Compassionate Care Programme Research Articles

Implementing personalized lung cancer care with spatial profiling, patient derived organoids, and rationally designed drug testing.

e20521 Background: Lung cancer (LC) remains the leading cause of cancer-related death in 2024, with most LC diagnoses with non-small cell lung cancer (NSCLC) subtype. Tyrosine kinase inhibitors (TKI) and targeted therapy against oncogenic drivers (KRAS, EGFR, or ALK fusions, others) are effective initial therapies; however, nearly all treated patients eventually develop resistance to therapy. Key reasons are the focus on limited predictive biomarkers and lack of patient derived LC models that reflect the underlying heterogeneity and the various phenotypic cell states among subclones within and between patients. Methods: We report the establishment of a novel platform for personalized LC care by refining the resolution of molecular interrogation of diagnostic and resistance biopsies to the single cell level, and with spatial profiling using single cell spatial multiomic (scSpMO) and coupling these enhanced diagnostic tools with functional validation with rational designed drug screens in patient-derived organoids (PDOs). Results: For deriving LC PDOs in epithelial and tumor microenvironment (TME) conditions to faithfully maintain the histological and genetic features of their respective LC tissues, we developed enrichment conditions for LC PDOs guided by tumor mutation variants and activated pathways. PDOs are maintained under the same treatment condition in the clinic (e.g., Lorlatinib) and drug testing is tailored to identify potentially most effective next lines of therapy. With nine patients enrolled and others in ongoing studies, single cell PDOs (at > 80% establishment rate) were used to determine activated pathways, lineage plasticity and acquired resistance. Functional assays for acquired resistance such as PI3K/AKT signaling, Src kinase, BRAF fusion and MET hyperactivity allow the identification of potentially novel lines of therapy and treatment sequence and/or combinations for each patient, through the compassionate care program and/or trial participation. Conclusions: Our platform when empowered by combining datasets from scRNA-seq and scSpMO signatures, with validated functional drug responses in PDOs, offers the ability to perform high-content assays, predict and/or act on resistance to therapy for each patient, and provides a path for precision medicine-guided impact on patient care.

Abstract 6496: Assessment of tyrosine kinase inhibitor bypass mechanisms in lung cancer using single cell multiomics, patient derived organoids and rationally designed drug screens

Abstract Lung cancer (LC) is the leading cause of cancer-induced mortality, with 350 patients in the US dying from LC daily, the majority from non-small cell lung cancer (NSCLC). Molecular-targeted therapy such as tyrosine kinase inhibitors (TKI) are effective in first and subsequent lines of therapy against oncogenic drivers (KRAS, EGFR, or ALK fusions, others); however, nearly all treated patients progress eventually and run out of therapeutic options. Key reasons are the lack of predictive biomarkers and LC models that reflect the underlying heterogeneity and different phenotypic cell states among subclones within and between patients. Here, we developed a novel platform for refining the resolution of molecular interrogation to the single cell level, using single cell spatial multiomic (scSpMO), coupled with rational designed drug screens in patient-derived organoids (PDOs) from LC biopsies obtained upon progression. By deriving LC PDOs in epithelial and tumor microenvironment (TME) conditions to faithfully maintain the histological and genetic features of their respective LC tissues, we identified enrichment conditions for LC PDOs guided by tumor mutation variants and activated pathways. PDOs are maintained under the same treatment condition in the clinic (e.g., Lorlatinib) and drug testing is tailored to identify next lines of combined therapy. With six patients enrolled and others in ongoing studies, single cell PDOs (at >80% establishment rate) were used to determine key molecular bypass mechanism for resistance to TKI, including on-target variants, driver bypass, lineage plasticity and acquired resistance. Functional assays for acquired resistance such as PI3K/AKT signaling, Src kinase, BRAF fusion and MET hyperactivity allow the identification of potential novel combined lines of therapy for each patient through the compassionate care program and/or trial participation. Our platform when empowered with datasets of bulk, scRNA-seq and scSpMO signatures of primary human NSCLC, together with PDOs offer the ability to perform analysis of LC phenotypes such as lineage transformation in high-content assays, predict and/or act on resistance to therapy and provides a path for precision medicine-guided immediate impact on patient care. Citation Format: Liqiong Liu, Ann Strange, Schuyler Lee, Bifeng Gao, Daniel Merrick, Tejas Patil, James DeGregori, D Ross Camidge, Sharon R. Pine, Hatim E. Sabaawy. Assessment of tyrosine kinase inhibitor bypass mechanisms in lung cancer using single cell multiomics, patient derived organoids and rationally designed drug screens [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6496.

