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.