In search of compassion: a new taxonomy of compassionate physician behaviours

Abstract

Background Compassion has been extolled as a virtue in the physician-patient relationship as a response to patient suffering. However, there are few studies that systematically document the behavioral features of physician compassion and the ways in which physicians communicate compassion to patients. Objective To develop a taxonomy of compassionate behaviors and statements expressed by the physician that can be discerned by an outside observer. Design Qualitative analysis of audio-recorded office visits between oncologists and patients with advanced cancer. Setting and Participants Oncologists (n=23) and their patients with advanced cancer (n=49) were recruited in the greater Rochester, New York, area. The physicians and patients were surveyed and had office visits audio-recorded. Main Outcome Measures Audio-recordings were listened to for qualitative assessment of communication skills. Results Our sensitizing framework was oriented around three elements of compassion: recognition of the patient’s suffering, emotional resonance, and movement towards addressing suffering. Statements of compassion included direct statements, paralinguistic expressions, and performative comments. Compassion frequently unfolded over the course of a conversation rather than being a single discrete event. Additionally, non-verbal linguistic elements (e.g. silence) were frequently employed to communicate emotional resonance. Discussion and Conclusions This study is the first to systematically catalog instances of compassionate communication in physician-patient dialogues. Further refinement and validation of this preliminary taxonomy can guide future education and training interventions to facilitate compassion in physician-patient interactions.

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

“…We chose silences co-occurring with poignant moments of connection to examine one way in which communication facilitates patient-centered care–through the use of silence. Silences are bounded by both lexical and musical elements; here we have elucidated rhythmic elements of speech which may be crucial to the communication of emotion and the formation of patient-clinician relationships [17,45–48]. In particular, dialog rhythm mirroring was a marker of this particular kind of silence [3].…”

Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery, and General Practice

“…In comparative contrast, general practitioners form close, long-term relationships with patients, treat high volumes of patients per unit time, and may risk becoming professionally isolated relative to their hospital-based colleagues. 34,35 Similarly, pediatricians in New Zealand tend to care for children with complex, long-term, and often incurable problems. They also contend with stressed, difficult, and angry parents 11 and with dying children.…”

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

“…[17][18][19] These moral attributes are expressed through a kind of situational awareness in which vulnerability and suffering are perceived and acknowledged. 19,20 These perceptions underpin participation of the nurse in responsive action that is aimed at relieving suffering and ensuring dignity, and which involves the nurse in a participatory relationship in which the nurse exercises relational capacity 19,[21][22][23] through which empathy is experienced and a caring pastoral relationship is constructed. 15,24,25 Our systematic review of research reporting older patients' experiences of hospital care highlights the importance of this caring relationship to shaping experiences.…”