The initial validation of an Evidence-informed, competency-based, Applied Compassion Training (EnACT) program: a multimethod study.
Compassion
Compassionate care
Competence
Education
Training
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
21 Jun 2024
21 Jun 2024
Historique:
received:
26
01
2024
accepted:
12
06
2024
medline:
22
6
2024
pubmed:
22
6
2024
entrez:
21
6
2024
Statut:
epublish
Résumé
Compassion is positively associated with improved patient outcomes, quality care ratings, and healthcare provider wellbeing. Supporting and cultivating healthcare providers' compassion through robust and meaningful educational initiatives has been impeded by a lack of conceptual clarity, inadequate content coverage across the domains of compassion, and the lack of validated evaluation tools. The EnACT program aims to address these gaps through an Evidence-informed, competency-based, Applied, Compassion Training program delivered to healthcare providers working in various clinical settings. In this study, we describe the development and initial validation of the program, which will inform and be further evaluated in a forthcoming Randomised Controlled feasibility Trial (RCfT). A multimethod design was used to explore learner needs, experiences, and outcomes associated with the program. Pre- and post-training surveys and qualitative interviews (1 month post training) were conducted among twenty-six healthcare provider learners working in acute care and hospice. Quantitative measures assessed professional fulfillment/burnout, self-confidence in providing compassion, learner satisfaction, and compassion competence. Qualitative interviews explored learners' experiences of the program, integration of learnings into their professional practice, and program recommendations. Learners exhibited relatively high self-assessed compassion competence and professional fulfillment pre-training and low levels of burnout. Post-training, learners demonstrated high levels of compassion confidence and satisfaction with the training program. Despite high levels of reported compassion competence pre-training, a statistically significant increase in post-training compassion competence was noted. Thematic analysis identified five key themes associated with learners' overall experience of the training day and integration of the learnings and resources into their professional practice: (1) A beginner's mind: Learner baseline attitudes and assumptions about the necessity and feasibility of compassion training; (2) Learners' experiences of the training program; (3) Learner outcomes: integrating theory into practice; (4) Creating cultures of compassion; and (5) Learner feedback. Findings suggest that the EnACT program is a feasible, rigorous, and effective training program for enhancing healthcare provider compassion. Its evidence-based, patient-informed, clinically relevant content; interactive in class exercises; learner toolkit; along with its contextualized approach aimed at improving the clinical culture learners practice holds promise for sustaining learnings and clinical impact over time-which will be further evaluated in a Randomized Controlled feasibility Trial (RCfT).
Identifiants
pubmed: 38907199
doi: 10.1186/s12909-024-05663-0
pii: 10.1186/s12909-024-05663-0
doi:
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
686Subventions
Organisme : Canadian Institutes for Health Research
ID : Project Grant #178185
Informations de copyright
© 2024. The Author(s).
Références
Strauss C, Taylor BL, Gu J, Kuyken W, Baer R, Jones F, Cavanagh K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clin Psychol Rev. 2016;47:15–27. https://doi.org/10.1016/j.cpr.2016.05.004 .
Gilbert P. Compassion: Conceptualisations, Research and use in psychotherapy. Routledge; 2005.
Ledoux K. Understanding compassion fatigue: understanding compassion. J Adv Nurs. 2015;71(9):2041–50. https://doi.org/10.1111/jan.12686 .
doi: 10.1111/jan.12686
Pettit A, McVicar A, Knight-Davidson P, Shaw‐Flach A. Releasing latent compassion through an innovative compassion curriculum for specialist community public health nurses. J Adv Nurs. 2019;75(5):1053–62. https://doi.org/10.1111/jan.13928 .
doi: 10.1111/jan.13928
Malenfant S, Jaggi P, Hayden KA, Sinclair S. Compassion in healthcare: an updated scoping review of the literature. BMC Palliat Care. 2022;21(1). https://doi.org/10.1186/s12904-022-00942-3 .
Sinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, McClement S, Bouchal SR. Compassion: a scoping review of the healthcare literature. BMC Palliat Care. 2016;15(1). https://doi.org/10.1186/s12904-016-0080-0 .
