by Sarah Gill
Sympathy, empathy, and compassion are words that have not only remained largely uncontested in health care, but are often treated interchangeably within palliative care research, policy, education, and practice – but are they? And according to whom?
In a Straussian grounded theory study by Shane Sinclair PhD, Associate Professor, Cancer Care Research Professorship, University of Calgary, Canada, of 53 palliative care patients, it was discovered that patients could not only delineate between the aforementioned care constructs, but were also clear on their preference for compassion. Sympathy was understood by patients as a pity-based response to a distressing situation that is characterized by a lack of relational understanding and the self-preservation of the observer. While it shared the attribute of acknowledging a distressing situation, with empathy and compassion, patients were clear that it was unhelpful, unwelcome, and often compounded their distress. While patients identified a number of distinguishing features between empathy and compassion, their relationship to one another was more like ‘close cousins’ in comparison to the ‘distant/estranged’ relationship status that each of these shared with sympathy.
Empathy was understood by study participants as an effective response that acknowledges and attempts to understand an individual’s suffering through emotional resonance. It involves the ability to put oneself in another person’s shoes, to not only acknowledge suffering but to feel with the person and attempt to understand them in the process.
Compassion, from the perspective of patients, included many of the attributes of empathy but added additional, distinguishing components of virtues and actions. To be clear, virtues of love, kindness, acceptance, and genuineness were not equated with morality or piety but were simply understood as the good and noble qualities of healthcare providers. In essence, it involves not just the ‘what’ of healthcare providers but the ‘who’ – the personal qualities that they bring to the bedside. As a result, compassion was perceived as extending feeling with to feeling for, while also adding the quintessential feature of action – doing for. Compassionate action ranged from routine care, motivated by virtues versus remuneration or a mere sense of duty, to acts that went beyond the call of duty by going the extra mile or beyond the ‘job description’.
While an individual’s capacity for compassion is as unique as the experiences of patients receiving it, the call to compassion, while being a high bar, is not an endpoint. Rather, compassion is a dynamic care construct that can be cultivated through practice and when it is expressed, according to patients, is the most potent form of care that healthcare providers can express.
As Therapists it can be difficult to find products that work and are easy for a palliative patient and/or carers to utilise. Oedema and leaking in limbs of patients can often cause them great distress. Mobiderm autoift garments are a range of products that have Velcro tabs and have Class 1 compression. When the garment is worn a shear effect is created on the Mobiderm (foam squares move down and across simultaneously). This shear effect mobilises the skin which pulls on the collagen fibres stimulating the opening of the initial lymphatic vessels. It also creates a pressure differential in the interstitial tissues. Mobiderm not only reduces the rate of filtration it also stimulates the lymphatic system. The Mobiderm autofit sock can be used as a replacement for standard daytime compression socks. It can be easily donned and doffed by carers and can also been worn with Soft cotton short stretch bandage cut into a tube to protect extra sensitive skin. To order products or for more information on the use of Mobiderm in the palliative setting including case studies go to the Mobiderm website.