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

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.

Feel the Fear and Do It Anyway-Beliefs About Compassion Predict Care and Motivation to Help Among Healthcare Professionals

AIMS

To develop and preliminarily validate a measure of beliefs about compassion in health care and assess whether and which beliefs may predict compassion.

DESIGN

Pre-registered cross-sectional online survey study with a repeated-measures vignette component.

METHOD

Exploratory and Confirmatory Factor analyses were performed on a split sample of 890 healthcare professionals in Aotearoa New Zealand (NZ). Links with fears of compassion for others, burnout, trait compassion, compassion competency and ability and self-efficacy were used to assess convergent and divergent validity. Linear mixed model regression analyses were used to assess relationships between beliefs and compassion. In writing this report, we adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

RESULTS

Four-factor structure featuring three negative (compassion as harmful, not useful, draining) and one positive (compassion is important) type of beliefs was established. Confirmatory factor analysis indicated a good fit and subscales indicated good measures of validity. Internal consistency was achieved for the subset of beliefs (harmful, not useful). Regression analyses indicated negative effects of the belief that compassion is draining on caring, motivation to help and compassion overall; negative effects of the belief that compassion is not useful on the motivation to help and a positive effect of the belief that compassion is important on caring and compassion overall. There was no effect of beliefs that compassion is harmful on compassion measures.

CONCLUSION

This report extends prior qualitative studies of beliefs about compassion in a large healthcare sample, offering a way to measure these potentially malleable factors that might be targeted in education, interventions and future research.

PATIENT OR PUBLIC CONTRIBUTION

The study was designed in consultation with healthcare and compassion research professionals, including substantial input from Indigenous Māori healthcare professionals.

Peer support provider and recipients' perspectives on compassion in virtual peer support stroke programs: "You can't really be supportive without compassion"

BACKGROUND

Peer support programs demonstrate numerous benefits, including emotional, instrumental, informational, and affirmational social support. Since the COVID-19 pandemic, many peer support stroke programs in Canada have been delivered virtually. Compassion must be consistently applied to build meaningful interactions, but the shift to virtual services may have changed the quality of interaction and compassion in virtual services. While compassion is recommended in health and social services to improve outcomes, satisfaction, and service quality, compassion in virtual peer support stroke programs remains understudied. We aimed to describe compassionate support in virtual peer support stroke programs from peer support providers' and recipients' perspectives.

METHODS

This qualitative descriptive study was guided by Sinclair & colleagues' model of compassion. Peer support recipients or peer support providers participated in interviews transcribed and analyzed using a hybrid thematic analysis.

RESULTS

Sixteen were peer support recipients, six were peer support providers, and two were both peer support providers and recipients. Participants agreed that compassion was essential in these programs. Participants perceived compassion to be a result of the virtues of compassionate facilitators (i.e., genuineness, passion, and empathy), relational space, and communication within the virtual peer support stroke program (e.g., sense of awareness or intuition of compassion, aspects of engaged peer support provision), virtuous response (e.g., knowing the person and actions that made the peer support recipient feel like a priority). Compassion was facilitated by listening and understanding peer support recipients' needs as they relate to stroke (i.e., seeking to understand peer support recipients and their needs), attending to peer support recipients' needs (e.g., timely actions to address their needs), and achieving compassion-related program outcomes (e.g., alleviating challenges and enhancing wellbeing). The absence of these components (e.g., lacking genuineness, passion and empathy) was a barrier to compassion in virtual peer support stroke programs.

CONCLUSIONS

Study findings describe facilitators and barriers to perceived compassion in virtual peer support stroke programs and provide practical recommendations that can be adapted into programs to improve program quality.

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).

Substantial Increases in Healthcare Students' State Empathy Scores Owing to Participation in a Single Improvisation Session

PURPOSE

To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session.

METHODS

Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale.

RESULTS

The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively).

CONCLUSIONS

These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.

Vignettes as a novel research tool in spiritual care: A methods paper

AIMS

To discuss the construction and use of vignettes as a novel approach in spiritual care research and education.

DESIGN

Methods paper.

METHODS

In this methods paper, the authors introduce the use of vignettes in spiritual care research and provide insight into the construction of vignettes. The vignette presented was part of a study of neurosurgical nurses' attitudes and responses to the spiritual needs of neuro-oncology patients. The development process, consisting of four steps, is explained in this paper.

RESULTS

Using a vignette to explore nurses' attitudes towards spiritual care is an innovative way to understand what behaviours nurses consider appropriate in situations where the patient is seeking meaning and connection. Transparent description of the development process is crucial to ensure reproducibility.

CONCLUSION

The use of theoretically constructed and validated vignettes in spiritual care research is new. Vignettes used in surveys have the potential to elicit nurses' responses to patients' search for meaning and connectedness.

IMPLICATIONS

In order to investigate nurses' attitudes and behaviours towards patients' spiritual needs, carefully constructed and validated vignettes are valuable research tools.

IMPACT

Vignettes have proven to be a valuable research tool in the social and health sciences. So far, their use as a survey instrument in spiritual care research has not been investigated. Therefore, this method paper introduces vignettes as a novel approach to spiritual care research. Our findings contribute to the further development of vignettes in nursing science, as there are similarities with case development and simulation training in nursing education.

REPORTING METHOD

Reporting guideline is not applicable.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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.

What is the Most Valid and Reliable Compassion Measure in Healthcare? An Updated Comprehensive and Critical Review

Our previous review of compassion measures in healthcare between 1985 and 2016 concluded that no available measure assessed compassion in healthcare in a comprehensive or methodologically rigorous fashion. The present study provided a comparative review of the design and psychometric properties of recently updated or newly published compassion measures. The search strategy of our previous review was replicated. PubMed, MEDLINE, CINAHL, and PsycINFO databases and grey literature were searched to identify studies that reported information on instruments that measure compassion or compassionate care in clinicians, physicians, nurses, healthcare students, and patients. Textual qualitative descriptions of included studies were prepared. Instruments were evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. Measures that underwent additional testing since our last review included the Compassion Competence Scale (CCS), the Compassionate Care Assessment Tool (CCAT)^©, and the Schwartz Center Compassionate Care Scale (SCCCS)™. New compassion measures included the Sussex-Oxford Compassion for Others Scale (SOCS-O), a self-report measure of compassion for others; the Bolton Compassion Strengths Indicators (BSCI), a self-report measure of the characteristics (strengths) associated with a compassionate nurse; a five-item Tool to Measure Patient Assessment of Clinician Compassion (TMPACC); and the Sinclair Compassion Questionnaire (SCQ). The SCQ was the only measure that adhered to measure development guidelines, established initial construct validity by first defining the concept of interest, and included the patient perspective across all stages of development. The SCQ had the highest EMPRO overall score at 58.1, almost 9 points higher than any other compassion measure, and achieved perfect EMPRO subscale scores for internal consistency, reliability, validity, and respondent burden, which were up to 43 points higher than any other compassion measure. These findings establish the SCQ as the ‘gold standard’ compassion measure, providing an empirical basis for evaluations of compassion in routine care.

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00942-3.