Table 2 Summary of the contexts, mechanisms, and outcomes most commonly associated with compassion training for practicing healthcare providers
Contexta | Description of contexts | |
Setting |  | • Mixed, acute care, palliative care, primary care; mental health; elderly care; care home; high-risk populations; oncology |
Healthcare provider |  | • Nurses; clinicians; multidisciplinary |
Healthcare system context | Need for an integrated approach to care | • Lack of leadership and team practices that nurture and sustain individual caregiver relational capacity • Creation of unpredictable pressures due to complex challenges in the health-care setting • Need for patient-centered processes aimed at improving efficiency, safety, and the patient experience to be central to the delivery, and evaluation of health care services |
Healthcare provider context | Need to nurture innate compassion | • Need to understand the personal and clinical experiences of healthcare providers as they impact the healthcare provider-patient relationship |
Need for stress-reduction | • Stress and burnout impact negatively on the caring relationship and the healing environment | |
Need to improve clinical competence | • The specific knowledge, skills and attitudes of healthcare providers must be increased to improve quality of care | |
Mechanismsb | Description of mechanism | |
Resource | Workplace based learning | • Development of leadership and team practices giving healthcare providers a framework to deliver compassion based on human interactions. • Rounds, multidisciplinary forums in which participants reflect on clinical experiences. |
|  | Participatory interventions supporting individual healthcare providers | • Contemplative therapy, including mindfulness and compassion-oriented practices, meditation, and mind body therapies • Complementary therapy, including Healing Touch (an integrative biofield therapy) and Compassionate Touch as nonpharmacological approaches to patient care • Fostering reflection through bounded time or use of various media such as literature, art, writing and sharing narratives • Rounds • Self care through contemplative and complementary therapies • Evidence-based curricula targeted at specific patient populations • Simulation and role play • Vignettes focused on improving patient and family centred care • Clinical instruction and community service |
Reasoning | Teaching mechanisms | • Highly qualified program leaders and facilitators who provided mentoring, role modeling, advice and training • Team learning activities, e.g., developing a community of practice, implementing collective action plans, and conducting local team climate analyses, values clarification, team study days, and team discussions • Continuous learning, e.g. ensuring clinical work covered by float healthcare providers, offering booster sessions, and sending weekly reminders and tips • Staff empowerment • Education in context • Contemplative practices • Discussion, briefing and debriefing following ‘best practice’ • Case based scenarios • Role play • Patient storytelling • Didactic lecture • Video/audio taping • Multimodal |
Learning mechanisms | • Group participation, created a sense of community and a vital common goal • Feedback, generated discussion on why particular interactions worked well • Recognition and sharing of positive practices • Reflection, increased learners subjective understanding of the patient experience • Discussion • Mentoring, provided a safe teaching environment • Experiential/hands-on learning • Critical thinking and problem solving • Linking theory to practice | |
Organizational mechanisms | • Integration of activities with the priorities of the wider organization • Time efficient e.g., abbreviated format with dedicated online resources • Flexibility in programming • Cost-effective, costs of compassion training balanced against organizational benefits and cost savings of increasing the quality of care • Course credits and cash/prize incentives | |
Outcomesc | Description of outcomes | |
|  | Program level | • Training was perceived to be highly important • Training was informative, engaging and enjoyable • Training was well designed, delivered and facilitated |
|  | Healthcare provider level | • Increased self-awareness • Reduced burnout, depression, anxiety, and stress • Promoted self care • Enhanced interpersonal relationships • Enhanced compassion for self and compassion for others |
|  | Healthcare system level | • Created better leaders who assumed authority, implemented change, and supported team learning • Improved relational capacity within teams • Improved staff–patient interactions and emotional care of patients and their relatives • Increased clinical knowledge and development of new skills and ideas to improve care • Decreased unplanned work absences • Improved patient safety |