example, medical education and continuing courses for clinical staff.

Exploring the impact of a compassion-oriented training program on personal care workers in a nursing home: A mixed-methods pilot study

This pilot study aimed to explore the impact of a compassion-oriented training program on Personal Care Workers (PCWs) in a nursing home. A mixed-methods approach was used, including pre- and post-questionnaire surveys to measure changes in compassion, and in-depth interviews and daily diaries to explore PCWs' perceptions and experiences. A convenience sample of five female PCWs from a nursing home in Hong Kong participated in the study. The quantitative results showed that the PCWs experienced a decline in compassion after participating in the program. The qualitative data analysis identified three themes: (1) the multifaceted nature of compassion, (2) barriers and threats to compassion, and (3) transfer of skills at the workplace. Overall, These findings highlighted the complexity of implementing effective compassion training programs in nursing home, and emphasized the importance of recognizing the multifaceted nature of compassion and addressing barriers and threats to compassion in the workplace.

The Language of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression via Other-Oriented, Inclusive Language

Objectives

Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes.

Methods

Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation.

Results

We found that compassion capacity was significantly associated with chaplains' LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language.

Conclusions

These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review

Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.

Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners

Background

Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.

Objectives

This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.

Methods

Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software.

Results

Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.

Discussion

Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

A compassion-based program to reduce psychological distress in medical students: A pilot randomized clinical trial

OBJECTIVES

Physicians and medical students are subject to higher levels of psychological distress than the general population. These challenges have a negative impact in medical practice, leading to uncompassionate care. This pilot study aims to examine the feasibility of Compassion Cultivation Training (CCT) to reduce psychological distress and improve the well-being of medical students. We hypothesize that the CCT program, as compared to a waitlist control group, will reduce psychological distress (i.e., stress, anxiety, and depression) and burnout symptoms, while improving compassion, empathy, mindfulness, resilience, psychological well-being, and emotion-regulation strategies after the intervention. Furthermore, we hypothesize that these improvements will be maintained at a two-month follow-up.

METHODS

Medical students were randomly assigned to an 8-week CCT or a Waitlist control group (WL). They completed self-report assessments at pre-intervention, post-intervention, and a 2-month follow-up. The outcomes measured were compassion, empathy, mindfulness, well-being, resilience, emotional regulation, psychological distress, burnout, and COVID-19 concern. Mixed-effects models and Reliable Change Index were computed.

RESULTS

Compared with WL, CCT showed significant improvements in self-compassion, mindfulness, and emotion regulation, as well as a significant decrease in stress, anxiety, and emotional exhaustion component of burnout. Furthermore, some of these effects persisted at follow-up. No adverse effects of meditation practices were found.

CONCLUSIONS

CCT enhanced compassion skills while reducing psychological distress in medical students, this being critical to preserving the mental health of physicians while promoting compassionate care for patients. The need for institutions to include this type of training is also discussed.

What influences dental students' attitudes regarding the treatment of older adults? A scoping review

PURPOSE

The aim of this study is to investigate the literature to evaluate dental students' attitudes regarding the treatment of older adults.

METHODS

A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses/PRISMA guidelines to identify articles from four electronic databases: MEDLINE via the PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Gray literature searches were also performed in Scopus, Web of Science, and ProQuest Dissertations and Theses-Health and Medicine.

RESULTS

Eleven articles were assessed. The majority (72, 72%) were published between 2011 and 2020, evidencing various contexts of dental students, such as different countries and cultures, and levels of education. The most commonly used tool/instrument to survey dental students' attitudes was the Aging Semantic Differential Scale. Student age, race, and marital status did not seem to interfere with dental students' attitudes regarding the treatment of older adults.

CONCLUSIONS

Dental students tend to have a positive attitude toward older people. In this context, female students, students who interact with older people, and clinical students have more positive attitudes than male and nonclinical students.

Fostering an affiliative environment in residential youth care: A cluster randomized trial of a compassionate mind training program for caregivers enrolling youth and their caregivers

BACKGROUND

Affiliation has a positive role on well-being and human development. Most children and youth living in residential youth care (RYC) experienced maltreatment from significant others, becoming a particularly vulnerable group. Their complex needs require well trained caregivers who help them to heal and thrive.

