Article

An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients Say Such Care Is Missing

Schwartz Center for Compassionate Healthcare, Boston, Massachusetts, USA.
Health Affairs (Impact Factor: 4.97). 09/2011; 30(9):1772-8. DOI: 10.1377/hlthaff.2011.0539
Source: PubMed

ABSTRACT

As the US health care system undergoes restructuring and pressure to reduce costs intensifies, patients worry that they will receive less compassionate care. So do health care providers. Our survey of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is "very important" to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care. Given strong evidence that such care improves health outcomes and patients' care experiences, we recommend that national quality standards include measures of compassionate care; that such care be a priority for comparative effectiveness research to determine which aspects have the most influence on patients' care experiences, health outcomes, and perceptions of health-related quality of life; and that payers reward the provision of such care. We also recommend the development of systematic approaches to help health care professionals improve the skills required for compassionate care.

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    • "Care providers also experience workplace suffering due to their extended exposure to patient suffering and their vulnerability to compassion fatigue and burnout, which can hinder the intimate and particular understanding of a patient needed to provide high-quality care (Benner et al., 1996). To that end, healthcare organizations have developed and implemented compassion practices that allow caregivers to detect and respond to the unique suffering patients and their families experience (i.e., concern for patients), and encourage providers to treat them accordingly (Lown et al., 2011; Von Dietze & Orb, 2000). Prior work finds that organizational practices can foster compassion by enhancing the degree to which an organization and its employees notice, feel, and respond to workplace suffering (Dutton, Worline, Frost, & Lilius, 2006; Lilius, Worline, Dutton, Kanov, & Maitlis, 2011). "
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    • "In a number of countries, care that is less than compassionate has been identified as a problem in healthcare (Youngson 2010, Lown et al. 2012). In the UK, official reports of poor care in NHS hospitals, home care and care homes have been picked up by national media and policy makers, so that 'compassionate care' has become a policy buzzword. "
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    ABSTRACT: How to promote compassionate care within public services is a concern in several countries; specifically, some British healthcare scandals highlight poor care for service users who may readily be stigmatised as ‘other’. The article therefore aims to understand better the relationship between stigma and compassion. As people bereaved by a drug- or alcohol-related death often experience stigma, the article draws on findings from a major British study, conducted during 2012–2015 by the authors, of people bereaved in this way, in order to see how service provision can be improved. One hundred and six bereaved family members were interviewed in depth about their experiences of loss and support. Thematic analysis developed theoretical understandings of participants’ lived experiences. This article analyses our data on how bereaved people experienced stigma and kindness from practitioners of all kinds. We found that stigma can be mitigated by small acts of kindness from those encountered after the death. Stigma entails stereotyping, othering and disgust, each of which has emotional and cognitive aspects; kindness entails identification and fellow feeling; professionalism has classically entailed emotional detachment, but interviewees found cold professionalism as disturbing as explicit disgust. Drawing on theories concerning the end of life, bereavement and emotional labour, the article analyses the relationship between stigma, kindness and professionalism, and identifies some strategies to counter stigmatisation and foster compassion.
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    • "Yet, compassion is by no means a purely UK agenda. The Hearts In Healthcare campaign, for example, emanates from New Zealand (Youngson, 2010), while in recent years in the USA a discourse of (lack of) compassion has arisen in healthcare in general (Lown et al., 2012) and within EOLC Schwartz rounds are a much-cited technique for advancing compassionate care. 9 The discourse of compassion therefore is used internationally to re-construct EOLC as a way of responding to presumed (unnecessary) suffering at the end of life. "
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    ABSTRACT: End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done. Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity. Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
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