Compassionate Use of Belantamab Mafodotin for Treatment of Patients with Relapsed/Refractory Multiple Myeloma Heavily Treated. Spanish Experience

Background: Heavily pretreated relapsed and refractory multiple myeloma (RR MM) constitutes a specific and unmet medical need. Median survival ranges from as little as 6 to 9 months, and responses to treatment are characteristically short (Richardson et al. 2007). Belantamab Mafodotin (BM), a novel anti-BCMA antibody conjugated to microtubule-disrupting agent monomethyl auristatin F, showed single-agent activity in the phase 1 DREAMM-1 and phase 2 DREAMM-2 studies in heavily pre-treated patients with RRMM (Lonial et al, 2019 & 2021). We aim to assess efficacy and safety of BM treatment administered via the expanded access compassionate care program for triple class MMRR patients in the region of Madrid (Spain).Methods: An observational, retrospective and multicenter study has been performed including all patients who received at least one dose of BM under the expanded access program in the region of Madrid (Spain) from Nov 2019 to Jun 2021. Hematology centers provided data from the medical records and entered them in a case report form distributed to the sites. Primary endpoint was overall response rate (ORR). Secondary endpoints were progression free survival (PFS), overall survival (OS) and the incidence of treatment emergent adverse events (TEAEs), with a major focus on ocular and hematologic toxicity.Results: A total of 33 patients (pts), from 14 different centers, were included from February 2020 till May 2021. Median age was 70 (46-79) years. 55% of the pts were women. Median time from diagnosis was 71 (10-858) months. 30.3% were high-risk cytogenetic features. Median of prior therapy lines was 5 (3-8) and at least 88% of the pts were triple class refractory. The median number of BM doses per patient was 3 (1-16) and the median follow-up was 11 months (95%CI 6.34-15.66). ORR was 42.2%, and 18.2% achieved ≥VGPR. Median PFS was 3 months (95%CI 0.92-5.08). Median PFS for patients who achieved ≥PR was 11 months (HR 0,26; 95% CI 0,10-0,68). No significant differences were found in PFS according to age, cytogenetic risk and prior therapy lines. OS was 424 days (95% CI 107-740). The incidence of non-hematological TEAEs was 57.6% and the most common of which was ocular toxicity (45.5%). The incidence of ≥G3 non-hematological TEAEs was 30.3%. 51.5% of the pts were diagnosed of keratopathy and 21.2% was ≥G3. 30.3% of the pts showed a reduced visual acuity, but this event was resolved in 92.9% of the pts. The most common symptoms were blurry vision (30.3%, n=10) and dry eye (24.2%, n=8). The incidence of ≥G3 hematological TEAEs was 18.2% and thrombocytopenia was the most frequent (21.2%). Dose reductions of BM were required in 30.3% of the pts and delayed in 36.4% due to TEAEs. Main causes for treatment discontinuation (81%, n=27) were disease progression (54.5%, n=18), toxicity (15.2%, n=5), death (6.1%, n=3) and due to patient's decision (3%, n=1).Conclusion: Compassionate use of BM in heavily pretreated RR MM pts showed a relevant anti-myeloma activity with a manageable safety profile.These results are similar to those observed in the DREAMM-1 and DREAMM-2 clinical trials. DisclosuresNo relevant conflicts of interest to declare.

Mitochondrial transplantation-a possible therapeutic for mitochondrial dysfunction?: Mitochondrial transfer is a potential cure for many diseases but proof of efficacy and safety is still lacking.

Transplantation of functional mitochondria directly into defective cells is a novel approach that has recently caught the attention of scientists and the general public alike. Could this be too good to be true?

Nurses’ and midwives’ views of the “Leaders for Compassionate Care Program”: A qualitative analysis

