The Compassion Connection in Cancer Care

I have recently been reading a lot about compassion. I’m not sure whether it’s triggered by a specific event or due to a long-standing interest in the interpersonal domain of oncology nursing. I have always wondered about the varying degrees of compassion I have observed at the bedside over the decades. Why are some of us so virtuous in our caring and others so distant and disconnected? Where does compassion come from anyway? Was a family member a role model for it for us when we were young or was it a profound reaction to some event we observed? And what, exactly, is compassion?

In 2017, Canadian colleagues published the results of a study in which they interviewed 53 patients with advanced cancer and asked them about their perceptions of sympathy, empathy, and compassion.¹ They also asked the patients what these constructs looked like in healthcare providers. Sympathy was depicted as an unwanted, pity-based response.

Empathy was perceived as an affective reaction whereby the professional attempts to understand the patient’s suffering. Compassion was the most preferred response. It was perceived to have empathy embedded in it and was distinguished by 2 unique characteristics, both relating to action rather than just feelings.

Compassionate professionals had a desire to relieve suffering rather than merely understand it. They acted on their feelings. There was an altruistic nature to their demonstrations of kindness, which were identified as going above and beyond the expected. Thus, if compassion is highly desired by patients who are suffering, we need to consider whether we can teach compassion as a necessary competency.

Contemporary neuroscientific research has identified a link between the mental and emotional foundations of compassion with brain functioning. Another study described that our brains don’t remain fixed over our lifetime and that by engaging in activities that foster connectivity and sensitivity at the bedside, we can enhance our capacity to read others’ cues and empathically respond.²

A growing body of work posits that our interactions can have physiologic effects that influence healing, improve functional impairment, and relieve psychological pain.^3,4 In the context of compassionate exchanges, we can trigger immunologic, hormonal, and neurologic processes, not just by what we say but by how we say it. Decades ago, in championing the modern hospice movement, Cicely Saunders, OM, DBE, FRCS, FRCP, FRCN, shared her insight that the power of listening and the ability to embody a compassionate presence in the face of suffering might be as important as any medical intervention.

In the book Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference, the authors speak of a “compassion crisis in healthcare.”⁵ In physicians, this can be characterized by brief, clinical interactions devoid of compassion, poor listening skills, and depersonalization, or the inability to connect with patients. Unfortunately, especially in teaching facilities, these behaviors may be exemplified in physician leaders and are emulated by those in training. How can we change this current problematic paradigm?

First and foremost, we must solicit more feedback from patients and families about their experiences, and we need to share these results. Years ago, as part of a grief group I cofacilitated, we asked family caregivers what it was like to be in the hospital setting when their loved one was dying. Results revealed that the nursing staff was perceived as extremely compassionate and concerned about the family’s well-being. In describing their loved one’s physicians, however, this was not the case.

The majority of comments were negative. Families felt abandoned. Their interactions with the physicians were void of compassion. They sensed the oncologists’ discomfort and saw this linked to their limited conversations, brief visits, or staying away altogether. In a subsequent cancer committee meeting, I shared this feedback with the predominantly physician group. I quoted the responses verbatim, making it hard to refute the accurateness of the comments. Little was said following my presentation, and the next item on the agenda was quickly brought forth. Despite this, I felt I had accomplished my goal, namely, to be the voice of our families and advocate on their behalf.

In a time of crisis, no one wants to be cared for by a healthcare professional devoid of compassion. I believe compassion can be taught and that this topic needs to be part of all healthcare professionals’ basic education. Subsequent skill enhancement should also be a component of ongoing education in the work setting.

I have been the recipient of non-compassionate and compassionate care by healthcare providers, over the years, mostly as a family caregiver. I can tell you that the difference between the two is palpable. Marketing the positive aspects of exemplary compassion might be a strategy to consider in motivating colleagues to embrace and learn this competency.

With compassion comes reciprocity. Personally, the extension of myself to suffer with a patient leaves me with the sense that I showed up and made a difference. What a gift. Mark Twain said that kindness is the language which the deaf can hear and the blind can see. True compassion has no limits.

References:

• Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliat Med. 2017;31(5):437-447. doi: 10.1177/0269216316663499.
• Baugher JE. Contemplative Caregiving: Finding Healing, Compassion, and Spiritual Growth Through End-of-Life Care. Boulder, CO: Shambhala Publications; 2019.
• Trzeciak S, Mazzarelli A. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. Pensacola, FL: Studer Group; 2019.
• Rakel D. The Compassion Connection: The Healing Power of Empathy and Mindful Listening. New York, NY: W.W. Norton & Co; 2018.
• Clark D. Cicely Saunders: A Life and Legacy. New York, NY: Oxford University Press; 2018.