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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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Self-citationTurkish version of the 5-item Compassion Measurement Tool: A validity and reliability study
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“4,5 Therefore, compassion competence is crucial for mental health nurses.”
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“14,15 The Department of Health, England, has proposed three pillars for quality healthcare: patient safety, clinical effectiveness, and patient experience.”
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Adaptation of the Sinclair Compassion Questionnaire Into Turkish: A Validity and Reliability Study
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“Compassion was recently em-pircially de fi ned as “ a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action ” (Sinclair et al., 2016).”
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“Sinclair et al. (2016b) conducted a scoping review of the concept of compassion in human healthcare, finding themes that emerged from compassion-related studies included the nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical…”
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“Although empathy and compassion are conceptually distinct, some literature has noted that they are occasionally used inter-changeably in clinical discourse [12,13].”
Behan, C., & Kelly, B. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009390217.006
Behan, C., & Kelly, B. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009390217.002
Background to Compassionate Healthcare
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“In recent years, compassion has gained increasing importance in healthcare (Sinclair et al., 2016a, 2016b) due to personal benefits such as improvements in mental and physiological health, emotional regulation, or interpersonal and professional relationships (Matos et al., 2022), highlighting a…”
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“The seminal work by Sinclair and colleagues [22,23] considers compassion as a distinct and overarching component of quality care: it requires “healthcare providers to invoke their personhood along with their clinical proficiencies to have an optimal effect in alleviating patient suffering” [22] (p.…”
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“However, publications investigating how patients and their families experience compassion in healthcare are beginning to emerge [5].”
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Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530384
Self-citationAdditional file 1 of A scoping review of the self-reported compassion measurement tools
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Additional file 1 of Compassionate care during the COVID-19 pandemic
Su, J. J., Bayuo, J., Lin, R. S. Y., Wong, A. K. C., Abu‐Odah, H., He, Q., & Baťalík, L. (2024) · Figshare · doi:10.6084/m9.figshare.25405912
Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530390
Self-citationSinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530387
Self-citationSinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530393
Self-citationAdditional file 1 of Compassion in healthcare: an updated scoping review of the literature
Malenfant, S., Jaggi, P., Hayden, K. A., & Sinclair, S. (2022) · Figshare · doi:10.6084/m9.figshare.19791004
Self-citationBoss, H., MacInnis, C. C., Simon, R., Jackson, J., Lahtinen, M., & Sinclair, S. (2024) · Figshare · doi:10.6084/m9.figshare.26751185
Self-citationSinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530378
Self-citationDeDecker, J. L., & Ladd, W. (2025) · The Journal of Perinatal Education · doi:10.1891/jpe-2024-0041
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Thanthrige, A. N. W., & Wickramasinghe, N. S. (2026) · JMIR Research Protocols · doi:10.2196/86515
“The chatbot integrates Google Dialogflow ES, operational-izing empathy-driven interactions grounded in the CARE framework [17].”
InfluentialRigatos, S., Lionis, C. D., Gouva, M., Tzenalis, A., Anastasaki, M., & Albani, E. N. (2026) · Cureus · doi:10.7759/cureus.104092
“…absence of a control group and the lack of longitudinal follow-up preclude the ability to definitively isolate the intervention's effect from natural maturation or to assess the sustainability of improvements once students transition into "systemically uncompassionate" clinical environments [28].”
Patsakos, E., Simpson, R., Nelson, M. L., Penner, M., Bayley, M. T., & Munce, S. E. (2026) · doi:10.2196/preprints.93178
Sinclair, S., Kondejewski, J., Jaggi, P., Ordons, A. R. D., Kassam, A., Hayden, A., Harris, D., & Hack, T. (2021) · Figshare · doi:10.6084/m9.figshare.16530381
Self-citationExploring the role of compassion in mental health nursing
Bond, C., Ashmore, R., & Cottam, C. (2026) · Mental Health Practice · doi:10.7748/mhp.2026.e1756
Yang, C., & Rho, E. (2026) · Emerald Group Publishing Limited eBooks · doi:10.1108/s0749-742320260000023011
Thanthrige, A. N. W., & Wickramasinghe, N. S. (2026) · Digital Health · doi:10.1177/20552076261436271
“The MiCARE framework serves as the designed artifact — the tangible output of design science research methodology (DSRM) — synthesizing multi-theoretical models: Self-Determination Theory (SDT), 31 the CARE framework (Compassion, Assistance, Respect, Empathy), 32,33 UCD, 34,35 and Inclusive Design.”
Müller, C., Authier, D., Steger-Arand, C., Braun, R., Herr, W., Schnell, A., & Rechenmacher, M. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14399-0
Fujikawa, H., Mori, H., Kondo, K., Nishizaki, Y., Watari, T., 片岡仁美, Emoto, T., & Naito, T. (2026) · Medical Teacher · doi:10.1080/0142159x.2026.2663861
“A growing body of literature suggests that compassion is not only determined by individual-level attributes but is also influenced by contextual or environmental factors [20,21].”
Gentile, S., Mosienko, L., Pankratz, L., Olafson, K., Pirzada, S., Papineau, K., Gill, G. K., Hiebert, T., Kredentser, M. S., Bolton, J. M., et al. (2026) · Journal of Critical Care · doi:10.1016/j.jcrc.2026.155578
Self-citation
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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