Sinclair S, Kondejewski J, Jaggi P, Dennett L, Roze des Ordons AL, Hack TF. What is the state of compassion education? A systematic review of compassion training in health care. Acad Med. 2021;96(7):1057–70. https://doi.org/10.1097/ACM.0000000000004114 .
doi: 10.1097/ACM.0000000000004114
Sinclair S, Raffin-Bouchal S, Venturato L, Mijovic-Kondejewski J, Smith-MacDonald L. Compassion fatigue: a Meta-narrative review of the Healthcare Literature. Int J Nurs Stud. 2017;69:9–24. https://doi.org/10.1016/j.ijnurstu.2017.01.003 .
doi: 10.1016/j.ijnurstu.2017.01.003
Sinclair S, Kondejewski J, Raffin-Bouchal S, King-Shier K, Singh P. Can self-compassion promote healthcare provider wellbeing and compassionate care to others? Results of a systematic review. J Appl Psychol. 2017;9(2):168–206. https://doi.org/10.1111/aphw.12086 .
doi: 10.1111/aphw.12086
Sinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, Chochinov HM. Compassion in health care: an empirical model. J Pain Symptom Manage. 2016;51(2):193–203. https://doi.org/10.1016/j.jpainsymman.2015.10.009 .
doi: 10.1016/j.jpainsymman.2015.10.009
Sinclair S, Kondejewski J, Jaggi P, Roze des Ordons AL, Kassam A, Hayden KA, Harris D, Hack TF. What works for whom in compassion training programs offered to practicing healthcare providers: a realist review. BMC Med Educ. 2021;21(1). https://doi.org/10.1186/s12909-021-02863-w .
Sinclair S, Torres M, Raffin-Bouchal S, Hack TF, McClement S, Hagen NA, Chochinov HM. Compassion training in healthcare: what are patients’ perspectives on training healthcare providers? BMC Med Educ. 2016;16(1). https://doi.org/10.1186/s12909-016-0695-0 .
Sinclair S, Hack TF, McClement S, Raffin-Bouchal S, Chochinov HM, Hagen N. Healthcare providers perspectives on compassion training: a grounded theory study. BMC Med Educ. 2020;20. https://doi.org/10.1186/s12909-020-02164-8 .
Sinclair S, Harris D, Kondejewski J, Roze des Ordons AL, Jaggi P, Hack TF. Program leaders’ and educators’ perspectives on the factors impacting the implementation and sustainment of compassion training programs: a qualitative study. Teach Learn Med. 2022;35(1):21–36. https://doi.org/10.1080/10401334.2021.2017941 .
doi: 10.1080/10401334.2021.2017941
Sinclair S, Hack TF, Raffin S, McClement S, Stajduhar K, Singh P, Hagen NA, Sinnarajah A, Chochinov HM. What are healthcare providers understanding and experiences of compassion: the healthcare compassion model. BMJ Open. 2018;18. https://doi.org/10.1136/bmjopen-2017-019701 .
Sinclair S, Jaggi P, Hack TF, McClement SE, Raffin-Bouchal S, Singh P. Assessing the credibility and transferability of the patient compassion model in non-cancer palliative populations. BMC Palliat Care. 2018;17(1). https://doi.org/10.1186/s12904-018-0358-5 .
Sinclair S, Bouchal SR, Schulte F, Guilcher G, Kuhn S, Rapoport A, Punnett A, Fernandez CV, Letourneau N, Chung J. Compassion in pediatric oncology: a patient, parent and healthcare provider empirical model. Psychosoc Oncol. 2021;30(10):1728–38. https://doi.org/10.1002/pon.5737 .
doi: 10.1002/pon.5737
Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC Geriatr. 2019;19(1). https://doi.org/10.1186/s12877-019-1135-x .
