'It's very values driven': A qualitative systematic review of the meaning of compassion according to healthcare professionals.

AIMS AND OBJECTIVES: To explore the meaning ascribed to the concept of compassion by healthcare professionals. BACKGROUND: Compassion is universally regarded as the foundation of healthcare, a core value of healthcare organisations, and essential to the provision of quality care. Despite increasing research on compassion in healthcare, how healthcare professionals understand compassion remains unclear. DESIGN: A systematic review of qualitative studies was conducted and is reported following PRISMA guidelines. METHOD: Medline, Emcare, PsychINFO and CINAHL were searched to November 2021 for qualitative studies in English that explored healthcare professionals' understandings of compassion. Included studies were appraised for quality before data were extracted and thematically analysed. FINDINGS: Seventeen papers met the inclusion criteria. An overarching theme, 'It's very values driven' underpins the four main themes identified: (1) 'It's about people and working with them': Compassion as being human, (2) 'There is this feeling': Compassion as being present, (3) 'If I don't understand them, I won't be able to help': Compassion as understanding, (4) 'Wanting to help in some way': Compassion as action. CONCLUSIONS: Healthcare professional participants reported compassion as motivated by values and inherent to humanistic healthcare practice. The meanings healthcare professions described were varied and contextual. Qualitative research should further explore healthcare practitioners' experiences of compassion as part of their practice to inform health professions education, policy, and practice. RELEVANCE TO CLINICAL PRACTICE: To practice with compassion, healthcare professionals require supportive and humanistic organisations that honour each person's humanity and encourage people to be human and compassionate to each other as well as to patients, their families and/or carers. Healthcare professionals need to reflect on what compassion means to them, how it is situated within their unique practice context, and how compassion can enhance clinical practice. NO PATIENT OR PUBLIC CONTRIBUTION: This systematic review had no patient or public contribution.

Using Positive Deviance to Enhance HIV Care Retention in South Africa: Development of a Compassion-Focused Programme to Improve the Staff and Patient Experience.

Background: HIV burden remains high in South Africa despite intensive efforts to curtail the epidemic. Public primary care facilities, where most people with HIV (PWH) in South Africa receive treatment, face myriad challenges retaining patients on antiretroviral therapy (ART). Nevertheless, some facilities manage to consistently retain PWH in care. We used a participatory Positive Deviance (PD) approach to discover characteristics of primary care facilities with above-average 12-month retention rates to develop an intervention. PD is an asset-based approach to behavior change that consists of discovering how high-performing outliers succeed despite sizable barriers, and then using those data to develop interventions for low-performers. Methods: We conducted 11 in-depth leadership interviews, 9 staff focus groups with 29 participants, 11 patient focus groups with 45 participants, 23 patient shadowing visits, and 3 clinic observations in each of 3 high- and 3 low-retention public primary care facilities in Cape Town, South Africa, to discover characteristics of high-retention facilities that might be contributing to higher retention rates. Results: Themes found to a greater degree in high-retention facilities were compassionate, respectful, patient-centered care; higher staff morale, passion for the work and team cohesion; efficient workflow procedures; and a welcoming physical environment. From these themes we developed the Connect intervention, consisting of strategies within three domains: (1) Engage, encourage, and support staff (e.g., a monthly staff support huddle, a compassion training); (2) Expedite and augment workflow procedures (e.g., adjust folder system to lower wait times); (3) Create a welcoming physical environment (e.g., fresh paint and plants in the waiting area). Conclusions: A PD approach enabled us to identify factors that could be contributing to higher ART retention rates within low-resource public sector primary care facilities in Cape Town, South Africa. If effective, Connect could be a feasible, affordable complement to existing programmes aimed at improving care for PWH.

A psychometric study of the Compassionate Love Scale for Humanity Short version (CLS-H-SF) within a paramedicine student cohort.

INTRODUCTION: There is a lack of research on compassion within paramedicine practice despite it being a fundamental component of healthcare. Existing studies have focussed primarily on the related concept of empathy. Additionally, the concept of common humanity has been suggested as a core component of compassion, and it informs the assessment scale utilised in the present study. METHODS: An Exploratory Factor Analysis (EFA) was performed on the 9-item Compassionate Love Scale for Humanity (CLS-H-SF), using a convenience sample of paramedicine students from an Australian university. RESULTS: A total of 225 students completed the study (55% response rate). EFA of the CLS-H-SF supported a one-factor solution with all items being retained and accounted for 53.26% of the total explained variance. The Cronbach alpha coefficient for the 9-items was α .909 indicating excellent internal consistency. DISCUSSION: Factor analysis supported results from a previous psychometric examination of the CLS-H-SF, indicating that the scale shows strong psychometric properties. The literature has also reported other abridged versions of the original 21-item scale; however, these have not been tested within a paramedicine cohort. CONCLUSION: This evaluation suggests that the CLS-H-SF demonstrates robust psychometric characteristics when used in an Australian paramedic student cohort. Although further examination is warranted, it appears that the CLS-H-SF may be a valuable tool to examine compassion within paramedicine students.

Pharmacokinetics of buprenorphine: a comparison of sublingual tablet versus liquid after chronic dosing.

Although buprenorphine is approved for use in the outpatient treatment of opioid addiction in 2 tablet formulations, a monoproduct containing buprenorphine only (Subutex) and a buprenorphine/naloxone combination product (Suboxone), much of the clinical data that support the approval by the U.S. Food and Drug Administration were generated by using a sublingual liquid. To interpret the literature in prescribing parameters for tablet buprenorphine, this study was designed to determine steady state buprenorphine plasma levels for the 2 formulations and to assess the relative bioavailability of each. A randomized, double-blind, crossover study with dose increases was conducted during a 12-week period at an outpatient treatment clinic. Of the 184 subjects initially randomized to treatment, 133 (72.3%) were evaluated for the steady-state trough plasma concentration, 16 (8.7%) for relative bioavailability, and 31 (16.8%) for dose proportionality. At steady state, differences in the trough plasma concentrations of buprenorphine between the 2 formulations were found across all the dose levels. Average plasma concentration (Cavg) of the tablet at twice the milligram dose of the liquid was twice that of the liquid; intersubject variability was greater for the tablet. At double the dose of tablet, there is no difference in steady state plasma concentrations. The bioavailability seems equivalent for the 2 formulations across all the dose levels.