What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

Abstract

Background: Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers.

Methods: Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts.

Results: Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners' attitudes, knowledge, skills and behaviors and the clinical process.

Conclusions: In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.

Keywords: Clinicians; Compassion; Education; Healthcare providers; Nurses; Training.

Fig. 1

Flow chart of study selection

Fig. 2

Program theory showing the relationships between contextual factors, mechanisms and outcomes (right) for compassion training. Bolded items have a stronger association with compassion training outcomes. Contexts were defined as conditions in which compassion training was introduced and that triggered the training (background circumstances/ unmet need); mechanisms explained the impact of the component introduced by the context (the under lying resources) on the cognitive or emotional decisions and behaviors of the learners (reasoning) that caused compassion training to produce a change; and outcomes were defined as intended and/or unintended consequences of compassion training (57, 58, 59). *bolded items have a stronger association with compassion training outcomes