OBJECTIVE

This cluster randomized trial sought to test the Compassionate Mind Training program for Caregivers (CMT- Care Homes) effectiveness on affiliative outcomes across time.

PARTICIPANTS AND SETTING

A sample of 127 professional caregivers and 154 youth from 12 Portuguese residential care homes (RCH) participated on this study.

METHODS

RCHs were randomized to treatment (n = 6) and control (n = 6) groups. Caregivers and youth completed self-report measures at baseline, post-intervention, and 6-month follow-up on social safeness and emotional climate. Caregivers were also evaluated on compassion outcomes.

RESULTS

MANCOVA indicated large multivariate time X group effects. Univariate results suggested that caregivers from the treatment group showed improvements in compassion towards others and in self-compassion across time, while the control group gradually deteriorated in both variables. Youth and caregivers from the treatment group noticed a more soothing and safer RCH emotional climate, as well as feeling safer within relationships. At 6-month follow-up, improvements were retained by caregivers, but not by youth.

CONCLUSIONS

The CMT- Care Homes brings a new model to RYC, that represents a promising approach in promoting safe relationships and affiliative environments in RCHs. Supervision should be provided to monitor care practices and sustain change across time.

Social responsiveness: The key ingredient to achieve social accountability in education and health care

While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each other in practice. Institutions must be truly socially accountable, which is possible if there is spontaneous SR to the needs, and is fueled by compassion. Compassion in this article is defined as a "feeling for other people's sufferings, and the desire to act to relieve the suffering." Compassion has a long history, whereas SA is more recently described concept that follows the historical development of social justice. SR is the moral or ethical duty of an individual to behave in a way that benefits society. Not everyone feels the need to do something for others. Even if the need is felt, there may be a lack of will to act for the needs or to act effectively to fulfill the needs of society. The reasons are many, some visible and others not. SR provides the basis for being compassionate; hence, medical schools need to include SR as a criterion in their admissions process for student recruitment and inculcate compassion in health professions education and health care. By fostering SR and engaging compassion and self-compassion to achieve SA, we can humanize medical education systems and health care.

Value of Schwartz Rounds in promoting the emotional well-being of healthcare workers: a qualitative study

OBJECTIVES

Schwartz Rounds are forums that enable healthcare staff to reflect on emotional and social dimensions of their work. In this study, we aimed to explore the experiences of Schwartz Rounds on emotional aspects of care and practice within a clinical environment.

DESIGN

Using qualitative methods, we interviewed participants individually and in focus groups. Interviews were recorded, transcribed and analysed by thematic analysis.

SETTING

The study was based at a public health service Te Whatu Ora Counties Manukau in Auckland, New Zealand's largest, most ethnically diverse population.

PARTICIPANTS

Participants were panellists who took part in successive Schwartz Rounds over a 10-month period. There were 17 participants with a range of experience (1-30 years) and occupations including clinical, allied, technical and administrative staff from medical specialties of plastic surgery, pain services, emergency medicine, intensive care, organ donation services, COVID-19 response and palliative care services.

RESULTS

Three themes were identified: the need for emotional processing, valuing guided reflection and realising our humanity. The third theme 'realising our humanity' comprised altruism, connection and compassion. Schwartz Rounds provided staff with clear benefits: emotionally resonant experiences within an environment of psychological safety and connection to the wider organisation. The daunting nature of emotional disclosure was mitigated by a supportive audience.

CONCLUSION

There is an organisational imperative to ensure that staff have opportunities to process intense emotions associated with healthcare work. Schwartz Rounds are one means to attend to the emotional welfare of healthcare staff, enabling them to gain different perspectives in the care of their patients and colleagues within system constraints.

Teaching compassion for social accountability: A parallaxic investigation

BACKGROUND

In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement.

AIM

This paper explores the co-evolution of compassion and SA.

METHODS

The study used an arts integrated approach to investigate people's perceptions of SA in four medical schools across Australia, Canada, and the USA. Each school engaged approximately 25 participants who partook in workshops and in-depth interviews.

