Improving Compassionate Communication Through a Train-the-Trainer Model: Outcomes and Mechanisms for Transformation

Compassionate communication is an essential component of compassionate care and involves recognizing another person who needs compassion, relating to their suffering, and reacting verbally and/or nonverbally to their needs. Higher-quality compassionate communication facilitates positive patient-clinician relationships, which in turn lead to the development of trust, higher rates of adherence, and reduced health care costs. However, patients report that compassionate communication is lacking across many health care interactions. Research is needed to evaluate innovative educational programs that facilitate improved compassionate communication.

This report evaluates the Sanford Compassionate Communication Academy Fellowship at UC San Diego Health, a 60-hour arts and humanities fellowship that teaches compassionate communication to clinicians alongside artists using Kirkpatrick's 4-level evaluation model. At the time of this analysis, 27 fellows participated in the fellowship, using improvisation and theater exercises, role-play, visual thinking strategy, narrative reflection, poetry, literature, and principles drawn from journalism to build personal skills and learn to facilitate a compassionate communication curriculum. This analysis of 30 hours of field notes and 30- to 40-minute interviews conducted from January 2022 to November 2023 was guided by transformative learning theory.

Five themes contributed to improved compassionate communication: empathic listening, pacing, checking for understanding, improved teaching and mentoring, and mechanisms for transformation. In interviews, fellows described how improving these various skills has positively transformed their communication with patients and students. Participants identified 6 innovative mechanisms for transformation: dedicated time and resources, reflective practice, environment of care and safety, arts and humanities integration, colearning between artists and clinicians, and the train-the-trainer model.

Next steps include conducting additional studies to evaluate the fellowship's effect using mixed methods with added patient and student perspectives. In addition, training will be offered to other institutions, and different delivery modalities and durations of instruction will be compared.