Compassion in Advanced Care: Measuring Factors That Might Inhibit or Facilitate the Emergence of Compassion in Advanced Care Settings

Abstract

Compassion is a fundamental component of effective healthcare that may be particularly salient in the context of advanced care. Used throughout this thesis, advanced care is a term adopted to encompass a growing area of specialist services oriented towards improving the quality of life for patients facing life-limiting conditions or advanced ages/diseases. Importantly in terms of compassion, advanced care represents a unique context characterised by a particular workforce, patients, and challenges. Despite this, however, little is known about the factors that may inhibit or facilitate compassion, whether they are different in advanced care, whether they vary across different roles, the psychological and motivational factors that predict reports of barriers to care, or the possible importance of patient factors. Grounded in the Transactional Model of Physician Compassion, the current thesis assessed the barriers to compassion pertaining to stress/burnout, patient/family, clinical context and environment in advanced care professionals. Despite the difficulties posed by the COVID-19 pandemic, a total of one hundred and two English speaking medical specialists, nurses, and healthcare assistants (HCAs) working in advanced care settings across New Zealand were recruited. Participants completed a web-based survey indexing demographics, professional and employment information, standardised measures of the barriers to compassion, burnout/satisfaction, motivations, social desirability, work centrality, work intentions, and subjective role perceptions. Furthermore, to test questions regarding the possible role of patient responsibility in the advanced care, participants were asked to indicate how compassionate they felt towards two gender-matched counterbalanced patient vignettes (manipulated to reflect high vs. low patient responsibility). In contrast to expectations, significant differences in barriers to compassion were not evident across the three advanced care roles studied here, nor were there specific differences between physicians working in advanced care (the current sample) and previously collected physician data representing other medical specialisations. However, low numbers of healthcare assistants (and the accompanying likelihood of power issues) together with theoretical considerations, suggested the need for the ongoing exploration of barriers to compassion in the advanced care setting. Consistent with expectations, perceptions of day-to-day tasks as more central to one’s role and higher controlled motivations were related to generally higher barriers to compassion, while perceiving psychosocial support as more central to role was related to lower barriers. In addition, as seen in other areas of health, greater patient responsibility predicted lower compassion (at least in the nursing subsample). Overall, these findings provide a useful first contribution to the understanding of the barriers to care in the special context of advanced care. Although this early study did not provide definitive evidence of differences across professional roles or between advanced care and other specialisations, they provide a useful starting point for future work and hold several implications for potential interventions. In discussion, findings are reintegrated into prior studies of the barriers to care in healthcare, explanations are offered, and limitations and key directions for future research are provided.