Fighting the flinch: Experimentally induced compassion makes a difference in health care providers

Abstract

Objectives. Although health care providers are required to sustain care in difficult circumstances, some patients challenge this principle. Evoking compassion seems likely to be helpful in such situations. This research aimed to evaluate whether inducing compassion in health care providers might mitigate disengagement with patients who have challenging presenting features such as those with disgusting symptoms and/or are to blame for their own health problems.Design. An online experimental study with clinical health care providers.Methods. Medical students (n = 219) and qualified health care professionals (n = 108) took part in an online experiment. Participants were randomized to view a slideshow of either neutral images (control) or compassion-inducing images (compassion condition) and were then presented with a series of patient vignettes where presenting problems systematically varied on patient responsibility and disgusting symptoms. Engagement was assessed by asking participants how caring they felt, how much they would want to help, how challenging it would be, and whether they would wear a mask.Results. Participants reported less engagement with patients who were responsible for their illness and who presented with disgusting symptoms. Induced compassion offset disengagement and qualified health professionals were more caring and willing to help patients than medical students. The compassion induction eliminated some differences between experienced and trainee clinicians.Conclusions. This research demonstrates that disgust and patient responsibility impacts clinical engagement and that medical students are more impacted by such scenarios than qualified health providers. Inducing compassion may help to mitigate these differences, and further investigation into strategies that foster engagement with difficult patients is warranted.

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

“… 146 A 2-minute compassion condition slideshow consisting of images of humans or animals in various situations depicting helplessness, vulnerability, and physical and emotional pain induced clinical engagement and compassion in qualified health professionals. 147 Evaluation methods for these programs were varied (see Table 1 and Supplemental Digital Appendix 3 at http://links.lww.com/ACADMED/B91 for more information).…”

“…A limited number of studies in this systematic review included a comparator/control group in the assessment of the impact of the compassion education intervention. 45 , 47 , 48 , 51 – 53 , 56 , 109 , 118 , 125 , 127 , 135 , 138 , 147 The majority of studies identified used only a single group post-test design to evaluate the intervention, with the lack of a comparator/control group hindering our ability to determine whether a given intervention increased, decreased, or did not change learners’ compassion as compared with what they possessed at baseline.…”

How Do Health Professionals Maintain Compassion Over Time? Insights From a Study of Compassion in Health

“…Consistent with this view, basic science work tells us that "compassion fade" is moderated by dispositional factors (Markowitz et al, 2013) and that the extent to which suffering is self-inflicted (Reynolds et al, 2019) and that greater self-other similarity are likely important (Oveis et al, 2010). More directly, experimental studies in health contexts have shown that compassion and patient engagement are more impacted by aversive patient characteristics among student physicians than among more experienced practitioners (Reynolds et al, 2019). Although developmental effects were not evident in the data presented here, individual differences in the tendency or ability to use particular types of compassion-maintaining strategies may well help us understand responses to the array of challenges to compassion evident in healthcare settings.…”

“…The Transactional Model (Fernando and Consedine, 2014a) suggests that compassion arises out of the dynamic interactions between patient, clinician, the clinical picture, and the environments in which compassion is needed. Consistent with this view, basic science work tells us that "compassion fade" is moderated by dispositional factors (Markowitz et al, 2013) and that the extent to which suffering is self-inflicted (Reynolds et al, 2019) and that greater self-other similarity are likely important (Oveis et al, 2010). More directly, experimental studies in health contexts have shown that compassion and patient engagement are more impacted by aversive patient characteristics among student physicians than among more experienced practitioners (Reynolds et al, 2019).…”

“…However, it should also be recalled that the professional is likely only one factor in the process by which compassion is (and is not) generated in healthcare (Fernando et al, 2016). Experimental studies, for example, suggest that the effects of patient characteristics on compassion are often substantially larger than the effects of physician factors , perhaps particularly in less experienced practitioners (Reynolds et al, 2019). Patient factors such as the degree to which are seen as responsible for suffering, have off-putting or disgusting characteristics, are unpleasant, rude, demanding or hostile "suck the oxygen" from compassion (Fernando et al, 2016).…”