Abstract
Continuous exposure to the suffering and death of patients produces certain syndromes such as compassion fatigue in health professionals. The objective of this study was to analyze the effect and the effectiveness of interventions based on mindfulness, aimed at training or cultivating compassion or self-compassion in compassion fatigue, self-compassion, compassion, and compassion satisfaction of health professionals. A systematic review is reported in line with the PRISMA guideline and was registered in PROSPERO. The PubMed, Web of Science, PsycINFO and CINAHL databases were used. Interventions based on compassion training or cultivation were selected, aimed at health professionals. A meta-analysis was performed using a random-effects model. The effect size and hetereogeneity of the studies were calculated. Eight articles were selected. Among the programmes for the cultivation of compassion we highlight Compassion Cultivation Training (CCT), Mindfulness and Self-Compassion (MSC), Compassionate Meditation (CM), and Loving Kindness Meditation (LKM). The interventions decreased compassion fatigue and increased compassion, self-compassion, and compassion satisfaction in healthcare professionals. Compassion fatigue in healthcare professionals is due to a deficit in empathic and compassionate skills. Health systems should incorporate programmes based on the cultivation of compassion and self-compassion in order to improve the work conditions and quality of life of health professionals.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Health professionals are exposed to a great physical, emotional and spiritual requirements associated with the circumstances of the health environment (Ruiz-Fernández et al., 2020b), which have worsened in the context of the global pandemic (Thapa et al., 2021). Among the stressors typical of the healthcare environment are: long working hours (Wasson et al., 2020); a shortage of personnel (Spurlock, 2020); a demanding workload (Shah et al., 2021); and witnessing the pain and suffering of patients and their families (Kartsonaki et al., 2022; Wasson et al., 2020). Continued exposure to suffering and death in patients has been linked with an increased risk of developing compassion fatigue (Aslan et al., 2022) and decreased compassion satisfaction (Balinbin et al., 2020).
Etymologically, the term compassion comes from the Latin cumpassio, from com (together with) and pati (to suffer), and the latter from the Greek meaning “to suffer with, to suffer together, to feel for” (Papadopoulos et al., 2017; Perez-Bret et al., 2016). In writings the concept of compassion appears as something proper and consubstantial to human beings, being identified as a shared and ineffective sadness or even being equated with pity (Corrêa, 2017; Montero-Orphanopoulos, 2019). In literature, too, compassion sometimes appears as a quality close to empathy (Su et al., 2020). However, the most scientifically accepted definition of compassion is “a sensitivity to the suffering of self and others, coupled with the motivation to prevent and alleviate it” (Gilbert & Choden, 2014; Jinpa, 2015).
As a multidimensional response to suffering, compassion involves sensitivity, recognition, understanding, emotional resonance, empathic concern, and tolerance of distress generated by the suffering of others, coupled with motivation and relational actions to alleviate and prevent it (Gilbert et al., 2017; Lown et al., 2015). Compassionate behavior activates areas of the brain such as the frontal cortex, the anterior cingulate cortex, the medial prefrontal cortex, the insula and the periaqueductal grey matter and with changes at the level of autonomic activation involving neurotransmitters such as oxytocin and vasopressin (Tala, 2023; Foerster & Kanske, 2021).
Compassion satisfaction and compassion fatigue are theoretical opposites, compassion satisfaction being identified with the “positive payoff” of caring and compassion fatigue with the “cost of care” (Fahey & Glasofer, 2016). Compassion satisfaction is the gratification that comes from providing care to alleviate the suffering of other people (Radey & Figley, 2007; Sinclair et al., 2016). However, compassion fatigue is the physical, mental, and spiritual exhaustion, as well as the emotional withdrawal of healthcare professionals for a prolonged period of time (Sorenson et al., 2016; Gustafsson & Hemberg, 2022). This phenomenon produces a decrease in the empathic or compassionate capacity, which may affect personal life and professional competence (Cetrano et al., 2017) as it is related to the low quality of health care provided (Chachula, 2022). These problems are more pronounced for nurses caring for highly vulnerable patients: observing the daily suffering, pain, loss and death of others can accelerate the onset of job dissatisfaction, burnout and compassion fatigue (Favrod et al., 2018; McKnight et al., 2020).
The practice of compassion and self-compassion improves care at work, which translates into increased confidence, communication, and performance within the team, decreasing the risk of excess stress and burnout (Campling, 2015). High levels of compassion in professionals lead to fewer hospitalisations, reduced use of intensive care at the end of life and better psychological adjustment to a cancer diagnosis (Lown et al., 2011; Lown et al., 2015).Training in self-compassion or self-kindness increases resilience and thus the ability to adapt to stress in a positive way (Kotera et al., 2021). Resilience involves resisting stress, tolerating pressure in adverse situations, and reacting by deploying strategies to overcome negative or traumatic experiences (Cooper et al., 2020; Henshall et al., 2020). Therefore, compassion and self-compassion are part of resilience, as a multidimensional and dynamic concept (Ruiz-Fernández et al., 2021).
