Measuring Compassion in Healthcare: A Comprehensive and Critical Review

  • Shane Sinclair
  • Lara B. Russell
  • Thomas F. Hack
  • Jane Kondejewski
  • Richard Sawatzky
Systematic Review



There is international concern about the lack of compassion in healthcare systems. A valid and reliable tool for measuring compassion in healthcare systems and educational institutions is required. This comprehensive and critical narrative synthesis identified and compared existing measures of compassionate care in clinical settings.


PubMed, MEDLINE, CINAHL and PsycINFO databases and grey literature were searched to identify studies that report information on instruments that measure compassion or compassionate care in clinicians, nurses, healthcare students and patients. Textual qualitative descriptions of included studies were prepared. Instruments were evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool.


Nine studies containing information on the Compassion Competence Scale, a self-report instrument that measures compassion competence among Korean nurses; the Compassion Scale, the Compassionate Care Assessment Tool©, and the Schwartz Center Compassionate Care Scale™, patient-reported instruments that measure the importance of healthcare provider compassion; the Compassion Practices Scale, an instrument that measures organisational support for compassionate care; and instruments that measure compassion in educational institutions (instructional quality and a Geriatric Attitudes Scale), were included. Each instrument is associated with significant limitations. Most only measure certain aspects of compassion and lack evidence of adaptability to diverse practice settings. The EMPRO of self-report instruments revealed a lack of psychometric information on measurement reliability, validity, responsiveness and interpretability, respondent, administrative and scoring burden, and use in subpopulations.


The findings of this narrative synthesis identified an unmet need for a psychometrically validated instrument that comprehensively measures the construct of compassion in healthcare settings.


Healthcare Provider Instructional Quality Compassionate Care Compassion Satisfaction Healthcare Student 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

All authors were involved in the study design, overseeing the review process and contributed to the manuscript. In addition to these substantive contributions, SS conceived, designed, oversaw the review and was the primary author of the manuscript. JK and SS conducted the searches and selected eligible studies. LBR and RS conducted the comparative review of the measurement instruments using the EMPRO. TFH provided expert opinion on review content.

Compliance with Ethical Standards


The preparation of this review was supported by Dr. Sinclair’s Cancer Care Research Professorship from the Faculty of Nursing, University of Calgary. Dr. Hack is supported by a Research Chair in Psychosocial and Supportive Care Oncology from the Canadian Breast Cancer Foundation. Dr. Sawatzky is supported by a Canada Research Chair in Patient-Reported Outcomes.

Conflict of interest

Drs. Sinclair, Russell, Hack, Kondejewski and Sawatzky have no conflicts of interest pertaining to the conduct or results of this study.

Supplementary material

40271_2016_209_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)


