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Compassion in Health Care: An Empirical Model
Open accessAbstract
CONTEXT: Compassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators, and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lacking-making compassion one of the most referenced yet poorly understood elements of quality care. OBJECTIVES: The objective of this study was to investigate palliative cancer patients' understanding and experiences of compassion to provide a critical perspective on the nature and importance of compassion. METHODS: This grounded theory study used semi-structured interviews to investigate how patients understand and experience compassion in clinical care. Using convenience and theoretical sampling, 53 advanced cancer inpatients were recruited over a seven-month period from a specialized palliative care unit and hospital-wide palliative care service within a Canadian urban setting. Data were analyzed by four members of the research team through the three stages of Straussian grounded theory. RESULTS: Qualitative analysis yielded seven categories, each containing distinct themes and subthemes. Together, they constitute components of the compassion model-the first empirically based clinical model of compassion. The model defines compassion as a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action. CONCLUSION: The components of the compassion model provide insight into how patients understand and experience compassion, providing the necessary empirical foundation to develop future research, measures, training, and clinical care based on this vital feature of quality care.
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“The authors note however that, compassion qualities can be cultivated or eroded over time, with practice setting being one of the most powerful modifiers.”
From Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an "on the job" program. (2018) · cites this paper as [73]
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“Thus, although the roots of compassion seem to be innate, current evidence suggests that training, including meditation, can help to sustain compassion and nurture it over time.”
From Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an "on the job" program. (2018) · cites this paper as [73]
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“They concluded that patient’s perceived compassion as being rooted in the virtues of their health care provider, generating the first evidence-based definition of compassion—a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.”
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“Compassion has been defined as “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action” [14].”
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“Patients experienced compassion if they perceived virtues such as love, genuineness, honesty, and kindness in the healthcare provider; if the provider created a relational space of engaged caregiving and sought to understand the patient and their needs; and if the provider attended to multiple patient needs—physical,…”
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“[28,40] These results are consistent with studies done by Gustin and Wagner [41] wherein a connection between empathy and compassion were established.”
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“Compassionate care (CC) is a core ethical principle of care among healthcare professionals (HCPs) in providing quality care [1], which is highlighted in codes of ethics [2], practice guidelines [3], and health policies [3, 4].”
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“Sinclair et al. (2016) describe the benefits to an oncology interdisciplinary team.”
BackgroundThe Art of Compassion in Mental Healthcare for All: Back to the Basics
Sengupta, P., & Saxena, P. (2023) · Indian Journal of Psychological Medicine · doi:10.1177/02537176231158126 · Cited by 15
“Both research 25,26,27 and anec-dotal accounts indicate an acute crisis of lack of compassion in healthcare.”
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“Research findings suggest a discrepancy between patients’ and healthcare providers’ perceptions of compassionate care – a phenomenon that is replicated across the globe (Sinclair et al., 2016a).”
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Rosa, W. E. (2018) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000415 · Cited by 11
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“31 This may impact clinical decisions, patient care and patient engagement.”
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“Moreover, patients and their families, providers, and health organizations identify compassion as a hallmark of quality care (Paterson, 2011; Sinclair et al., 2016; Cochrane et al., 2019; Trzeciak and Mazzarelli, 2019).”
BackgroundProviding compassionate care via eHealth
Su, J. J., Bayuo, J., Lin, R. S. Y., Baťalík, L., Chen, X., Abu‐Odah, H., & Chan, E. A. (2024) · Nursing Ethics · doi:10.1177/09697330231196226 · Cited by 9
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“An extensive and growing body of research highlights the importance of caregiver compassion for patient well-being and clinical outcomes [53,54], and our findings are consistent with this in as much as the systematic cultivation of resilient compassion in CCSH appears to improve SHC effectiveness.”
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“The notion of presence has been described as a pivotal part of nonverbal communication at the bedside (Sinclair et al., 2016) as well as defined as ‘‘providing one-on-one time that is devoted solely to a patient and their family that allowed for a sharing of thoughts and reflections.”
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“Compassion is defined as a response that “seeks to address the suffering and needs of a person through relational understanding and action” [55, 56].”