Compassion fatigue in healthcare professionals is not caused by excess compassion but rather by the absence of its basic attributes, in addition to a lack of training in empathy and compassion skills (Ruiz-Fernández et al., 2020b). Among the protective factors for compassion fatigue, we can mention compassion satisfaction and interventions aimed at developing self-compassion (Conversano et al., 2020) and promoting compassion (Anderson & Gustavson, 2016; Ruiz-Fernández et al., 2020a). Compassion is defined as a feeling of affection or closeness towards other human beings who are suffering, in addition to the intention to alleviate their suffering (Brito, 2015).
Furthermore, self-compassion is kindness, support, and compassion towards oneself, accepting one’s own suffering, and adopting an understanding and non-judgmental attitude towards one’s own failures, acknowledging mistakes as part of the common human experience (Pavlova & Consedine, 2023).
Scientific interest in compassion has increased in the last decade because of its health and wellness benefits (Malenfant et al., 2022), with the development of a series of interventions focused on the cultivation and development of compassion based on brain neuroplasticity, which represents the ability of the nervous system to change its reactivity as a result of successive activations (Lee et al., 2008). The main programmes developed are: Compassion Cultivation Training (CCT) (Jinpa & Weiss, 2013); Mindfulness Self-Compassion (MSC) (Neff & Germer, 2013); Self-Compassion for Healthcare Communities (SCHC) (Neff et al., 2020); Compassion Meditation (CM), and Loving Kindness Meditation (LKM) (Amutio-Kareaga et al., 2017). CCT is a programme focused on the cultivation of compassion, empathy, and kindness towards oneself where skills are developed to improve mental and emotional well-being (Goldin & Jazaieri, 2017), and it is one of the most prominent worldwide (Scarlet et al., 2017). In addition, it has been shown to decrease negative feelings, increase compassion, improve interpersonal competence (Weingartner et al., 2019) and self-compassion, and prevent burnout, empathic distress, and depersonalization (Gonzalo Brito et al., 2019). On the other hand, MSC offers a series of skills to improve self-compassion and integrate it into daily life (Delaney, 2018), with health professionals being one of the populations where this intervention is most suitable both physically and emotionally (Germer & Neff, 2019). SCHC is an adaptation of MSC in which meditation is removed, and the organization, flow, and framework of the exercises are modified to accommodate the time constraints of health professionals (Neff et al., 2020). Finally, Compassion Meditation (CM) is a practice that seeks to develop a sense of common humanity (Lang et al., 2019) and alleviate suffering for oneself and others (Hao et al., 2022; Martin-Allan et al., 2021). Therefore, healthcare professionals are exposed to a stressful and distressing context and are therefore susceptible to developing certain syndromes such as compassion fatigue (Ruiz-Fernández et al., 2020b). There are interventions based on compassion and self-compassion that may help to prevent this problem (Wasson et al., 2020) and its benefits can spill over into people’s daily lives and transform their personality traits in a healthier direction (Dahl et al., 2015). However, there are no studies that examine the effects of these compassion and self-compassion-based programmes on compassion fatigue in healthcare professionals.
Objective
The objective of this study was to determine the efficacy and the effectiveness of interventions based on the cultivation of compassion and self-compassion in health professionals in order to reduce compassion fatigue and improve self-compassion, compassion, and compassion satisfaction as outcome variables.
Methods
Register and design
A systematic review and meta-analysis was carried out following the recommendations of the PRISMA guide (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (Page et al., 2021). This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020208619.
Research question
This review addressed the following research question: Is the use of a programme or intervention based on the cultivation of compassion effective and efficient in fostering compassion in healthcare professionals? For this purpose, the PIO strategy was used (Table 1).
Databases and search strategy
A search for studies with interventions based on compassion training was carried out between December 2022 and June 2023. In order to carry out this project, structured language terms (MeSH) such as “Health Occupations”, “Compassion Fatigue”, and the natural language terms “Health professionals”, “Intervention”, “Programme”, “Compassion”, “Self-compassion”, “Compassion Satisfaction”, and “Compassion fatigue” were used. Similar descriptors were combined using the “OR” operator, while the “AND” operator was used to combine intersection concepts. The following specialized databases in health sciences were consulted: PubMed, CINAHL, PsycINFO, and the Web of Science. The references of the articles were reviewed to obtain studies that had not been identified in the search. In addition, a grey literature search was performed in the Google Scholar database. This whole process was carried out by three researchers from the study.