  1. 1.
    Cole-King A, Gilbert P. Compassionate care: the theory and the reality. J Holist Healthc. 2011;8(3):29–37.Google Scholar
  2. 2.
    Goetz J, Keltner D, Simon-Thomas E. Compassion: an evolutionary analysis and empirical review. Psychol Bull. 2010;136(3):351–74.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schantz M. Compassion: a concept analysis. Nurs Forum. 2007;42:48–55.CrossRefPubMedGoogle Scholar
  4. 4.
    van der Cingel M. Compassion: the missing link in quality of care. Nurse Educ Today. 2014;34:1253–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Sinclair S, Norris JM, McConnell SJ, et al. Compassion: a scoping review of the healthcare literature. J Pain Symptom Manage BMC Palliat Care. 2016;15:6–20.CrossRefGoogle Scholar
  6. 6.
    Sinclair S, McClement S, Raffin Bouchal S, et al. Compassion in healthcare: an empirical model. J Pain Symptom Manage. 2016;51(2):193–203.CrossRefPubMedGoogle Scholar
  7. 7.
    Frampton SB. Compassion as the foundation of patient-centered care: the importance of compassion in action. J Comp Eff Res. 2013;5(3):443–55.CrossRefGoogle Scholar
  8. 8.
    Heyland DK, Dodek P, Rocker G, Canadian Researchers End-of-Life Network (CARENET), et al. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006;174(5):627–33.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Riggs JS, Woodby LL, Burgio KL, et al. “Don’t get weak in your compassion”: bereaved next of kin’s suggestions for improving end-of-life care in Veterans Affairs Medical Centers. J Am Geriatr Soc. 2014;62(4):642–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Crowther J, Wilson KC, Horton S, Lloyd-Wiliams M. Compassion in healthcare: lessons from a qualitative study of the end of life care of people with dementia. J R Soc Med. 2013;106(12):492–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry. London: The Stationary Office; 2013.Google Scholar
  12. 12.
    Flocke SA, Miller WL, Crabtree BF. Relationships between physician practice style, patient satisfaction, and attributes of primary care. J Fam Pract. 2002;51(10):835–40.PubMedGoogle Scholar
  13. 13.
    McDonagh JR, Elliott TB, Engelberg RA, et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med. 2004;32(7):1484–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Lown BA, Rosen J, Marttila J. An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Aff (Millwood). 2011;30:1772–8.CrossRefGoogle Scholar
  15. 15.
    Youngsen R. Foreward. In: Shea S, Wynyard R, Lioni C, editors. Providing compassionate healthcare: challenges in policy and practice. London: Routledge; 2014. pp. xix–xxiii.Google Scholar
  16. 16.
    Sturgeon D. Measuring compassion in nursing. Nurs Stand. 2008;22(46):42–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Willis L. Raising the bar: the shape of caring review. London: Health Education England; 2015.Google Scholar
  18. 18.
    Paterson R. Can we mandate compassion? Hastings Cent Rep. 2011;41(2):20–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Institute of Medicine. Improving medical education: enhancing the behavioral and social science content of medical school curricula. Washington, DC: National Academies; 2004.Google Scholar
  20. 20.
    American Medical Association. Code of medical ethics: principle 1 2001. Available from: Accessed Feb 2016.
  21. 21.
    Maclean R. The Vale of Leven Hospital Inquiry. Edinburgh: APS Group; 2014.Google Scholar
  22. 22.
    Eva K, Rosenfeld J, Reiter H, Norman G. An admissions OSCE: the multiple mini interview. Med Educ. 2004;38:314–26.CrossRefPubMedGoogle Scholar
  23. 23.
    Callwood A, Cooke D, Allan H. Developing and piloting the multiple mini-interview in pre-registration student midwife selection in a UK setting. Nurse Educ Today. 2014;34:1450–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Department of Health. Confidence in caring: a framework for best practice. London: Department of Health; 2008.Google Scholar
  25. 25.
    National Health Service Commissioning Board Chief Nursing Officer and Department of Health Chief Nursing Adviser. Compassion in practice: nursing, midwifery and care staff. Our vision and strategy. Leeds: Department of Health; 2012.Google Scholar
  26. 26.
    Reader TW, Gillespie A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Serv Res. 2013;13:156–70.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Papadopoulos I, Ali S. Measuring compassion in nurses and other healthcare professionals: an integrative review. Nurse Educ Pract. 2016;16(1):133–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Bramley L, Matiti M. How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. J Clin Nurs. 2014;23(19–20):2790–9.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    van der Cingel M. Compassion in care: a qualitative study of older people with a chronic disease and nurses. Nurs Ethics. 2011;18(5):672–85.CrossRefPubMedGoogle Scholar
  30. 30.
    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. 2016. doi: 10.1177/0269216316663499.
  31. 31.
    Popay J. Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC Methods Programme. Lancaster: Lancaster University; 2006.Google Scholar
  32. 32.
    Valderas JM, Ferrer M, Mendivil J, et al. Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures. Value Health. 2008;11(4):700–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res. 2009;18:1115–23.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Lee Y, Seomun G. Development and validation of an instrument to measure nurses’ compassion competence. Appl Nurs Res. 2016;30:76–82.CrossRefPubMedGoogle Scholar
