The Effects of Chronicity and Patient Responsibility on Compassion in Medicine - An experimental study

Abstract

Compassion is a prosocial response at the forefront of quality care within medicine. Despite its importance, little is understood regarding this inherent process and the potential factors that may elicit or diminish it, specifically in medical settings. Of particular interest to the current thesis is whether patient chronicity and perceptions of responsibility are likely to affect compassion among health professionals. While prior qualitative research indicates that health professionals report less compassion toward chronic patients and those perceived as responsible for their condition, no empirical studies have directly investigated the effects of chronicity and responsibility on compassion in medicine. Thus, the current study experimentally investigated the effects of chronicity (as indirectly indexed by a rating of “urgency”) and responsibility on compassion. Additionally, a qualitative analysis examined the frequency of language used to describe lesser and more favoured patient reflections. Eighty-three participants, including doctors, nurses, medical students, and nursing students aged between 23-69, were recruited via channels from the University of Auckland or other online platforms. All participants completed a Qualtrics survey comprised of demographic questions, a responsibility metric (assessing objective responsibility for chronic and acute conditions), a dispositional trait measure, patient ratings (assessing the degree of patient difficulty, urgency, caring, helping, and responsibility), and a reflection of lesser versus more favoured patient reflections from their clinical past. Participants were randomised into either a high or low patient responsibility condition and presented with two patient vignettes, one depicting acute symptoms and the other chronic symptoms. Participants read these vignettes in a counterbalanced order and then provided the previously mentioned ratings on each patient vignette. Contrary to expectations, manipulation checks suggested that while manipulations of perceived patient responsibility were generally effective, the manipulation of chronicity (at Effects of Chronicity and Patient Responsibility on Compassion least as indexed by an indirect rating of "urgency") was not. More consistent with expectation, mixed-model ANOVAs showed that participants randomised to the low responsibility condition rated both vignettes (intended chronic and acute) with greater compassion than those in the high responsibility condition. Although these findings were inconsistent with prior research findings that health professionals report less compassion for chronic patients, they were consistent with independent prior research showing that higher patient responsibility lowers compassion. The current study's findings are interpreted regarding compassion functioning via an appraisal of responsibility, and that responsibility may generally be more negatively perceived by health professionals. Followed by an interpretation of the failed chronicity manipulation, and the potential interactive relationship that responsibility and chronicity may have. To conclude, implications, limitations, and future directions for the study of responsibility, chronicity, and compassion are provided.