Eligibility criteria
The selection criteria of the studies were: a) original publications in English and Spanish available in full text; b) the study population had to be health professionals (physicians or nurses); c) the interventions had to be based on compassion training or cultivation; d) studies had to have a quasi-experimental design, with or without a control group, with or without randomization and clinical or experimental studies; and e) studies had to measure compassion, compassion fatigue, or self-compassion. The exclusion criteria were: a) duplicate articles, reviews, dissertations, abstracts, book chapters, point of view or expert opinion, monographs and theses; and b) articles in which the sample and evaluation of the population were composed only of individuals with some morbidity. The search period was unlimited until June 2023.
Methodological quality assessment
The quality of the articles was analyzed based on the Cochrane Collaborations’ risk of bias assessment tool (Higgins et al., 2011). This instrument is the recommended tool to assess the risk of bias in randomized trials, although they can be used for other types of studies (Cajal et al., 2020). It has 7 items (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias), and the evaluation of each item was divided into three categories (yes, no, and unclear). Quality assurance was performed by two independent investigators (author 1 and author 6), and, in case of disagreement, a third independent reviewer (author 2) was consulted.
Procedure and selection process
The selection was carried out in three phases, with the aim of discerning the suitability of the articles. The first consisted of reading the title, the second of reading the abstract and, finally, reading the full text to verify that they corresponded to the aims of the study. A data collection sheet was designed that included country, authors, aim of the study, sample size, type of intervention, study design, evaluation instruments, pre and post-intervention measures of the variables, and results (compassion, self-compassion or compassion fatigue). The articles were extracted from the databases and entered into the Cochrane Review Manager (Rev Man V.5). The selection was made by two investigators independently and a third investigator resolved disagreements.
Data análisis: meta-analysis
Meta-analysis was performed using the Cochrane Review Manager (Rev Man) statistical programme, Version 5.4 (The Cochrane Collaboration, 2020). Studies were considered that provided sample size, mean, and standard deviation of the outcome variables (self-compassion and compassion satisfaction) of the control and experimental groups in the post-intervention phase. An inverse variance statistical method with a random effects model was used (Borenstein et al., 2010). The results were plotted on a forest pot chart showing the effect size of each study and the weighted mean effect of all studies with their respective 95% confidence intervals. Cohen’s d showed whether the effect size was small (d ≤ 0.20); moderate (0.20 < d > 0.80); and large (d ≥ 0.80) (Cohen, 1988). The contrast statistic Z associated with the probability level (p ≤ .05) allowed us to test the null hypothesis of a mean effect of the intervention programmes in the studied population equal to 0. The inter-study variance was calculated using the Tau2 test by the DerSimonian and Laird (1986) method and the Q heterogeneity statistic (Chi2) with its degrees of freedom. The degree heterogeneity of the studies was analysed through the I2 statistic, interpreting 25% as low, 50% as medium, and 75% as high (Botella-Ausina & Sanchez-Meca, 2015). The probability of publication bias was calculated with Egger’s Regression (Egger et al., 1997) and Fail-Safe N using the Rosenthal Approach (Rosenthal, 1979). In addition, a sensitivity analysis by leave-one-out method was performed to detect influential studies by effect size. The R software, version R-4.3.2 for Windows (R Core Team, 2021) was used. Finally, the power analysis was calculated for each meta-analysis at the significance level of 0.05 with the SPSS statistical software, Version 29 (IBM, , 2023). This analysis allows us to detect what is the power to detect an effect given the average sample size.
Results
Prisma diagram
Figure 1 shows the article selection process. A total of 1277 articles were identified, selecting 1260 studies after eliminating duplicates. Of these, the full texts of 71 were reviewed, after being filtered by title and abstract. Only 8 articles were selected for the systematic review and four for the meta-analysis. The rest of the studies were removed for various reasons.
The aims of the different studies were: to evaluate the effects of an MSC intervention on self-compassion and mindfulness in health professionals (Aranda-Auserón et al., 2018); to examine the efficacy of the SCHC programme to improve wellbeing and reduce burnout among professionals (Neff et al., 2020); to analyze the benefits of a CCT programme on compassion fatigue and mindfulness (Scarlet et al., 2017); to determine the efficacy of MBSRT and CCT on mindfulness, self-compassion, fatigue compassion, and compassion satisfaction (Sansó et al., 2019); to compare the efficacies of the abbreviated MBSR and MSC training programmes in relation to the standard training programme on the levels of mindfulness, self-compassion, and self-perceived empathy (Pérula-de Torres et al., 2021); to test the feasibility and acceptability of a shorter intervention on compassion training for professionals providing end-of-life care and to explore its impact and psychological discomfort, occupational burnout, compassion fatigue, self-compassion, and mindfulness (Watts et al., 2021); to investigate the effect of LKM on compassion fatigue of nurses working in the NICU of selected hospitals in Tehran (Asadollah et al., 2023) and, finally, to investigate the capacity of a programme of short structured meditations on compassion fatigue and compassion satisfaction in healthcare professionals (Hevezi, 2015). Table 2 shows the characteristics of the main studies.
