In search of compassion: a new taxonomy of compassionate physician behaviours.

BACKGROUND

Compassion has been extolled as a virtue in the physician-patient relationship as a response to patient suffering. However, there are few studies that systematically document the behavioural features of physician compassion and the ways in which physicians communicate compassion to patients.

OBJECTIVE

To develop a taxonomy of compassionate behaviours and statements expressed by the physician that can be discerned by an outside observer.

DESIGN

Qualitative analysis of audio-recorded office visits between oncologists and patients with advanced cancer.

SETTING AND PARTICIPANTS

Oncologists (n = 23) and their patients with advanced cancer (n = 49) were recruited in the greater Rochester, New York, area. The physicians and patients were surveyed and had office visits audio recorded.

MAIN OUTCOME MEASURES

Audio recordings were listened to for qualitative assessment of communication skills.

RESULTS

Our sensitizing framework was oriented around three elements of compassion: recognition of the patient's suffering, emotional resonance and movement towards addressing suffering. Statements of compassion included direct statements, paralinguistic expressions and performative comments. Compassion frequently unfolded over the course of a conversation rather than being a single discrete event. Additionally, non-verbal linguistic elements (e.g. silence) were frequently employed to communicate emotional resonance.

DISCUSSION AND CONCLUSIONS

This study is the first to systematically catalogue instances of compassionate communication in physician-patient dialogues. Further refinement and validation of this preliminary taxonomy can guide future education and training interventions to facilitate compassion in physician-patient interactions.