title: Compassion: a scoping review of the healthcare literature.
abstract: BACKGROUND
  Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare.
  
  
  METHODS
  Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used.
  
  
  CONCLUSIONS
  Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students.
  
  
  CONCLUSIONS
  This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary.
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. sinclair@ucalgary.ca.|Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. sinclair@ucalgary.ca.|Manitoba Palliative Care Research Unit, CancerCare Manitoba, 3017 - 675 McDermot, Winnipeg, MB, R3E 0V9, Canada. sinclair@ucalgary.ca.
authors.forename: Shane
authors.initials: S
authors.lastname: Sinclair
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. jmnorris@ucalgary.ca.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. mcconnsj@ucalgary.ca.
authors.forename: Shelagh J
authors.initials: SJ
authors.lastname: McConnell
authors.affiliation: Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada. hchochinov@cancercare.mb.ca.|Manitoba Palliative Care Research Unit, CancerCare Manitoba, 3017 - 675 McDermot, Winnipeg, MB, R3E 0V9, Canada. hchochinov@cancercare.mb.ca.
authors.forename: Harvey Max
authors.initials: HM
authors.lastname: Chochinov
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Room CR3018, 369 Taché Ave, Winnipeg, MB, R2H 2A6, Canada. THack@sbrc.ca.|Manitoba Palliative Care Research Unit, CancerCare Manitoba, 3017 - 675 McDermot, Winnipeg, MB, R3E 0V9, Canada. THack@sbrc.ca.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hack
authors.affiliation: Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. neilhagen5@gmail.com.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Hagen
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Room CR3018, 369 Taché Ave, Winnipeg, MB, R2H 2A6, Canada. smcclement@cancercare.mb.ca.|Manitoba Palliative Care Research Unit, CancerCare Manitoba, 3017 - 675 McDermot, Winnipeg, MB, R3E 0V9, Canada. smcclement@cancercare.mb.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: McClement
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. raffin@ucalgary.ca.
authors.forename: Shelley Raffin
authors.initials: SR
authors.lastname: Bouchal
mesh_terms: D001291:Attitude of Health Personnel; D000068376:Compassion Fatigue; D003695:Delivery of Health Care / Q000592:standards*; D004645:Empathy; D006282:Health Personnel / Q000193:education; D006801:Humans; D007858:Learning; D009723:Nurse-Patient Relations; D010465:Perception