Design
This review included four quasi-experimental studies (Hevezi, 2015; Neff et al., 2020; Sansó et al., 2019; Scarlet et al., 2017), three randomized clinical trials (Aranda-Auserón et al., 2018; Asadollah et al., 2023; Pérula-de Torres et al., 2021); and a pre/post observational pilot study (Watts et al., 2021).
Participants and interventions
The studies included in this review were conducted in Spain (Aranda-Auserón et al., 2018; Sansó et al., 2019; Pérula-de Torres et al., 2021), USA (Hevezi, 2015; Neff et al., 2020; Scarlet et al., 2017), Iran (Asadollah et al., 2023) and Australia (Watts et al., 2021). The sample size ranged from 165 to 17 participants, who were multidisciplinary health professionals (Aranda-Auserón et al., 2018; Neff et al., 2020; Pérula-de Torres et al., 2021; Scarlet et al., 2017; Watts et al., 2021) and nurses (Asadollah et al., 2023; Hevezi, 2015). On the other hand, the professionals belonged to different fields: primary care (Aranda-Auserón et al., 2018; Pérula-de Torres et al., 2021; Sansó et al., 2019); hospitals (Asadollah et al., 2023; Hevezi, 2015; Neff et al., 2020; Scarlet et al., 2017); and both (Watts et al., 2021). The total number of participants in this review was 577, of whom 341 were members of the intervention group and 174 members of the control group. Participants were designated into an intervention group (Hevezi, 2015; Neff et al., 2020; Scarlet et al., 2017; Watts et al., 2021), two intervention and control groups (Pérula-de Torres et al., 2021), and a control and intervention group (Aranda-Auserón et al., 2018; Asadollah et al., 2023; Neff et al., 2020; Sansó et al., 2019).
The studies used different programmes based on the cultivation of compassion as interventions. The studies by Sansó et al. (2019) and Scarlet et al. (2017) used the CCT programme, while Aranda-Auserón et al. (2018) used the MSC programme. On the other hand, Neff et al. (2020) used an adaptation of the MSC programme called SCHC. In addition, two studies used a combination of interventions based on the cultivation of compassion: MBSR, CCT, and MSC (Watts et al., 2021); and, MBSR and MSC (Pérula-de Torres et al., 2021). Finally, Asadollah et al. (2023) used a LKM programme that consists of listening to audio files .and Hevezi (2015) used a meditation-focused programme that combined breathing, mindfulness, and LKM based on the cultivation of compassion.
The duration of the intervention programme was different in the various studies: 4 weeks (Hevezi, 2015; Pérula-de Torres et al., 2021); 6 weeks (Asadollah et al., 2023; Neff et al., 2020; Watts et al., 2021); 8 weeks (Aranda-Auserón et al., 2018; Pérula-de Torres et al., 2021; Scarlet et al., 2017); and 12 weeks (Sansó et al., 2019).
Variables
The instruments used to measure self-compassion were: the short version (Aranda-Auserón et al., 2018; Sansó et al., 2019; Scarlet et al., 2017; Pérula-de Torres et al., 2021; Watts et al., 2021); and the long version of the Self-Compassion Scale (SCS) (Delaney, 2018; Neff et al., 2020). On the other hand, the studies by Watts et al. (2021) and Hevezi (2015) measured compassion fatigue and compassion satisfaction using the professional quality of life scale (ProQoL version 5). In their first study Neff et al. (2020) used 10 items of the compassion satisfaction dimension on the ProQol scale, and, in the second, they used the complete ProQol scale. The short version of this scale (Short ProQol) was used by Sansó et al. (2019). Furthermore, Asadollah et al. (2023) used the scale Nursing Compassion Fatigue Inventory (NCFI) to measure compassion fatigue. Lastly, the study by Neff et al. (2020) measured compassion through the Santa Clara Brief Compassion Scale in their first study and through the “Compassion Scale” in their second study.
Methodological quality assessment
High scores were obtained for selection bias (random sequence generation and allocation concealment) and performance bias (blinding of participants and personnel). In addition, unclear scores were found in the blinding of outcome assessment and selective reporting due to lack of information (Fig. 2).