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“There is much literature on the subject of compassion and empathy in healthcare and how much they are needed as part of quality care; many models are being developed for reintroducing it in the teaching curricula of healthcare professionals [27, 35,36].”
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“Leaders through creating trust and the conditions for valuable teamwork, known tenets in creating positive relationships, can strengthen these layers (Lee et al., 2018; Sinclair et al., 2016).”
Family and Patient Spiritual Narratives in the ICU: Bridging Disclosures through Compassion
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“These aspects are also mentioned as generic components of compassionate care (Sinclair et al., 2016) or patient-centered TJA care (MarcusAiyeku et al.”
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“…add to the collective evidence describing the significant impact of empathetic, patient-centered, and compassionate interactions from healthcare workers on outcomes (Barker et al., 2023; Durkin et al., 2022; Nätterlund, 2010; Rose et al., 2019; Sinclair et al., 2016; Smith-MacDonald et al., 2019).”
Breaking the silence: barriers to maternal healthcare utilisation among women in South-South Nigeria
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“Having recently developed a model of compassion across various clinical settings [10, 15–18,”
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Bond, C. (2024) · Nursing Standard · doi:10.7748/ns.2024.e12444 · Cited by 6
Ekwonye, A. U., Brueggemann, A., Gerdes, S., Phi, K. M., Kloepfer, V., Karmacharya, P., Phung, V., & Sidek, S. M. (2022) · Gerontology & Geriatrics Education · doi:10.1080/02701960.2022.2057968 · Cited by 6
“According to Sinclair et al. (2016), compassion is a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.”
BackgroundInfluentialJoy, P. R., Thomas, A., & Aston, M. L. (2022) · Qualitative Health Research · doi:10.1177/10497323221110701 · Cited by 11
“Within healthcare compassion has been noted to be a priority (Sinclair et al., 2016).”
BackgroundInfluentialNursing and Midwifery Managers’ Views on Compassion in Daily Practice: A Survey in Greece and Cyprus
Kouta, C., Apostolara, P., Rousou, E., Malliarou, M. M., & Papadopoulos, I. (2022) · Journal of Health Management · doi:10.1177/09720634221128087 · Cited by 6
“Compassion in healthcare is considered a ‘hallmark of quality’ (Sinclair et al., 2016, p. 193), however researchers suggest that the nursing profession must reset its moral compass (De Zulueta, 2015; Johnstone, 2017).”
BackgroundPavlova, A., Paine, S., Cavadino, A., O’Callaghan, A., & Consedine, N. S. (2023) · British Journal of Health Psychology · doi:10.1111/bjhp.12687 · Cited by 7
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“The present study illustrated that displaying compassion towards patients is another important element in clinical communication and facilitates trust in healthcare providers [61].”
BackgroundWhat Might a Good Compassionate Force Protocol Look Like?
George, C. E. (2021) · The AMA Journal of Ethic · doi:10.1001/amajethics.2021.326 · Cited by 6
Compassion is a key quality for palliative care teams
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Compassionate care in obesity management: reclaiming humanity in health care
Wharton, S., Boaventura, B. C. B., Salas, X. R., Brocq, S. L., Sinclair, S., & Stanford, F. C. (2025) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(25)00089-0 · Cited by 6
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“11,12 Moreover, there is a growing emphasis on the moral attributes of “ compassionate ” healthcare professionals.”
Empathy and Humanistic Care Ability in Oncology Nurses: The Mediating Role of Emotional Intelligence
Wei, J., Dai, D., Sun, Y., Zheng, W., Gao, M., & Liu, Y. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.70463 · Cited by 5
Intensive Care Nurses’ Experience of Caring in Greece; A Qualitative Study
Parissopoulos, S., Timmins, F., Mpouzika, M. D. A., Μαντζώρου, Μ., Kapadochos, T., & Papagaroufali, E. (2023) · Healthcare · doi:10.3390/healthcare11020164 · Cited by 5
“Empathy in critical care encompasses acting in the best interest of the patient and results in caring with compassion [78].”
