Routine, empathic and compassionate patient care: definitions, development, obstacles, education and beneficiaries

Post, Stephen G.; Ng, Lauren; Fischel, Janet E.; Bennett, Mary; Bily, Linda; Chandran, Latha; Joyce, Jeremiah; Locicero, Briana; McGovern, Kelly; McKeefrey, Robyn L.; Rodriguez, Jackie V.; Roess, Michael

doi:10.1111/jep.12243

Cited by 59 publications

(56 citation statements)

References 42 publications

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“…These results are consistent with studies focused on healthcare providers’ conceptualizations of compassion as an intensification of both cognitive and affective empathy coupled with the addition of action 30,41 aimed at the alleviation of suffering. 16,30,41 …”

Section: Discussionmentioning

confidence: 99%

“…7–10 But what specifically do these terms mean, how are they related to one another, and what are patients’ perceptions and preferences toward each of them? A scoping review of the literature 11 revealed that, while considerable scholarly activity has been conducted to distinguish between these constructs, 12–16 there is a lack of empirical research informing this topic. While addressing this gap is important throughout all of healthcare, it is perhaps most important within palliative care, where relief of suffering and providing compassion in patients with advanced illness are explicit goals of care.…”

Section: Introductionmentioning

confidence: 99%

“…16,20,21 In general, researchers identify two types of empathy: cognitive empathy (detached acknowledgment and understanding of a distressing situation based on a sense of duty) and affective empathy, which while containing each of the elements of cognitive empathy, extends to an acknowledgment and understanding of a person’s situation by “feeling with” the person. 16,22 Neurological studies have reported that witnessing a person in suffering activates neural pain pathways in the brain of the empathizer. 22 Studies investigating empathy from the perspective of healthcare providers have identified a troubling trend—the erosion of empathy over the course of healthcare education and clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences

et al. 2016

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Background:Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent.Aim:The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice.Design:Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory.Setting/participants:Data were collected from 53 advanced cancer inpatients in a large urban hospital.Results:Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful.Conclusion:Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences

et al. 2016

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“…The ability to imagine, understand and resonate emotionally with the feelings of someone else is described as essential to the practice of medicine [15, 16]. An empathic physician enhances doctor-patient communication, and patient compliance, satisfaction and outcomes [16–20].…”

Section: Introductionmentioning

confidence: 99%

Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents

Phillips

Dalgarno

2017

BMC Med Educ

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BackgroundFormal and informal medical curricula convey expectations about professionalization, that is, the development of physician identity, and also about professionalism. This study examined whether, in general, junior residents experienced any dissonance between these roles and focused particularly on how they negotiated conflicts between compassion, self-care, duty and medical expertise.MethodsIn 2015, purposive sampling was used to select 21 first-year residents at a Canadian medical school. Participants listened to a 5-min audio-recording narrated in either male or female voice. Facing compassion fatigue after three obstetrical disasters over less than 2 days the resident narrator asks to go home. Participants reacted in writing to questions about this request and relevant teaching/modelling. Responses were analyzed using a qualitative, exploratory, thematic research design.ResultsFour themes were identified: i) empathy, self-doubt and fear of weakness, ii) the need for support from and communication with physicians and others, iii) education received, and iv) professionalization outranks professionalism. Participants agreed that under the circumstances the narrator’s care, compassion and request were appropriate. Never the less, many grappled with feeling that asking to be relieved of work demonstrated weakness and a shirking of responsibility. Respondents had received no formal teaching about balancing compassion for patients or self with professional duty. Preceptors’ informal teaching and modeling valorized scientific disengagement above all else. What emerged was participants’ drive to become detached clinicians who set aside emotional responses and interactions that could impede and be incompatible with professionalization. However, participants also recognized and lamented what was lost in such a transformation.ConclusionIn the transition from student to practitioner, trainees’ views and the modeling they receive shift emotion and compassion, whether for self or patients, from assets to liabilities as they aim to be invincible medical experts.

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“…First, the alignment of values and goals in this patient's care improved the process for team‐based decision making that involved the clinical providers, as well as the patient and her husband . These conversations happened early in her diagnosis and often throughout her management, and her providers’ honesty about prognosis facilitated a realistic picture of her disease circumstances, which allowed her to reflect on her priorities of care . For example, the avoidance of surgical facial disfigurement was important for her psychosocial function, and she adamantly refused the prospect of additional recommendations for adjuvant radiation therapy given the perceived risk of additional complications.…”

Section: Discussionmentioning

confidence: 99%

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

Munz

Helman

Tiner

et al. 2019

Special Care in Dentistry

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This reflection describes a life‐limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70‐year‐old female was diagnosed with a T4aN2bM0 biopsy‐proven invasive, well‐differentiated keratinizing SCC. Surgical wide‐local excision included teeth #11‐16 with left unilateral neck dissection, levels I‐V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus. She experienced multiple recurrences. At a certain point, negative margins could not be achieved without facial disfigurement. The patient, her husband, and providers decided together that further management would be palliative. Before the additional surgical procedures, she communicated a thorough ACP with her husband and providers who were prepared to facilitate difficult care decisions on her behalf. The patient passed away at home with hospice care at the age of 74. This motivated patient with oral SCC and impactful postmanagement complications appreciated the clarity of an ACP. Her values and goals of care were incorporated with ongoing communication and documentation of this plan, which was instrumental in facilitating her person‐centered care. The providers apply lessons learned here in future practice and education of residents and students.

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Routine, empathic and compassionate patient care: definitions, development, obstacles, education and beneficiaries

Abstract: We discern a shift away from concepts of clinical empathy and compassionate care that deny a significant place for an affective component and that idealize 'detachment'.

Cited by 59 publications

References 42 publications

Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences

Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences

Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

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