Results of the intervention programmes
Six of the seven studies used obtained a significant improvement in self-compassion (Aranda-Auserón et al., 2018; Neff et al., 2020; Sansó et al., 2019; Scarlet et al., 2017; Pérula-de Torres et al., 2021; Watts et al., 2021). In the studies by Aranda-Auserón et al. (2018), Neff et al. (2020), and Scarlet et al. (2017) the self-compassion variable improved when comparing the pre and post-intervention measures. Similarly, in the study by Pérula-de Torres et al. (2021) self-compassion showed statistically significant differences in the control group and the second intervention group, the latter showing the most pronounced increase. In addition, in a study by Sansó et al. (2019) both the CCT and the MBSRT interventions obtained significant pre-post intervention results in the self-compassion variable. Finally, Watts et al. (2021) found no significant pre-post intervention results for self-compassion. However, significant increases were obtained when comparing the pre-intervention and follow-up measures eight weeks later. The effect of the intervention on self-compassion varied from a large effect (Sansó et al., 2019) to a small one (Pérula-de Torres et al., 2021). Regarding the maintenance over time of the effect of the intervention, only four studies made this measurement (Neff et al., 2020; Pérula-de Torres et al., 2021; Scarlet et al., 2017; Watts et al., 2021), finding a sustained effect over time (Neff et al., 2020; Pérula-de Torres et al., 2021; Scarlet et al., 2017) or an increase (Watts et al., 2021) in the levels of self-compassion. Compassion for others as a variable was only studied by Neff et al. (2020) in their two studies. In the first study the increase in the level of compassion was close to significant (p = 0.068). In the second study significant improvements were obtained in the pre-post compassion intervention variable. A follow-up was carried out in the first study, showing an effect maintained over time of the programme.
Four studies analyzed compassion fatigue as an outcome variable after applying compassion-based programmes (Asadollah et al., 2023; Hevezi, 2015; Sansó et al., 2019; Watts et al., 2021). Compassion fatigue was measured through the ProQOL instrument, which evaluates two elements of the variable: burnout and secondary traumatic stress. Compassion fatigue decreased significantly in the pre-post intervention measures of the studies by Hevezi (2015) and Sansó et al. (2019). Specifically, in the study by Sansó et al. (2019) the decrease in the level of compassion fatigue was greater with the MBSRT programme than with CCT. On the other hand, Watts et al. (2021) obtained a significant decrease in burnout, a component of compassion fatigue. In addition, only these authors carried out a follow-up measure, discovering that the decrease in burnout was maintained over time. On the other hand, Asadollah et al. (2023) measured compassion fatigue with the NCFI, obtaining a significant improvement in the intervention group.
Lastly, the compassion satisfaction variable was analyzed in four studies (Hevezi, 2015; Neff et al., 2020; Sansó et al., 2019; Watts et al., 2021). In three of them programmes based on the cultivation of compassion significantly increased pre-post measures of compassion satisfaction (Hevezi, 2015; Neff et al., 2020; Watts et al., 2021). However, in the study by Sansó et al. (2019) the CCT intervention did not significantly improve compassion satisfaction. Regarding follow-up measures, only two studies examined the effect of long-term interventions on compassion satisfaction (Neff et al., 2020b; Watts et al., 2021). In the study by Watts et al. (2021) statistically significant differences were found in the pre-intervention and follow-up measures, with no significant relationship between post-intervention and follow-up. Similarly, Neff et al. (2020) found no significant differences between the post-intervention and follow-up measures, suggesting that the acquired skills were maintained over time.
Meta-analysis results
Meta-analysis: self-compassion variable
Six studies measured the self-compassion variable as an outcome variable (Aranda-Auserón et al., 2018; Neff et al., 2020; Pérula-de Torres et al., 2021; Sansó et al., 2019; Scarlet et al., 2017; Watts et al., 2021). Two of these studies were excluded because they did not have a control group (Scarlet et al., 2017; Watts et al., 2021). The total number of participants was 253, taking into account the two intervention groups of the study by Pérula-de Torres et al. (2021). Self-compassion was measured in all the studies through the SCS instrument, both in the short version of 12 items (Aranda-Auserón et al., 2018; Sansó et al., 2019; Pérula-de Torres et al., 2021) and in the full version of 22 items (Neff et al., 2020). In the studies by Aranda-Auserón et al. (2018) and Sansó et al. (2019) the average score of the total scale was calculated through the average scores of the different dimensions of the questionnaire. All the studies identified a positive effect on the development of self-compassion, that is, the interventions based on compassion and self-compassion showed an increase in the experimental group with respect to the control group. The standardized mean difference was 0.29 [0.17,0.42], considered a small effect according to Cohen (1988), while the total effect was significant (Z = 4.63, p ≤ 0.01).