RESULTS

We began with a study of SA and the topic of compassion emerged out of our qualitative data and biweekly meetings within the research team. Content analysis of the data and pedagogical discussion brought us to realize the importance of compassion in the practice of SA.

CONCLUSIONS

The cultivation of compassion needs to play a significant role in a socially accountable medical educational system. Medical schools as educational institutions may operate themselves with compassion as a driving force in engaging partnership with students and communities. Social accountability without compassion is not SA; compassion humanizes institutional policy by engaging sympathy and care.

Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review

OBJECTIVE

Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS.

METHODS

Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings.

RESULTS

Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS.

CONCLUSIONS

A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.

Compassion, emotions and cognition: Implications for nursing education

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion.

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

Background

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored.

Objectives

The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare?

Materials and methods

A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice.

Results

Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships.

Conclusion

There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships.

Implications

In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

Program Leaders' and Educators' Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study

PHENOMENON

Training programs have been used to improve compassion in healthcare, but the factors necessary to make such programs successful and sustainable have not been identified. This thematic analysis aimed to bridge the gap between theory and practice by drawing on the experiences of international leaders and educators of compassion training programs to develop a clear understanding of what is relevant and effective and how compassion training is implemented and sustained.

APPROACH

International leaders and educators of compassion training programs (N = 15) were identified through convenience sampling based on academic and gray literature searches. Semi-structured face-to-face interviews with these participants were conducted between June 2020 and November 2020 in order to identify facilitators, barriers, and environmental conditions influencing the implementation and maintenance of compassion training programs. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

Six categories affecting the operationalization of compassion training programs were identified 1) origins, foundational principles and purpose, 2) curricular content, 3) methods of teaching and learning, 4) trainer qualities, 5) challenges and facilitators, and 6) evaluation and impact.

INSIGHTS

Compassion training should be rooted in the construct of interest and incorporate patients' needs and their experience of compassion, with patient-reported compassion scores integrated before and after training. Compassion training should be delivered by highly qualified educators who have an understanding of the challenges associated with integrating compassion into clinical practice, a dedicated contemplative practice, and a compassionate presence in the classroom. Prior to implementing compassion training, leadership support should be secured to create an ethos of compassion throughout the organization.

"Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease

Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.

Critical reflection on required service to the community propels prospective medical students toward higher empathy, compassion, and bias mitigation but are these gains sustainable?

Purpose

We observed increased cognitive empathy and reflective capacity scores when prospective medical students wrote critical reflections on mandatory team service-learning in a Medical Humanities course, but these findings did not include a control group. Here we compare these survey results in similar courses with and without required service-learning.

Methods

Forty-three prospective medical students completed a Medical Humanities course requiring critical reflection on team service-learning. In comparison, 32 students finished a similar course in which service to the community was not mandatory. Before starting the courses, students completed reliable surveys of their cognitive empathy and reflective capacity, and more than 93% of the students completed the same surveys after finishing the courses.

Results

Students' cognitive empathy and reflective capacity scores increased significantly when service-learning was required, but the scores did not increase significantly when service to the community was not required. The effect size for the empathy increase was of crucial practical importance (r = 0.50), whereas it was of moderate practical importance for the increase in reflective capacity (r = 0.34).

Conclusions

These and prior findings strongly support the conclusion that students' critical reflection on mandatory team service-learning fosters development of their cognitive empathy and reflective capacity. We present a model program to incorporate critical reflection on service to the community throughout the curricula of all healthcare professions trainees.

Compassion in healthcare: an updated scoping review of the literature

BACKGROUND

A previous review on compassion in healthcare (1988-2014) identified several empirical studies and their limitations. Given the large influx and the disparate nature of the topic within the healthcare literature over the past 5 years, the objective of this study was to provide an update to our original scoping review to provide a current and comprehensive map of the literature to guide future research and to identify gaps and limitations that remain unaddressed.

METHODS

Eight electronic databases along with the grey literature were searched to identify empirical studies published between 2015 and 2020. Of focus were studies that aimed to explore compassion within the clinical setting, or interventions or educational programs for improving compassion, sampling clinicians and/or patient populations. Following title and abstract review, two reviewers independently screened full-text articles, and performed data extraction. Utilizing a narrative synthesis approach, data were mapped onto the categories, themes, and subthemes that were identified in the original review. Newly identified categories were discussed among the team until consensus was achieved.