Background"Silences in palliative care-the primacy of human presence "
Simões, Â. (2018) · Hospice and Palliative Medicine International Journal · doi:10.15406/hpmij.2018.02.00081 · Cited by 5
Fraser, K., Brady, J. L., & Lordly, D. (2020) · Canadian Journal of Dietetic Practice and Research · doi:10.3148/cjdpr-2020-032 · Cited by 5
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“It is a key quality through which healthcare providers emotionally perceive patients’ suffering and needs by wanting to alleviate it with relational understanding and actions [2].”
BackgroundImpact of a mental health patient portal on patients’ views of compassion: a mixed-methods study
Shin, H. D., Durocher, K., Lo, B., Chen, S., Ma, C., Wiljer, D., & Strudwick, G. (2023) · BMC Digital Health · doi:10.1186/s44247-022-00002-z · Cited by 5
“Virtues and virtuous responses Patients feel that compassion arises from virtues of openness, understanding, and genuineness, and virtuous responses of clinicians are actions that convince virtue toward patients [5].”
BackgroundMethodInfluentialThe emergence of team compassion: Theoretical implications and practical interventions
Bui, L. T. T., Park, G., & Wang, L. (2024) · Australian Journal of Management · doi:10.1177/03128962241286180 · Cited by 6
Younas, A., & Rasheed, S. P. (2018) · Creative Nursing · doi:10.1891/1078-4535.24.4.220 · Cited by 5
“Within the healthcare context, compassion is defined as a virtuous and relational response of healthcare providers to understand their patients’ needs and suffering and alleviate their suffering (Sinclair et al., 2016); it also means being in solidarity with one another to share moments of sadness and doing with one a…”
BackgroundEmotional Hazards of Nurses' Work
Boyle, D. A., & Steinheiser, M. M. (2021) · Journal of Infusion Nursing · doi:10.1097/nan.0000000000000419 · Cited by 5
Tamura, N., Park, S., Sato, Y., Takita, Y., Morishita, J., Ninomiya, A., Kosugi, T., Sado, M., Mimura, M., & Fujisawa, D. (2020) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000022 · Cited by 5
Tam, L., Burns, K., & Barnes, K. (2020) · Health Expectations · doi:10.1111/hex.13155 · Cited by 5
Patsakos, E., Patel, S., Simpson, R., Nelson, M. L. A., Penner, M., Perrier, L., Bayley, M. T., & Munce, S. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1365205 · Cited by 4
“…the last 30 years, compassion has received increasing attention from the scientific community, recognizing its benefits and positive associations with quality of life, clinical outcomes, and satisfaction with healthcare services (Sinclair et al., 2016; Strauss et al., 2016; Malenfant et al., 2022).”
BackgroundInfluentialKavradım, S. T., Akgün, M., Özer, Z., & Boz, İ. (2022) · Perspectives In Psychiatric Care · doi:10.1111/ppc.13067 · Cited by 4
Beyond Compassion Fatigue: Motive-Based Approaches to Sustaining Compassion in Palliative Care
Pierdziwol, A. (2022) · Religions · doi:10.3390/rel14010050 · Cited by 5
Santos, L., Pinheiro, M., & Rijo, D. (2023) · Mindfulness · doi:10.1007/s12671-023-02239-9 · Cited by 4
“Compassionate care and communication can positively impact caregiver and care receiver interactions (Brown et al., 2014; Sinclair et al., 2016).”
BackgroundInfluentialThe Physician and End-of-Life Spiritual Care: The PALliatiVE Approach
Antunes, M., & Reis-Pina, P. (2022) · The American journal of hospice & palliative care · doi:10.1177/10499091211068819 · Cited by 3
“This is why compassion, a word that literally means suffering with another, is the physician’s main asset to become a source of hope for the patient and his family.(74) This means, necessarily, that not all doctors will have the ability to use this tool.”
BackgroundThe Centrality of Compassion in Mental Health Nursing
Bond, C., Usher, K. J., & Jackson, D. W. (2025) · International Journal of Mental Health Nursing · doi:10.1111/inm.70048 · Cited by 4
Compassionate Presence in Seriously Ill Cancer Patients
Renz, M., Gloggner, C., Bueche, D., & Renz, U. (2024) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091241226629 · Cited by 5
“10 Nevertheless, empirical data on the occurrence of compassion exhaust neither the phenomenon nor its meaning in existential situations.”