In terms of heterogeneity, studies show that variability is absent (Tau2 = 0.00), not statistically significant (Chi2 = 4.75, p = 0.31) and low (I2 = 16%) at a 95% confidence interval. However, when interpreting the results we must consider the differences between the studies such as the intervention programme and the control group. In this aspect, the studies of Pérula-de Torres et al. (2021), Aranda-Auserón et al. (2018), and Neff et al. (2020) did not make any intervention in the control group; however, in the study by Sansó et al. (2019) the group that received the MBSRT intervention was considered the control group (Fig. 3). Since Egger’s test suggested that the publication distribution might be symmetric (Egger’s test = 0.74, p = 0.48, respectively), the meta-analysis results might not be affected by the publication bias. The Fail-safe N self-compassion variable was 53 (p < 0.001). In other words, further studies are needed to negate the effects on this variable.
The sensitivity analysis showed the robustness of the analysis obtained in the meta-analysis, as none of the studies influenced the overall effect size measure. Figure 4 shows the “leave one out” sensitivity analysis, eliminating one study at a time. The meta-analysis suggests that there is significant variability among the included studies. The pooled estimate indicates a positive effect, but heterogeneity is high. The omission of study 2 seems to have a particular impact on heterogeneity.
Meta-analysis: satisfaction compassion variable
Four studies measured compassion satisfaction as an outcome variable (Hevezi, 2015; Neff et al., 2020; Sansó et al., 2019; Watts et al., 2021). However, only two studies were included in the meta-analysis as they included a control group (Neff et al., 2020; Sansó et al., 2019). The total number of participants was 96. Compassion satisfaction was measured through the ProQOl instrument (Neff et al., 2020) and the short version of this scale (Sansó et al., 2019). The standardized mean difference was 0.03 [−0.02, 0.09], with the effect not being significant (Z = 1.07, p = 0.28). There was no variation between the different studies (Tau2 = 0.00) and hetereogeneity was not statistically significant (Chi2 = 0.01, p = 0.93), in addition to being considered as low (I2 = 0%) at a 95% confidence interval (Fig. 5). Sensitivity analysis and publication bias could not be performed as there were only two studies.
Power analysis
A power analysis was then performed for each meta-analysis conducted. For the variable self-compassion, the power analysis indicated that for a mean sample of N = 22 the observed statistical power was 80.9. For the variable compassion satisfaction for a mean sample of N = 72 the power was 80.5.
Discussion
The aim of this study was to determine the efficacy and the effectiveness of interventions based on the cultivation of compassion and self-compassion in health professionals in order to reduce compassion fatigue and improve self-compassion, compassion, and compassion satisfaction as outcome variables. Despite the fact that all the studies had interventions based on the cultivation of compassion, there are differences between the interventions: MSC (Aranda-Auserón et al., 2018); SCHC (Neff et al., 2020); MBSRT supplemented with MSC (Pérula-de Torres et al., 2021); CCT (Sansó et al., 2019); meditation and LKM to cultivate compassion (Asadollah et al., 2023; Hevezi, 2015); and a programme based on MBSR, CCT and MSC (Watts et al., 2021).
Self-compassion has been associated with numerous benefits for health professionals, especially a decrease in anxiety and depression, improvement in psychological well-being and physical health, as well as interpersonal relationships (Chwyl et al., 2021). In our meta-analysis, a significant, albeit small, a positive effect was found for the self-compassion variable. Therefore, all interventions based on the cultivation of compassion and self-compassion were effective in increasing self-compassion in health professionals (Aranda-Auserón et al., 2018; Neff et al., 2020; Pérula-de Torres et al., 2021; Sansó et al., 2019). Another study not included in the metaanalysis also showed an increase in self-compassion after the intervention (Scarlet et al., 2017). In addition, Ratu and Tondol (2022) conducted a systematic review on the effect of the full and modified MSC programme. These authors found an improvement in self-compassion and other psychological well-being outcomes in various age groups and in non-clinical and clinical contexts. Another systematic review also found that the MSC programme in nurses had medium-to-large effect sizes for self-compassion and compassion satisfaction (Biber, 2022). On the other hand, it was found that the increase in self-compassion can be maintained and increased after the intervention (Neff et al., 2020; Watts et al., 2021). Along the same lines, the application of these programmes has shown positive results in strengthening self-compassion in the general population (Guo et al., 2020; Irons & Heriot-Maitland, 2021) and professions other than healthcare (Andersson et al., 2021; Ko et al., 2018; Neff & Germer, 2013).
