UCalgary researcher publishes systematic review of compassion training in health care

Compassion can be taught, but the comprehensiveness of such teaching is currently limited.

That’s one of the key findings of a study conducted by Dr. Shane Sinclair, PhD ’09, an associate professor in the Faculty of Nursing and director of the Compassion Research Lab, as part of a systematic review of compassion training for health-care practitioners.

In addition to appraising the evidence, Sinclair and his team used an empirical model of compassion — developed in his lab and created in consultation with health-care providers and patients — to create a benchmark for what encompasses compassion and to assess the comprehensiveness of the teaching content of the training programs reviewed.

“By having a blueprint of what compassion is, we were able to apply the model to the training programs and say, ‘So what exactly are the components of compassion that these training programs are teaching and what are the outcomes?” says Sinclair.

Understand the components of compassion

The review, published in Academic Medicine, details how most compassion training in health care weighs heavily toward the development of learner attitudes or qualities associated with compassion. Sinclair says this is a foundational component of compassion training as attitudes can inform behaviours, so, if people can think and reflect on compassion, then the logic is those skills will naturally be transferred into practice.

However, Sinclair warns this can be a “leap of faith,” because they’ve observed that relying on learners’ and educators’ good intentions does not necessarily translate into sustained changed behaviour. They need to be equipped with knowledge, skills and behaviours associated with patient’s experiences of compassion, he says.

“We need to mature in our training programs to move beyond simply nurturing feelings of compassion to actually providing health-care practitioners with the tangible evidence-based clinical skills and behaviours to provide compassion to patients in a more meaningful, robust and sustainable way,” he says.

Reliance on the practitioner's perspective

Sinclair and his team found considerable limitations related to how existing programs assessed and reported the impact of training, as most of the programs relied on learner assessments and their perceived improvements in providing compassion to patients. Sinclair compares this approach to assessment to filling out a survey at a restaurant — except, instead of the diner completing the questionnaire, the waiter and the chef determine how good the customer experience was. He says this is concerning, as health-care practitioners tend to overrate their ability to provide compassion.

The results of the review suggest that the effectiveness of compassion training needs to primarily be evaluated through patient assessment or patient-reported measures, as they are the ultimate target of compassion training in health care.

Another major review finding is that most compassion training is targeted toward future doctors and nurses in universities, with less training available to current health-care practitioners in clinical practice.

“While the emergence of compassion training in universities is promising, we know that if this training is not supported within the health-care system or cultivated through ongoing education, this initial training will be quickly forgotten,” says Sinclair.

Need for ongoing training in this area

Compassion training, he says, needs to be an ongoing part of a health-care practitioner’s development, and it needs to be encouraged and fostered by the health-care systems in which they work.

“If it is totally the learner’s responsibility to remain competent and compassionate, then that puts the entire onus of compassionate health care on that individual and their interactions with that patient,” says Sinclair. “I think that’s short-sighted, because you can have the most compassionate people, but, if you’re working in a system that doesn’t allow for that or has so many demands that compassion is an optional extra, I think the education process becomes futile.”

Sinclair says getting the review published is one of the proudest achievements in his academic career. Behind the paper was a ton of work put in by himself and his team. He says it’s nice to have the review serve as a blueprint for what is currently involved in compassion training, so evidence-based training programs can now be built within the Compassion Research Lab.

“This foundational cornerstone allows us to begin to build, to help health-care practitioners enhance their compassion in clinical care, to equip educators with the resources to develop comprehensive compassion training programs, to start to change practice and, ultimately, to improve the compassion patients receive in our health-care system,” says Sinclair.