Background: Compassionate patient care is essential for improving patient outcomes and enhancing healthcare experience. However, in lower-middle-income countries (LMICs) like Pakistan, systemic barriers and a lack of structured curricula hinder its consistent delivery. This study evaluates a targeted compassion-training intervention for residents in a tertiary care hospital and explores barriers to its implementation. Given shared challenges like resource constraints, high patient loads, and gaps in formal training, these findings have broader implications for integrating structured compassion-based education across LMICs.
Methods: This quasi-experimental mixed-methods study was conducted with first-year residents over a one-year period (November 2023 - October 2024). A 4-hour compassion-training session was delivered to develop compassion as a clinical competency. Quantitative data on satisfaction and self-reported compassion competence were collected using the Sinclair Compassion Questionnaire-Healthcare Provider Competence Self-Assessment (SCQ-HCPCSA) and analyzed via paired t-tests. Qualitative data from focused group discussions (FGDs) exploring barriers and facilitators underwent thematic analysis.
Results: 204 residents participated. Baseline compassion competence was 4.03 ± 0.54, with no demographic variations (p > 0.05). Participants rated sessions highly for interest (4.54 ± 0.65), relevance (4.50 ± 0.82), and interactivity (4.68 ± 0.61). Post-training, compassion competence significantly improved to 4.58 ± 0.47 (p < 0.001), with all SCQ-HCPCSA items showing significant improvements (p < 0.001). Qualitative findings revealed key barriers to practicing compassionate care, including time constraints, high workloads, and compassion fatigue, particularly in high-pressure specialties like surgery and intensive care. Institutional factors like documentation inefficiencies, financial pressures, and hierarchical workplace culture also limit compassionate care delivery. Culturally specific challenges emerged, including language barriers, differences in patient expectations, and perceptions of compassion as a transactional service in a largely out-of-pocket healthcare system. Facilitators of compassionate care included interdisciplinary collaboration, supportive senior staff, and effective communication strategies.
Conclusions: Targeted compassion-training interventions can enhance compassionate care among physicians. To ensure long-term impact, postgraduate medical education programs should formally integrate structured curricula, alongside institutional policy reforms that reduce administrative burdens and promote interdisciplinary collaboration. Future studies should explore long-term retention of training effects and assess scalability of similar curricula across diverse healthcare settings, particularly in other lower-middle-income countries.
Trial registration: Not applicable.
Keywords: Compassionate care; Curriculum; Empathy; Simulation-based learning.
© 2025. The Author(s).