BackgroundCompassionate care delivery is a key feature of nursing and midwifery and a marker of quality healthcare delivery. Training nurses and midwives in compassionate care is known to yield positive nursing, midwifery, and patient outcomes such as increased job satisfaction, reduced burnout, improved patient satisfaction, and enhanced quality of life. AimTo explore nurses’ and midwives’ views of a three-day program entitled “The Leaders for Compassionate Care Program” from the perspective of participating nursing/midwifery leaders, directors of nursing/midwifery, chief directors of nursing/midwifery, and program facilitators. MethodsA qualitative descriptive design was adopted. Purposive sampling was used to recruit participants (n = 15). Individual and focus group interviews were conducted via telephone and teleconferencing using a semi-structured interview protocol. Data were analyzed using inductive content analysis. FindingsParticipants perceived the program as innovative since it involved teamwork and networking and helped reiterate the human element of care. Participants identified the knowledge and expertise of the program facilitators as enablers to learning. The facilitators were committed to delivering a program that met the needs of individual leaders. DiscussionFindings suggest the need to explore the long-term impact of the program, offer similar programs to junior and senior nursing/midwifery leaders, and maintain the networking that took place during the program. This could be achieved through conducting follow-up sessions and masterclasses. ConclusionThe program served as an opportunity for the leaders to take time out, reflect on their practice using a compassionate care lens, network with colleagues from different institutions, and develop leadership skill.

Aetna's Compassionate Care Program: Sustained Value for Our Members with Advanced Illness.

Background: In 2004, Aetna, a national health insurer, launched the Aetna Compassionate Care Program (ACCP) targeting members diagnosed with an advanced illness with a view to increase access to palliative care and hospice services. Objective: The objective of this study is to evaluate the impact of ACCP on health care utilization and hospice enrollment among enrolled members. Methods: This was a retrospective cohort study comparing participants in ACCP to a matched control group using a propensity score method. The study group consisted of Aetna Medicare Advantage members who participated in the ACCP between January 2014 and June 2015. Potential control group members were those who were not identified by the predictive model nor were referred to the ACCP program through other means. The primary outcomes of interest were hospice use measured as percent of members electing hospice and median number of days in hospice; health care utilization and medical costs measured as rates and medical costs associated with acute inpatient admissions, emergency room, primary care, and specialty visits in the 30 and 90 days before death. Results: Participants in the ACCP program were 36% more likely to enroll in hospice (79% vs. 58%, p < 0.0001) and had reduced acute inpatient medical costs ($4169 vs. $5863, p < 0.0001) driven primarily by fewer inpatient admissions (860 vs. 1017, p < 0.0001) in the last 90 days of life. Conclusions: Advanced illness case management programs such as ACCP can improve access to hospice and improve patient outcomes while reducing unnecessary admissions in the last 90 days of life.

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

BackgroundConcerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.ObjectivesTo assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.DesignPilot cluster randomised trial (CRT) and associated process and economic evaluations.SettingSix inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).ParticipantsPatients (n = 639), staff (n = 211) and visitors (n = 188).InterventionCLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measuresQuality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sourcesStructured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.ResultsThe pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.LimitationsFindings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.ConclusionsUse of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registrationCurrent Controlled Trials ISRCTN16789770.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

Embedding compassionate care in local NHS practice: developing a conceptual model through realistic evaluation

The aim of this study was to critically analyse the impact of the ‘Leadership in Compassionate Care Programme’ and offer a conceptual model of factors that can embed compassionate care in contemporary health care environments. This three-year initiative (2008–2011) was designed to embed compassionate care in both practice and pre-registration education. Using a realistic evaluation approach this longitudinal qualitative study involved data collection in eight participating wards. The ‘level of adoption’ of the Programme varied across the wards, which pointed to key context and mechanisms that were influential in embedding compassionate care. Contextual factors that promoted adoption of the Programme were stability, support and leadership. The most important mechanisms were appreciative inquiry coupled with skilled facilitation. Powerful practice development techniques focused on articulating and demonstrating values; giving patients, relatives and staff a voice to express their experiences and emotions; and instituting effective feedback mechanisms. In the high adopting wards the main outcomes included personalisation of patient care, an increased sense of involvement for relatives and ‘caring conversations’ becoming an accepted part of working practice. Embedding and sustaining compassionate care demands strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development and effective leadership at all levels.

Encouraging compassion through teaching and learning: a case study in Cyprus

It has been suggested that the biomedical approach towards healthcare professional training may neglect the humanistic nature and personal values of care. As such, discussions with regard to the importance of introducing compassion training into undergraduate programmes and throughout professional practice are of interest. Within this paper, we report on a compassionate care programme designed for, and delivered to, healthcare professionals and managerial/administrative staff at a private hospital in Limassol, Cyprus. Six modules were developed, each of a 6 h duration. Each module was delivered twice to two separate groups of participants. Participants included 60 healthcare professionals along with 5 managerial and administrative staff. Using a range of innovative teaching methods and activities, the programme covered a number of issues relevant to compassion including patient centred care, therapeutic relationships, empathy, cultural awareness, conflict resolution, and advanced communication skills. The programme was evaluated using both qualitative and quantitative methods. Quantitative and qualitative feedback demonstrated high satisfaction and interest in the programme. Likewise, attending managerial and administrative staff considered the programme important for quality improvement and organizational culture change. Our findings demonstrate that programmes covering the topic of compassion are welcomed by both healthcare professionals and managerial/administrative staff. The impact of compassionate care training will be assessed effectively through a future longitudinal study.

