Agenda proposed to promote compassionate care

National survey shows about half of patients say it's missing in the US health care system

In light of a national survey showing that only about half of patients believe the U.S. health care system is a compassionate one, the Schwartz Center for Compassionate Healthcare today proposed an agenda for improving such care in an article in the September issue of Health Affairs, the nation's leading health policy journal.

"For most clinicians, compassionate care matters because it is fundamental to the practice of medicine, ethically sound, and humane," according to lead author Beth Lown, MD, medical director of the Schwartz Center and an associate professor of medicine at Harvard Medical School. "However, there is also strong evidence that compassionate care improves health outcomes and quality of life, increases patient satisfaction, and lowers health care costs. Particularly as our health care system faces such intense pressure to reduce costs, we must make sure that this critically important element of health care is not lost."

To ensure that all patients receive compassionate care, the Schwartz Center recommends that:

- The federal government include compassionate care measures in national quality standards and create a Compassionate Care Index (CCI) to measure the level of compassionate care being delivered by health care institutions and individual providers;
- The Patient-Centered Outcomes Research Institute created by the Affordable Care Act fund comparative effectiveness research to determine which aspects of compassionate care have the greatest impact on health outcomes, quality of life, and patient satisfaction;
- New health care payment systems, including the Centers for Medicare and Medicaid Services' proposed value-based purchasing system, reward providers for the compassionate care they provide to patients and families; and
- Comprehensive training programs be developed to help health care professionals and trainees develop the necessary skills required for compassionate care.

The Schwartz Center's recommendations are in response to the results of a national survey of 800 patients and 510 doctors that it conducted in the fall of 2010. The survey found that only 53 percent of patients and 58 percent of doctors rate the U.S. health care system as a compassionate one, despite strong agreement among patients and doctors that compassionate care is important to successful medical treatment and can even make a difference in whether a patient lives or dies.

The survey also found that more than two-thirds of patients (67%) and more than half of doctors (55%) are concerned that the changes taking place in the U.S. health care system, including the increased emphasis on controlling costs, will affect the ability of doctors, nurses, and other health care professionals to provide compassionate care. At the time of the survey, more than half of the doctors surveyed (53%) said they were already spending less time with patients than they wanted.

According to the Schwartz Center, compassionate care is defined by the following four essential characteristics:

- Empathy, emotional support, and a desire to relieve a patient's distress and suffering
- Effective communication at all stages of a patient's illness and treatment
- Respecting patients' and families' desires to participate in making health care decisions
- Knowing and relating to the patient as a whole person, not just a disease

"There is a great deal of emphasis in health care these days on providing 'patient-centered' care, but care without compassion cannot truly be patient centered," said Dr. Lown, who also works as a general internist at Mount Auburn Hospital in Cambridge, Massachusetts.

"Health care providers need time to listen to their patients, education in the skills of compassionate care, feedback based on measures of their performance, and leaders and systems that support healing relationships with patients and families," she and her co-authors write.

"Compassion is as important in helping patients manage chronic and acute conditions as it is at the end of life," Dr. Lown added. "To improve quality and reduce costs, compassion should be present in all aspects of our health care system."