Ağaç, M., Düzgün, N., & Demi̇r, S. (2024) · Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi · doi:10.37989/gumussagbil.1366946 · Cited by 3
Peerboom, F. B. A. L., Friesen-Storms, J. H. H. M., van der Steen, J. T., Janssen, D. J. A., & Meijers, J. M. M. (2024) · Geriatric Nursing · doi:10.1016/j.gerinurse.2024.08.042 · Cited by 9
Roskvist, R. P., & Consedine, N. S. (2025) · British Journal of Health Psychology · doi:10.1111/bjhp.70013 · Cited by 2
Akgün, M., Kavradım, S. T., Boz, İ., Özer, Z., & Cronin, S. N. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12702 · Cited by 4
Exploring concepts of compassion in care home settings: a scoping review protocol
Evans, J., Grant, L., Pessi, A. B., Evans, L., & Voolma, S.-R. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-055033 · Cited by 3
End of life care: how nurses can use a compassionate approach
Quinn, B. G. (2024) · Nursing Standard · doi:10.7748/ns.2024.e12260 · Cited by 3
Singh, H., Nelson, M. L. A., Premnazeer, M., Haghayegh, A. T., Munce, S., Sperling, C., & Gray, C. S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0309148 · Cited by 3
Bovero, A., Fraoni, A., Urru, S., Berchialla, P., Cotardo, F., Girolamo, I. D., Ostacoli, L., Sinclair, S., & Carletto, S. (2024) · Palliative & Supportive Care · doi:10.1017/s1478951524001202 · Cited by 3
“Compassion can be defined as “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action” (Sinclair et al. 2016a; 2017a).”
InfluentialSelf-citationCompassion in Healthcare: Theoretical Perspectives and Attributes
George, J. M. (2022) · International Journal of Health Sciences and Research · doi:10.52403/ijhsr.20220244 · Cited by 3
“Though many authors have conceptualized compassion in healthcare as a relational care construct, it was Sinclair et al. (2016) who defined it as engendering and developing relationships to achieve relevant outcomes to address needs, specifically those related to suffering (47–49).”
BackgroundSeeking Precision Healthcare in Rural Patients With Cancer: Learning Self-advocacy
Curtin, M. S., Somayaji, D., & Dickerson, S. S. (2024) · Cancer Nursing · doi:10.1097/ncc.0000000000001397 · Cited by 2
Chen, C., Yee, B., Sutton, J., Ho, S., Cabugao, P., Johns, N. B., Saucedo, R., Norman, K., Bassett, C. H., Batra, K., et al. (2024) · Healthcare · doi:10.3390/healthcare12232351 · Cited by 2
Self-citationConsedine, N. S., Pavlova, A., & Baguley, S. I. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09259-8 · Cited by 2
“27 Rather, most of our studies into the predictors and interventions to facilitate compassion are directly or indirectly based on the notion that increasing compassion among providers will make patients feel more cared for without asking patients about their experience of care in any systematic way.”
Metadata
- Authors
- Sinclair, S., McClement, S., Raffin-Bouchal, S., Hack, T. F., Hagen, N. A., McConnell, S., & Chochinov, H. M.
- Affiliations
- University of Calgary (CA)
- CancerCare Manitoba (CA)
- Corresponding author
- Sinclair, Shane
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 51
- Issue
- 2
- Pages
- 193-203
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W1912558312
- Cited by
- 328
- References
- 39
- Citations by year
- 2026: 42 · 2025: 39 · 2024: 39 · 2023: 21 · 2022: 39 · 2021: 36 · 2020: 41 · 2019: 27 · 2018: 21 · 2017: 13 · 2016: 10
- FWCI
- 11.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Libraries and Cultural Resources (University of Calgary) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (125931)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- compassion, palliative care, advanced cancer, patient experience, quality of care, patient suffering, relational understanding
- MeSH terms
- Canada, Empathy, Female, Humans, Inpatients, Interviews as Topic, Male, Middle Aged, Models, Theoretical, Neoplasms, Palliative Care, Urban Population, Qualitative Research
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