Reflections about experiences of compassionate care from award winning undergraduate nurses – What, so what … now what?

From 2007 until 2012 Edinburgh Napier University’s School of Nursing Midwifery and Social Care in conjunction with NHS Lothian, collaborated on a programme of action research entitled, the Leadership in Compassionate Care Programme. One strand of this research focused on learning and teaching about compassionate care within the undergraduate curriculum. This debate article focuses on the care issues raised by two award winning nursing students who reflected on the development of their compassionate caring skills during their three year Bachelor of Nursing programme. The reflective accounts debate the following issues related to compassionate care; Personal drivers supporting the provision of compassionate care, Challenging and influencing care practices, Providing relationship centred care and, Living with what can’t be achieved. Throughout the debate a model of compassionate care developed from the Leadership in Compassionate Care Programme is used to reflect on key practice issues and provide a framework for practice development. The care issues presented in this paper identify a need to support students in healthcare to; Develop strategies in questioning care practices which do not meet expectations of compassionate care; undertake focussed reflective activities where each student can explore personal drivers, values and perspectives of compassion; actively connect learning in practice with theory in university, enable development in compassionate caring and strategies that support self-compassion; facilitate an understanding and development of emotional intelligence supporting development of resilience. Implications for healthcare staff are to; Collectively seek, hear and respond to feedback about their service; activate caring conversations within the healthcare team; consider how the model of compassionate care presented in this paper, can be used to reflect on practice and provide a framework for development; consider how we maximise the experience of care during brief moments of contact with patients/families; activate leadership that promotes a culture of openness facilitating the development of compassionate care.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model

ABSTRACTThis article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

Compassionate Care: Student nurses' learning through reflection and the use of story

IntroductionCurrent concern in health care about delivering care that is compassionate has important implications for how compassion is taught and made explicit in nurse education curricula. This paper will describe the use of stories within the curricula to enhance knowledge and skills in compassionate caring. MethodologyThe Leadership in Compassionate Care Programme (LCCP) was a 3-year action research project that sought to capture what compassionate care means within practice and utilise this learning within education. Stories gathered within clinical practice were used to stimulate reflective learning as part of a nursing module that teaches recognition of acute illness and deterioration at Edinburgh Napier University. Students listened to stories which included experiences of staff, students, patients and relatives and related these to their own experiences in practice. In this paper, examples from the online discussions are discussed with reference to one of six themes that emerged from the LCCP, that of caring conversations. FindingsThe discussions suggest that reflective learning and the use of stories about the experience of giving and receiving care can contribute to the development of the knowledge, skill and confidence that enable student nurses to provide compassionate relationship centred care within practice. ConclusionsReflective learning can be a valuable strategy for students to ponder new knowledge and allow predetermined ideas to be challenged. Stories can initiate this process and help student nurses to understand not only the needs of others, but their own expectations and values, which in turn can inform how they plan and deliver person centred compassionate care.

Aetna’s Compassionate Care Program and End-of-Life Decisions

In this article we describe the successes of Aetna's Compassionate Care Program in providing case management services for people with advanced illnesses.

An exploration of a restorative space: A creative approach to reflection for nurse lecturer's focused on experiences of compassion in the workplace

This study was undertaken as part of a larger programme of research; the Leadership in Compassionate Care Programme. The aim of this study was to explore and respond to the perceptions of nurse lecturers in regard to experiences of compassion in the workplace. A participatory action research approach was adopted. The study took place in a large school of nursing and midwifery in the United Kingdom, eight lecturers participated in this study. A series of four facilitated reflective workshops titled a restorative space were provided and participants used the medium of collage as a process for reflection. Data was gathered in the form of collages, field and reflective notes. Data analysis involved an iterative process between facilitators and participants during the workshops and resulting actions were implemented. Findings from this study identified three key themes related to compassion in the workplace; leadership, culture, professional and personal development. Actions identified and implemented as a consequence of these findings included opportunities for lecturers to participate in a leadership development programme and implementing rapid feedback processes between lecturers and the senior management team. The restorative space workshops and utilisation of the creative medium of collage provided a valuable process for practitioners to collaboratively reflect on their workplace experiences.

