Developing multi-level interventions to facilitate compassion in healthcare
Year: 2024
Type: dissertation
Abstract: Compassion in healthcare is valued by both patients and healthcare professionals (HCPs) and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding compassion predictors or ways to intervene remains limited. This thesis (1) systematizes evidence regarding compassion predictors, (2) extends empirical knowledge regarding compassion barriers and facilitators in areas with less research, and (3) presents the findings from the first compassion interventions’ co-design conducted together with HCPs and healthcare leaders in Aotearoa/New Zealand (NZ). Three literature reviews were conducted to achieve the first thesis aim. The first review examined challenges to compassion in modern day healthcare, while the second explored selfcompassion as a potential intervention. Both reviews showed that existing work regarding compassion in healthcare was scattered, often inconclusive, and narrowly-focused. The third was a large-scale systematic review (PROSPERO: CRD42020177815) that demonstrated that the majority of studies of compassion predictors had been focused on physician-level factors that are largely immutable. As such, the second part of this thesis involved a large-scale survey to better understand the associations between organisational culture and HCPs’ ability to express compassion (N=1025), and an experimental study to understand the impact of patient urgency on HCPs' caring and motivation to help (N=939). Results of these studies confirmed that environmental and patient/clinical factors were consequential to HCPs ability and motivation to provide compassionate care. The final part of the thesis involved co-designing compassion interventions together with HCPs (N=21) and healthcare leaders (N=8) in NZ public secondary healthcare. Findings revealed resentment towards interventions that were designed “top-down” without understanding of the local healthcare context. Participants advocated for multi-level interventions targeting multidisciplinary teams, leadership, and broader organizational and policy levels. In addition to ongoing systemic concerns, the suggested interventions' core focus was on re-building interpersonal connections. Agile approaches and prioritising leadership as intervention site were recommended to make compassion interventions feasible and encourage buy-in. In sum, this thesis extended prior work by demonstrating that compassion is influenced by multiple dynamic and interrelated factors beyond the individual HCP, emphasizing the need for interventions that are more systemic and scalable.
Author: Pavlova, Alina
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7065023064