  35. 35.
    Fogarty LA, Curbow BA, Wingard JR, et al. Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol. 1999;17(1):371–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Kret DD. The qualities of a compassionate nurse according to the perceptions of medical-surgical patients. Med Surg Nurs. 2011;20(1):29–36.Google Scholar
  37. 37.
    Burnell L, Agan D. Compassionate care can it be defined and measured? The development of the compassionate care assessment tool. Int J Caring Sci. 2013;6:180–7.Google Scholar
  38. 38.
    Lown BA, Muncer SJ, Chadwisk R. Can compassionate healthcare be measured? The Schwartz Center Compassionate Care Scale™. Patient Educ Couns. 2015;98(8):1005–10.CrossRefPubMedGoogle Scholar
  39. 39.
    McClelland LE, Vogus TJ. Compassion practices and HCAHPS: does rewarding and supporting workplace compassion influence patient perceptions? Health Serv Res. 2014;49(5):1670–83.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Colletti JE, Flottemesch TJ, O’Connell TA, et al. Developing a standardized faculty evaluation in an emergency medicine residency. J Emerg Med. 2010;39(5):662–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Lee M, Reuben DB, Ferrell BA. Multidimensional attitudes of medical residents and geriatrics fellows toward older people. J Am Geriatr Soc. 2005;53:489–94.CrossRefPubMedGoogle Scholar
  42. 42.
    Reuben DB, Fullerton JT, Tschann JM, Croughan-Minihane M. Attitudes of beginning medical students toward older persons: a five-campus study. J Am Geriatr Soc. 1995;43:1430–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Park T, Lee HJ. The effects of public officials’ sociological variables on their emotional competence in the Korean central government. Korea Public Admin Rev. 2011;45:1–26.Google Scholar
  44. 44.
    Sprecher S, Fehr B. Compassionate love for close others and humanity. J Soc Pers Relat. 2005;22:629–51.CrossRefGoogle Scholar
  45. 45.
    Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983;44:113–26.CrossRefGoogle Scholar
  46. 46.
    Galek K, Flannelly K, Vane A, Galek R. Assessing a patient’s spiritual needs: a comprehensive instrument. Holist Nurs Pract. 2005;19:62–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Wu Y, Larrabee JH, Putman HP. Caring behaviors inventory: a reduction of the 42-item instrument. Nurs Res. 2006;55:18–25.CrossRefPubMedGoogle Scholar
  48. 48.
    Dewar B. Valuing compassion through definition and measurement. Nurs Manag. 2011;17(9):32–7.CrossRefGoogle Scholar
  49. 49.
    McCarthy B. Patients’ perceptions of how healthcare providers communicate with them and their families following a diagnosis of colorectal cancer and undergoing chemotherapy treatment. Eur J Oncol Nurs. 2014;18:452–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Cameron RA, Mazer BL, DeLuca JM, et al. In search of compassion: a new taxonomy of compassionate physician behaviours. Health Expect. 2015;18:1672–85.CrossRefPubMedGoogle Scholar
  51. 51.
    Way D, Tracy SJ. Conceptualizing compassion as recognizing, relating and (re)acting: a qualitative study of compassionate communication at hospice. Commun Monogr. 2012;79(3):292–315.CrossRefGoogle Scholar
  52. 52.
    Netemeyer RG, Bearden WO, Sharma S. Scaling procedures: issues and applications. Thousand Oaks: Sage; 2003. p. 224.CrossRefGoogle Scholar
  53. 53.
    DeVellis RF. Scale development: theory and applications. 3rd ed. Newbury Park: Sage; 2012. p. 205.Google Scholar
  54. 54.
    Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 5th ed. Oxford: Oxford University Press; 2015.Google Scholar
  55. 55.
    Vogus TJ, McClelland LE. When the customer is the patient: lessons from healthcare research on patient satisfaction and service quality ratings. Hum Resour Manage Rev. 2016;26(1):37–49.CrossRefGoogle Scholar
  56. 56.
    Murphy F, Jones S, Edwards M, et al. The impact of nurse education on the caring behaviours of nursing students. Nurse Educ Today. 2009;29(2):254–64.CrossRefPubMedGoogle Scholar
  57. 57.
    Bray L, O’Brien MR, Kirton J, et al. The role of professional education in developing compassionate practitioners: a mixed methods study exploring the perceptions of health professionals and pre-registration students. Nurse Educ Today. 2014;34(3):480–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Smith S, Gentleman M, Loads D, Pullin S. An exploration of a restorative space: a creative approach to reflection for nurse lecturer’s focused on experiences of compassion in the workplace. Nurse Ed Today. 2014;24(9):1225–31.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Shane Sinclair
    • 1
  • Lara B. Russell
    • 2
    • 3
  • Thomas F. Hack
    • 4
    • 5
  • Jane Kondejewski
    • 1
  • Richard Sawatzky
    • 3
    • 6
  1. 1.Faculty of NursingUniversity of CalgaryCalgaryCanada
  2. 2.School of NursingUniversity of VictoriaVictoriaCanada
  3. 3.Centre for Health Evaluation and Outcome SciencesProvidence Health CareVancouverCanada
  4. 4.Manitoba Palliative Care Research UnitCancerCare ManitobaWinnipegCanada
  5. 5.Rady Faculty of Health Sciences, College of NursingUniversity of ManitobaWinnipegCanada
  6. 6.School of NursingTrinity Western UniversityLangleyCanada

Personalised recommendations