The personal development tutor role: An exploration of student and lecturer experiences and perceptions of that relationship

This exploratory study formed part of the Leadership in Compassionate Care Programme (LCCP) that considered embedding the principles of person-centred compassionate care within an undergraduate nursing curriculum. Currently, there is a lack of literature regarding compassionate care in relation to the student-personal development tutor (PDT) relationship. The aim of the study was to explore the current personal development tutor role, within a pre-registration adult nursing programme, in relation to the support provided to students by PDTs and from this, establish what was important in the role from the student and lecturer perspectives, within the context of the LCCP. A qualitative approach utmilising participant interviews was employed. Six undergraduate nursing students on a Bachelor of Nursing adult programme and five PDTs participated in the study and Emotional Touchpoint technique was used to elicit participant experiences. Data were analysed using an adapted version of the Senses Framework, originally proposed by Nolan et al. (2006). The results demonstrate the importance that students and their PDTs attach to the relationship and how elements of care arising from the Senses Framework are fundamental to developing and sustaining this relationship. Further, it is apparent that role modelling in relation to care is considered an important element of the PDT role which has relevance to nurse education and practice. In light of these findings a range of strategies are proposed to enhance the PDT relationship by utilising a modified version of the Senses Framework as a model for PDT and student interaction.

Clarifying misconceptions about compassionate care

To discuss the meaning of compassionate care as it applies to staff, patients and families in health and social care settings, its application to practice and how organizational infrastructures affect the delivery of care. The term compassion has assumed headline status and inclusion in current health and social care policy. Clarity of what the term means in practice is needed and may help to promote delivery of compassionate care consistently across health and social care settings. Discussion paper. This article draws on data from an action research programme (Leadership in Compassionate Care Programme, 2007-2011) that focused on embedding compassionate care into practice and education and related literature focused on compassionate person-centred care. A literature search was conducted and articles published in English relating to the terms compassionate, person-centred care between 1999-2011 were included. Perceptions of compassion, practising compassion and the infrastructure to support compassion are discussed. It is anticipated that this discussion will prompt further debate, raise awareness and help to clarify the meaning of compassion in everyday practice with patients, relatives and staff, so that it can be more clearly named, valued and defended. This article challenges some of the beliefs and values that underpin the meaning of compassionate care and its application to practice. It brings greater clarity to the meaning of compassion, which could be used to form the basis of shared visions of caring, both strategic and operational, across organizations.

Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting

AimThis study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. BackgroundCompassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. Approach and methodsThe study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. FindingsThe study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on ‘appreciative caring conversations’ that enable all parties to gain two forms of ‘person and relational knowledge’ about ‘who people are and what matters to them’ and ‘how people feel about their experience’. Such knowledge enables staff, patients and carers to ‘work together to shape the way things are done’. The study generated a model called the 7 ‘C's that captures in detail the factors necessary to promote ‘appreciative caring conversations’. Conclusions and implicationsThe study demonstrates that engaging in ‘appreciative caring conversations’ promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such ‘relational practices’ must therefore be valued and accorded status. Staff require appropriate support, facilitation and strong leadership if these practices are to flourish.

Guidelines must be underpinned by compassion and empathy.

It is refreshing to read that the Leadership in Compassionate Care programme is benefiting from £1 million of funding from former nurse Ann Gloag (features September 12).

Compassion for keeps

A three-year programme in Scotland to encourage compassion in every aspect of nursing care drew to a close this summer. However, senior nurses are still involved in the Leadership in Compassionate Care programme, and are determined that its influence will continue to spread across the country.

Use of emotional touchpoints as a method of tapping into the experience of receiving compassionate care in a hospital setting

Improving the patient and family experience in hospital and supporting people to deliver compassionate dignified care is a priority on the policy agenda in the UK. The purpose of this paper is to describe our experiences of using the method of emotional touchpoints to learn about compassionate care in hospital settings. This work is part of the Leadership in Compassionate Care Programme which is using an action research approach to embed compassionate care in practice and education. Data were generated using the touchpoint method from 16 patients and 12 relatives from a range of care settings that included medicine for the elderly, older people’s mental health and a stroke unit. The benefits of using this approach include its ability to help practitioners to see in a more balanced way both the positive and negative aspects of an experience, and to help service users to take part in a meaningful and realistic way in developing the service. Significant learning arose from these stories that has directly influenced change on the wards. The changes have not only focused on practical solutions but have also provided a platform for discussing some of the more complex cultural aspects that contribute to the delivery of compassionate care.