Sinclair S, Beamer K, Hack TF, McClement S, Raffin Bouchal S, Chochinov HM, Hagen NA. Sympathy, empathy, and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliat Med. 2016;31(5):437–47. https://doi.org/10.1177/0269216316663499 .
doi: 10.1177/0269216316663499
Crowther J, Wilson KC, Horton S, Lloyd-Williams M. Compassion in healthcare – lessons from a qualitative study of the end-of-life care of people with dementia. J R Soc Med. 2013;106(12):492–7. https://doi.org/10.1177/0141076813503593 .
doi: 10.1177/0141076813503593
Heyland DK. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006;174(5):627–33. https://doi.org/10.1503/cmaj.050626 .
doi: 10.1503/cmaj.050626
Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine. 3rd ed. London: CRC; 2013.
doi: 10.1201/b20740
Trzeciak S, Mazzarelli A, Compassionomics. The revolutionary scientific evidence that caring makes a difference. Pensacola: Studer Group; 2019.
Pavlova A, Paine S, Sinclair S, O’Callaghan A, Consedine NS. Working in values-discrepant environments inhibits clinicians’ ability to provide compassion and reduces wellbeing: a cross-sectional study. J Intern Med. 2022;293(6):704–23. https://doi.org/10.1101/2022.11.09.22282159 .
doi: 10.1101/2022.11.09.22282159
Soler-Gonzalez J, San-Martín M, Delgado-Bolton R, Vivanco L. Human connections and their roles in the occupational well-being of healthcare professionals: a study on loneliness and empathy. Front Psychol. 2017;8. https://doi.org/10.3389/fpsyg.2017.01475 .
Thienprayoon R, Sinclair S, Lown BA, Pestian T, Awtrey E, Winick N, Kanov J. Organizational compassion: Ameliorating healthcare workers’ suffering and burnout. J Wellness. 2022;4(1). https://doi.org/10.55504/2578-9333.1122 .
Younas A, Maddigan J. Proposing a policy framework for nursing education for fostering compassion in nursing students: a critical review. J Adv Nurs. 2019;75(8):1621–36. https://doi.org/10.1111/jan.13946 .
doi: 10.1111/jan.13946
Deleo K, Anderson A, Cullerton-Sen C. Compassion training: the missing link in healthcare education? Int J Whole Pers Care. 2014;1(1). https://doi.org/10.26443/ijwpc.v1i1.31 .
Dewar B, Cook F. Developing compassion through a relationship centred appreciative leadership programme. Nurse Educ Today. 2014;34(9):1258–64. https://doi.org/10.1016/j.nedt.2013.12.012 .
doi: 10.1016/j.nedt.2013.12.012
Hojat M, Vergare M, Isenberg G, Cohen M, Spandorfer J. Underlying construct of empathy, optimism, and burnout in medical students. Int J M Educ. 2015;6:12–6. https://doi.org/10.5116/ijme.54c3.60cd .
doi: 10.5116/ijme.54c3.60cd
Patel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, Roberts BW. Curricula for empathy and compassion training in medical education: a systematic review. PLoS ONE. 2019;14(8). https://doi.org/10.1371/journal.pone.0221412 .
Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012;27(10):1280–6. https://doi.org/10.1007/s11606-012-2063-z .
doi: 10.1007/s11606-012-2063-z
Chu XR, Jaggi P, Louis JS, Sinclair S. Initial validation of a patient-reported compassion measure in a Mandarin-speaking long-term care patient population. J Nurs Meas. 2023. https://doi.org/10.1891/JNM-2022-0097 .
doi: 10.1891/JNM-2022-0097
Sinclair S, Hack TF, MacInnis CC, Jaggi P, Boss H, McClement S, Sinnarajah A, Thompson G. Development and validation of a patient-reported measure of compassion in healthcare: the Sinclair compassion questionnaire (SCQ). BMJ Open. 2021;11(6). https://doi.org/10.1136/bmjopen-2020-045988 .
