Study: Compassion and its importance in healthcare

A study published by the Journal of Pain and Symptom Management has conducted the first empirically based clinical model of compassion in the treatment of advanced cancer patients.

Compassion is an element of care often referred to as major indicator on the quality of care that patients receive. It is featured in the codes and ethics of major organizations such as the American Medical Association, where its codes states “a physician shall be dedicated to providing competent medical care with compassion and respect for human dignity and rights.” Yet the understanding of what constitutes true compassion to patients has gone unmeasured for too long.

Although the importance of compassion has been given credence across the entirety of the healthcare industry, there has been a significant lack of evidence of its reputation. Studies have shown compassion is what many patients and family members identify as the biggest indication of quality care, but most writings are theoretical and fail to incorporate the effects according to the patients who are receiving the compassion and care.

From May to December 2013, 53 patients were analyzed using face-to-face, semi-structured interviews to get a sense of how patients understand and experience compassion in their care. The sample was taken from a specialized palliative care unit and hospital-wide palliative care service within a large acute academic hospital in Canadia. Data was then analyzed using the Strauss and Corbin three stage approach to grounded theory.

Results yielded seven categories for compassion followed by specific themes to each of the categories. The model was able to produce a definition of compassion based on patient experiences as, “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.”

According to the study, the seven categories and themes of compassion are as follows:

1. Virtues: Patients showed that virtues were described as the “good or noble qualities embodied in the character of the health care provider.” Specifically, patients felt compassion stemmed from virtues of genuineness, love, honesty, openness, care, authenticity, understanding, tolerance, kindness and acceptance.
2. Relational Space: Defined as the “content of a compassionate encounter," relational space extended from acknowledging the patient illness to relating to them as a human being and actively engaging in their suffering.
3. Virtuous Response: The “enactment of a virtue toward a person in suffering” contained three broad themes within it: knowing the person, person as priority and beneficence.
4. Seeking to Understand: Patients wanted healthcare providers to prioritize them as individuals, to effectively “understand the person behind the disease.”
5. Relational Communicating: This was identified by patients consisting of “verbal and nonverbal displays of compassion conveyed through health care provider demeanor, affect, behavior and engagement with the person in suffering.”
6. Attending to Needs: Referring to “a timely and attuned desire to actively engage in and address a person's multifactorial suffering.”
7. Patient-Reported Outcomes: Referring to “the effect of compassion on suffering, patient well-being, and care.” Some patients felt compassion directly improved health outcomes; most felt it primarily enhanced their well-being and the quality of their relationship with their health care providers.

This study addressed the theory-practice gap between the lack of patient perspectives of compassion and is the first model of compassion to define and codify the core elements of what critical patients perceive as compassion. This measure will provide the information to conduct future trials and evaluations into educational interventions.

Shane Sinclair, PhD, and colleagues said in a discussion, “participates identified compassion primarily as a disposition, requiring action, constituting another important demarcation from empathy, which has been identified as an attitude, emotion, or state that is situational and contingent on health care providers' ability to “feel for” the patient, the degree to which they can personally relate to the patient, and the perceived deservedness of suffering

“Although compassion is seemingly intuitive, a gap persists between what patients consider a pillar of quality care and health care providers' ability to deliver this essential component of care from an evidence-based perspective,” said Sinclair and colleagues. “Although the compassion model codifies the key elements of compassion, providing a foundation for clinical practice and research, the nature and diversity of compassion will be as unique and particular as the players who enter the clinical encounter.”