RESULTS

Of the 14,166 number of records identified, 5263 remained after removal of duplicates, and 50 articles were included in the final review. Studies were predominantly conducted in the UK and were qualitative in design. In contrast to the original review, a larger number of studies sampled solely patients (n = 12), and the remainder focused on clinicians (n = 27) or a mix of clinicians and other (e.g. patients and/or family members) (n = 11). Forty-six studies explored perspectives on the nature of compassion or compassionate behaviours, traversing six themes: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Four studies reported on the category of educational or clinical interventions, a notable decrease compared to the 10 studies identified in the original review.

CONCLUSIONS

Since the original scoping review on compassion in healthcare, while a greater number of studies incorporated patient perspectives, clinical or educational interventions appeared to be limited. More efficacious and evidence-based interventions or training programs tailored towards improving compassion for patients in healthcare is required.

Beyond empathy decline: Do the barriers to compassion change across medical training?

BACKGROUND

Despite being a mandated, foundational value in healthcare, research on compassion remains limited. Studying the individual, patient, clinical, and contextual factors that interfere with compassion-the "barriers"-may clarify our understanding of the origins of compassion and identify potential targets for improving patient-centred care. Studies of the related construct of empathy have suggested that medical students report declines with increasing clinical experience. In contrast, when comparing physicians with medical students, increased clinical experience predicts lower barriers to compassion. Whether-and how-a similar experience-related decline in the factors that interfere with compassion occurs across medical training remains unknown.

AIMS

To describe how the barriers to compassion vary across clinical training in medical students.

METHOD

New Zealand medical students (N = 351) in their clinical years (Years 4-6) completed measures of the Barriers to Physician Compassion (BPCQ) and potential covariates such as demographics, work burden factors, and dispositional factors. The BPCQ indexes the extent to which barriers in four domains (individual, patient, clinical, and contextual) interfere with a physician/student's compassion towards patients. Analyses of variance and regression analyses were used to explore the effect of year level on the four types of barriers.

RESULTS

Year 4 students reported slightly lower student-related, environmental and patient/family-related (but not clinical) barriers than Year 6 students (effect size: ɷ2 < 0.05); all barriers increased comparably across training. Controlling for relevant confounds, regression analyses confirmed that lower year level predicted lower barriers to compassion. Higher self-compassion, but not gender, predicted lower barriers.

CONCLUSIONS

In extending studies of empathy decline, this report suggests that students experience higher barriers to compassion as clinical training progresses. This is in contrast to existing studies contrasting physicians with medical students, where greater experience was associated with lower perceived barriers to compassion. Self-compassion may offset increases in barriers to care.

Cultivating Skillful Means of Care in Schools Through Compassion Practice and Individual and Joint Inquiry

Objectives

We examined the extent to which compassion practices helped guide skillful means of care among educators. We engaged educators in a collaborative design (co-design) process that foregrounded two components: (1) contemplative practice and (2) developing skill in how social interactions are embedded within wider systems through individual and joint inquiry. We analyzed the ways educators developed awareness of social suffering and set intentions to alleviate suffering. We examined how co-design fostered an understanding of compassion and new ideas about how to respond skillfully to suffering in schools.

Methods

Using qualitative methods, we analyzed data from educators who participated in co-design, including their written reflections, field notes, semi-structured interviews, and surveys.

Results

Educators identified multiple opportunities for acting with compassion, including approaching school-based interactions with compassion, cultivating compassion for themselves, and envisioning school change through a lens of compassion. Educators' experiences in co-design directly informed how they imagined compassionate action in their schools. Specific elements highlighted were contemplative practice, reflection, and individual and joint inquiry.

Conclusions

The adaptation of a general program on compassion training can benefit from attending to how to show compassion in the context of concrete interactions in schools, and this can support educators in developing skillful means of care. Our analyses provide insight into the components that supported educators to offer compassion and suggest that educators' skillful means of care can be cultivated through both contemplative practice and inquiry into social suffering. We offer a conceptual model for developing skillful means of care educational settings.