Sinclair S, Kondejewski J, Hack TF, Boss HC, MacInnis CC. What is the most valid and reliable compassion measure in healthcare? An updated comprehensive and critical review. Patient. 2022;15(4):399–421. https://doi.org/10.1007/s40271-022-00571-1 .
doi: 10.1007/s40271-022-00571-1
O’Sullivan PS, Irby DM. Reframing research on faculty development. Acad Med. 2011;86(4):421–8. https://doi.org/10.1097/acm.0b013e31820dc058 .
doi: 10.1097/acm.0b013e31820dc058
Lockyer J. Needs assessment: lessons learned. J Contin Educ Health Prof. 1988;18(3):190–2. https://doi.org/10.1002/chp.1340180310 .
doi: 10.1002/chp.1340180310
Norman GR, Shannon SI, Marrin ML. The need for needs assessment in continuing medical education. BMJ. 2004;328(7446):999–1001. https://doi.org/10.1136/bmj.328.7446.999 .
doi: 10.1136/bmj.328.7446.999
Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L, Shanafelt T. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry. 2017;42(1):11–24. https://doi.org/10.1007/s40596-017-0849-3 .
doi: 10.1007/s40596-017-0849-3
Anguera MT, Blanco-Villaseñor A, Losada JL, Sánchez-Algarra P, Onwuegbuzie AJ. Revisiting the difference between mixed methods and multimethods: is it all in the name? Qual Quant. 2018;52(6):2757–70. https://doi.org/10.1007/s11135-018-0700-2 .
doi: 10.1007/s11135-018-0700-2
Brewer J, Hunter A. Foundations of multimethod research: synthesizing styles. Thousand Oaks: SAGE; 2006.
doi: 10.4135/9781412984294
Salmons JE. Conducting multimethod and mixed methods research online. In: Hesse-Biber SN, Johnson RB, editors. The Oxford Handbook of Multimethod and mixed methods Research Inquiry. New York: Oxford University Press; 2015. pp. 522–47.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa .
doi: 10.1191/1478088706qp063oa
Clarke V, Braun V. Teaching thematic analysis: overcoming challenges and developing strategies for effective learning. Psychologist. 2013;26(2):120–3.
Koch T. Establishing rigour in qualitative research: the decision trail. J Adv Nurs. 2006;53(1):91–100. https://doi.org/10.1111/j.1365-2648.2006.03681.x .
doi: 10.1111/j.1365-2648.2006.03681.x
Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25(9):1212–22. https://doi.org/10.1177/1049732315588501 .
doi: 10.1177/1049732315588501
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 1988.
Bray L, Brien MR, Kirton J, Zubairu K, Christiansen A. The role of professional education in developing compassionate practitioners: a mixed methods study exploring the perceptions of health professionals and pre-registration students. Nurse Educ Today. 2014;34(3):480–6. https://doi.org/10.1016/j.nedt.2013.06.017 .
doi: 10.1016/j.nedt.2013.06.017
Smith S, Gentleman M, Loads D, Pullin S. An exploration of a restorative space: a creative approach to reflection for nurse lecturer’s focused on experiences of compassion in the workplace. Nurse Educ Today. 2014;34(9):1225–31. https://doi.org/10.1016/j.nedt.2014.03.003 .
doi: 10.1016/j.nedt.2014.03.003
Adaro B, Clemens K. From safe spaces to Brave spaces: a New Way to frame dialogue around diversity and Social Justice. In: Landreman LM, editor. The art of effective facilitation. Sterling: Stylus Publishing; 2013. pp. 135–50.
Cook-Sather A. Creating Brave spaces within and through Student-Faculty Pedagogical partnerships. Teach Learn High Educ. 2016;18:1–5. http://repository.brynmawr.edu/tlthe/vol1/iss18/1 .
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ. 2009;14(4):595–621. https://doi.org/10.1007/s10459-007-9090-2 .
doi: 10.1007/s10459-007-9090-2
Nicol JS, Dosser I. Understanding reflective practice. Nurs Stand. 2016;30(36):34–42. https://doi.org/10.7748/ns.30.36.34.s44 .
doi: 10.7748/ns.30.36.34.s44
Winkel AF, Yingling S, Jones A, Nicholson J. Reflection as a learning tool in graduate medical education: a systematic review. J Grad Med Educ. 2017;9(4):430–9. https://doi.org/10.4300/jgme-d-16-00500.1 .
doi: 10.4300/jgme-d-16-00500.1
Yang Z, Tse MM, Chung JW, Chong DY, Wong TK. Exploring the impact of a compassion-oriented training program on personal care workers in a nursing home: a mixed-methods pilot study. Geriatr Nurs. 2023;54:16–22. https://doi.org/10.1016/j.gerinurse.2023.08.016 .
doi: 10.1016/j.gerinurse.2023.08.016
Canadian Mental Health Association. Despite almost all (92%) Canadians claiming to be compassionate, only 38% took action in the past year to alleviate hardship. (2024, May 2). https://cmha.ca/story/despite-almost-all-92-canadians-claiming-to-be-compassionate-only-38-took-action-in-the-past-year-to-alleviate-hardship/ .