Self-compassion has been closely related to compassion; however, there is currently a debate about the link between both concepts (Strauss et al., 2016), with disparate results: a significant relationship (Rashid et al., 2020); a not very significant relationship (Elices et al., 2017); and a non-significant relationship (López et al., 2018). Compassion has not been included in the meta-analysis due to the paucity of literature on the subject. Only one study analyzes compassion as an outcome variable after the application of programmes based on the cultivation of compassion (Neff et al., 2020).
Another of the variables analysed was compassion satisfaction, which is related to the quality of healthcare, improving job performance, commitment, and competence (Okoli et al., 2020). In the meta-analysis of the compassion satisfaction variable, no significant improvement was found after applying the compassion cultivation and self-compassion programmes. The study of this variable is conditioned by two factors: the limitations of the existing bibliography on the subject and the characteristics of the articles can generate doubtful results. Specifically, in the study by Neff et al. (2020), despite presenting a significant improvement in compassion satisfaction after the intervention, an increase in this variable is not reflected in the metaanalysis. This can be attributed to the fact that the compassion satisfaction variable shows higher pre-test results in the control group compared to the intervention group. In addition, the calculations of the meta-analysis can only be compared to the post-test results of the control and intervention groups, so the pre-post-test difference is not taken into account. On the other hand, in the study by Sansó et al. (2019) two interventions (MBSRT and CCT) were applied, producing a small non-significant improvement in the compassion satisfaction variable. The authors associate these results with the fact that the participants presented high levels of compassion satisfaction before the interventions. Likewise, the study by Hevezi (2015), not included in the meta-analysis, demonstrated that interventions based on the cultivation of compassion increase compassion satisfaction in health professionals. Two studies evaluated the longitudinality of the results, discovering that compassion satisfaction increases and is maintained over time (Neff et al., 2020; Watts et al., 2021).
Compassion satisfaction is an effective tool to counteract compassion fatigue (Kelly et al., 2017) experienced by certain healthcare professionals as a consequence of chronic exposure to work-related stress (Xie et al., 2021). Despite being considered theoretical opposites (Fahey & Glasofer, 2016), compassion satisfaction and compassion fatigue can exist independently or coexist (Braun et al., 2022). Four studies analyzed compassion fatigue as an outcome variable (Asadollah et al., 2023; Hevezi, 2015; Sansó et al., 2019; Watts et al., 2021); however, it was not possible to perform a meta-analysis since three of the studies did not have a control group. Only one study that measured compassion fatigue had a control group, obtaining a significant decrease in the intervention group but no significant difference was observed in the control group (Asadollah et al., 2023). In two of the studies, programmes based on compassion cultivation decreased compassion fatigue in healthcare professionals (Hevezi, 2015; Sansó et al., 2019). In the study by Sansó et al. (2019), the effect of the intervention was very small and was associated with the low levels of pre-intervention compassion fatigue of the participants. Another study analyzed the relationship between compassion cultivation programmes and compassion fatigue although it only found significant results in burnout, one of the components of the outcome variable (Watts et al., 2021). In line with our results, other authors have suggested that interventions based on the cultivation of compassion can reduce the likelihood of compassion fatigue as well as improve therapeutic relationships (Bentley, 2022; Soto-Rubio & Sinclair, 2018).
In terms of risk of bias, none of the selected articles had a low risk of bias in all the domains assessed, so the quality of the data provided by the studies seems rather questionable. Other reviews of similar interventions concur with these results (Li & Bressington, 2019; Zimmermann et al., 2018). However, we agree with the opinion of other studies that this situation is clearly influenced by a possible inadequacy of the Cochrane Collaborations risk of bias assessment tool for this type of study (Ruiz-Fernández et al., 2020a). These programmes require participants’ attendance, motivation and therefore voluntariness and adherence to the practice. It is complex with this need to conduct randomisation and blinding processes similar to other drug interventions.
In the meta-analysis of the variables self-compassion and satisfaction with compassion, it was observed that the hetereogeneity of the studies is very low or non-existent, as well as not being significant for both variables. One of the reasons may be due to the scarcity of studies used in the sample of studies in the meta-analysis for the variables analysed.
