What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada

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Abstract

Background

Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed.

Objectives

The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.

Design

Data were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory.

Setting and participants

57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada.

Results

Five categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.

Conclusions

An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.

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Most cited references 34

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Enhancing Compassion: A Randomized Controlled Trial of a Compassion Cultivation Training Program

Hooria Jazaieri, Geshe Jinpa, Kelly McGonigal … (2013)

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Compassion: a scoping review of the healthcare literature

Shane Sinclair, Jill M Norris, Shelagh McConnell … (2016)

Background Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare. Methods Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used. Results and discussion Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students. Conclusions This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary.

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An agenda for improving compassionate care: a survey shows about half of patients say such care is missing.

B Lown, H Marttila, Howard J. Rosen (2011)

As the US health care system undergoes restructuring and pressure to reduce costs intensifies, patients worry that they will receive less compassionate care. So do health care providers. Our survey of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is "very important" to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care. Given strong evidence that such care improves health outcomes and patients' care experiences, we recommend that national quality standards include measures of compassionate care; that such care be a priority for comparative effectiveness research to determine which aspects have the most influence on patients' care experiences, health outcomes, and perceptions of health-related quality of life; and that payers reward the provision of such care. We also recommend the development of systematic approaches to help health care professionals improve the skills required for compassionate care.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 14 March 2018

Volume: 8

Issue: 3

Electronic Location Identifier: e019701

Affiliations

[1 ] departmentFaculty of Nursing , University of Calgary , Calgary, Alberta, Canada

[2 ] departmentDepartment of Oncology , Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada

[3 ] departmentResearch Institute in Oncology and Hematology , CancerCare Manitoba , Winnipeg, Manitoba, Canada

[4 ] departmentCollege of Nursing, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg, Manitoba, Canada

[5 ] departmentPsychosocial Oncology and Cancer Nursing Research , St. Boniface Research Centre , Winnipeg, Manitoba, Canada

[6 ] departmentSchool of Nursing and Institute on Aging and Lifelong Health , University of Victoria , Victoria, British Columbia, Canada

[7 ] departmentDepartments of Clinical Neurosciences and Medicine , Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada

[8 ] departmentPalliative/End of Life Care, Calgary Zone , Alberta Health Services , Calgary, Alberta, Canada

[9 ] departmentDepartment of Psychiatry , University of Manitoba , Winnipeg, Manitoba, Canada

Author notes

[Correspondence to ] Dr Shane Sinclair; sinclair@ 123456ucalgary.ca

Author information

Neil A Hagen http://orcid.org/0000-0002-4376-4348

Article

Publisher ID: bmjopen-2017-019701

DOI: 10.1136/bmjopen-2017-019701

PMC ID: 5857658

PubMed ID: 29540416

SO-VID: 1abb6dcc-b8ea-491a-9286-0ac17759fd78

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 21 September 2017

Date revision received : 22 January 2018

Date accepted : 09 February 2018

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ScienceOpen disciplines: Medicine

Keywords: compassion,compassionate care,grounded theory,healthcare providers,model,qualitative research

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ScienceOpen disciplines: Medicine

Keywords: compassion, compassionate care, grounded theory, healthcare providers, model, qualitative research

What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada

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Abstract

Background

Objectives

Design

Setting and participants

Results

Conclusions

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Most cited references 34

Enhancing Compassion: A Randomized Controlled Trial of a Compassion Cultivation Training Program

Compassion: a scoping review of the healthcare literature

An agenda for improving compassionate care: a survey shows about half of patients say such care is missing.

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