Edwards RK, Kellner KR, Sistrom CL, Magyari EJ. Medical student self-assessment of performance on an obstetrics and gynecology clerkship. Am J Obstet Gynecol. 2003;188(4):1078–82.
doi: 10.1067/mob.2003.249
Ehrlinger J, Johnson K, Dunning D, Kruger J, Banner M. Why the unskilled are unaware: further explorations of (absent) self-insight among the incompetent. Organ Behav Hum Decis Process. 2008;105(1):98–121. https://doi.org/10.1016/j.obhdp.2007.05.002 .
doi: 10.1016/j.obhdp.2007.05.002
Haun DE, Zeringue A, Leach A, Foley A. Assessing the competence of specimen-processing personnel. Lab Med. 2000;31(11):633–7. https://doi.org/10.1309/8Y66-NCN2-J8NH-U66R .
doi: 10.1309/8Y66-NCN2-J8NH-U66R
Hodges B, Regehr G, Martin D. Difficulties in recognizing one’s own incompetence. Acad Med. 2001;76:S87–9. https://doi.org/10.1097/00001888-200110001-00029 .
doi: 10.1097/00001888-200110001-00029
Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121–34. https://doi.org/10.1037/0022-3514.77.6.1121 .
doi: 10.1037/0022-3514.77.6.1121
Pratt D, Collins J. Five perspectives on Teaching Education in Adult and Higher Education. Malabar: Kireger; 1998.
Beardsmore E, McSherry R. Healthcare workers’ perceptions of organisational culture and the impact on the delivery of compassionate quality care. J Res Nurs. 2017;22:42–56. https://doi.org/10.1177/1744987116685594 .
doi: 10.1177/1744987116685594
Crawford P, Brown B, Kvangarsnes M, Gilbert P. The design of compassionate care. J Clin Nurs. 2014;23:3589–99. https://doi.org/10.1111/jocn.12632 .
doi: 10.1111/jocn.12632
Tehranineshat B, Rakhshan M, Torabizadeh C, Fararouei M. Compassionate care in healthcare systems: a systematic review. J Natl Med Assoc. 2019;111(5):546–54. https://doi.org/10.1016/j.jnma.2019.04.002 .
doi: 10.1016/j.jnma.2019.04.002
Maslach C, Leiter MP. The burnout challenge: managing people’s relationships with their jobs. Cambridge: Harvard University Press; 2022.
doi: 10.4159/9780674287297
Landers M, Hegarty J, Saab MM, Savage E, Cornally N, Drennan J, Bassett G, Lunn C, Coffey A. Nurses’ and midwives’ views of the leaders for compassionate care program: a qualitative analysis. Collegian. 2020;27(1):2–10. https://doi.org/10.1016/j.colegn.2019.03.005 .
doi: 10.1016/j.colegn.2019.03.005
Lown BA, Shin A, Jones RN. Can organizational leaders sustain compassionate, patient-centered care and mitigate burnout? J Healthc Manag. 2019;64(6):398–412. https://doi.org/10.1097/jhm-d-18-00023 .
doi: 10.1097/jhm-d-18-00023
Saab MM, Drennan J, Cornally N, Landers M, Hegarty J, Savage E, Lunn C, Coffey A. Impact of a compassionate care leadership programme. Br J Nurs. 2019;28(11):708–14. https://doi.org/10.12968/bjon.2019.28.11.708 .
doi: 10.12968/bjon.2019.28.11.708
Jackson PW. Life in classrooms. New York: Teachers College; 1990.