Building Compassionate Experience through Compassionate Action: A Qualitative Behavioural Analysis (Preprint)

BACKGROUND The acceleration of virtual primary care during the COVID-19 pandemic outpaced the ability to understand whether and how it impacts care delivery and outcomes. As virtual care continues to evolve, focusing on the core construct of compassion in a primary care context will help ensure high-quality patient care and increased patient autonomy and satisfaction. The ability to successfully operationalize the use of technology in patient-clinician interactions hinges on not only understanding how compassionate care is experienced in this context, but understanding how clinicians can create it. OBJECTIVE The objectives were to (1) understand whether and how compassionate behaviours are experienced in virtual primary care interactions; and (2) identify the individual and contextual drivers that influence whether and how these behaviours occur. METHODS We conducted a series of one-on-one qualitative interviews with primary care physicians, nurses, and patients. Qualitative data were initially analyzed using an inductive thematic analysis approach to identify preliminary themes by participant group. We then looked across participant groups to identify areas of alignment and distinction. Descriptions of key behaviours that participants identified as elements of a compassionate interaction and descriptions of key drivers of these behaviours were inductively coded and defined at this stage. RESULTS A total of 74 interviews were conducted, including 40 patients, 20 nurses, and 14 primary care physicians. Key behaviours that amplified the experience of compassion included asking the patient’s modality preference, using video to establish virtual presence, sharing the screen, and practicing effective communication. Participants’ knowledge or skills as well as their beliefs and emotions influenced the specific behaviours described above. Elements of context beyond participants’ control influenced virtual interactions, including resource access, funding structures, culture, regulatory standards, work structure, societal influence, as well as patient characteristics and needs. A high-yield, evidence-based approach to address the identified drivers of compassion-focused clinician behaviours includes a combination of education, training, and enablement. CONCLUSIONS Much of the patient experience is influenced by clinician behaviour, however clinicians need a supportive system and adequate supports to evolve new ways of working in order to create the experience of compassionate care. The current state of virtual care operationalization has led to widespread burnout, societal pressure, and shifting expectations of both clinicians and the health system more broadly that are threatening the ability to deliver compassionate care. For clinicians to exhibit compassionate behaviours, they need more than just adequate supports; they need to receive compassion from and experience the humanity of their patients. CLINICALTRIAL

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