Limitations
Among the limitations found when carrying out this systematic review, the scarce scientific evidence available on compassion-based interventions, accentuated when the sample is limited to health professionals, stood out. Another limitation was the lack of a control group in some of the articles found, which made it impossible to include the variables of compassion and compassion fatigue in the meta-analysis. In addition, poor randomization and blinding of interventions is common in studies. The requirement of voluntariness and the involvement of the participants greatly hinders the control of both quality elements since they have to be people committed to dedicating their free time to the programme. The small sample size of the studies, which might influence the results, can also be mentioned. Similarly, most of the participants were women, identifying a difficulty in extrapolating the results to the male gender. In addition, the lack of homogeneity in the selection of professionals may imply a bias when generalizing the results. Another limitation is the lack of post-intervention follow-ups produces a lack of knowledge about the long-term effect of these interventions. Lastly, the impossibility of performing meta-regression, due to the number of included studies, which would allow a sensitivity analysis of the meta-analysis. As recommendations for future lines of research, the scant literature available makes it essential to stress the need to develop new studies on the effects of compassion-based interventions in health professionals in the short and long term.
Conclusion
The available scientific evidence indicates that interventions based on the cultivation of compassion are useful in reducing compassion fatigue and increasing compassion, self-compassion, and compassion satisfaction of health professionals. Health professionals present a risk of developing compassion fatigue and a decrease in compassion satisfaction due to their work environment. Compassion fatigue causes significant alterations in the professional and personal lives of health workers, and it occurs due to a lack of training in empathy and compassion skills.
Therefore, it is necessary for healthcare to incorporate programmes based on the cultivation of compassion and self-compassion in order to improve the work conditions and quality of life of healthcare professionals. These training programmes should be integrated from undergraduate training, in the university environment within the regulated training of the professional curriculum of the health professions. Likewise, in postgraduate development, the insertion of these compassion cultivation programmes should be promoted within the framework of the organization of work in institutions and later provide professionals with space and time for formal practice. in your work environment.
Finally, these programmes should not only target professionals in direct patient care practice, but should also be aimed, especially at managers of institutions, to promote more compassionate leadership in organisations. Indeed, incorporating interventions that improve professional and managerial competencies supports the delivery of quality care in healthcare settings, both for patients and families, and promotes organisations that better accompany people in their suffering.
Data availability
Data are available from the first author or corresponding author on reasonable request.
References
Amutio-Kareaga, A., García-Campayo, J., Delgado, L., Hermosilla, D., & Martínez-Taboada, C. (2017). Improving communication between physicians and their patients through mindfulness and compassion-based strategies: A narrative review. Journal of Clinical Medicine, 6(3), 33. https://doi.org/10.3390/jcm6030033
Anderson, L. W., & Gustavson, C. U. (2016). The Impact of a knitting intervention on compassion fatigue in oncology nurses. Clinical Journal of Oncology Nursing, 20(1), 102–104. https://doi.org/10.1188/16.CJON.102-104
Andersson, C., Mellner, C., Lilliengren, P., Einhorn, S., Bergsten, K. L., Stenström, E., & Osika, W. (2021). Cultivating compassion and reducing stress and mental ill-health in employees—a randomized controlled study. Frontiers in Psychology, 12, 748140. https://doi.org/10.3389/FPSYG.2021.748140
Aranda-Auserón, G., Elcuaz-Viscarret, M. R., Fuertes-Goñi, C., Güeto-Rubio, V., Pascual-Pascual, P., & Sainz de Murieta-García de Galdeano, E. (2018). Evaluation of the effectiveness of a mindfulness and self-compassion program to reduce stress and prevent burnout in primary care health professionals. Atención Primaria, 50(3), 141–150. https://doi.org/10.1016/j.aprim.2017.03.009
Aslan, H., Erci, B., & Pekince, H. (2022). Relationship between compassion fatigue in nurses, and work-related stress and the meaning of life. Journal of Religion and Health, 61(3), 1848–1860. https://doi.org/10.1007/S10943-020-01142-0/TABLES/5
Asadollah, F., Nikfarid, L., Sabery, M., Varzeshnejad, M., & Hashemi, F. (2023). The impact of loving-kindness meditation on compassion fatigue of nurses working in the neonatal intensive care unit: A randomized clinical trial study. Holistic Nursing Practice, 37(4), 215–222. https://doi.org/10.1097/HNP.0000000000000590
Balinbin, C. B. V., Balatbat, K. T. R., Balayan, A. N. B., Balcueva, M. I. C., Balicat, M. G. B., Balidoy, T. A. S., Macindo, J. R. B., & Torres, G. C. S. (2020). Occupational determinants of compassion satisfaction and compassion fatigue among Filipino registered nurses. Journal of Clinical Nursing, 29(5–6), 955–963. https://doi.org/10.1111/JOCN.15163
Bentley, P. G. (2022). Compassion practice as an antidote for compassion fatigue in the era of COVID-19. The Journal of Humanistic Counseling, 61(1), 58–73. https://doi.org/10.1002/JOHC.12172
Biber, D. (2022). Mindful self-compassion for nurses: a systematic review. Nursing Management, 29(3), 18–24. https://doi.org/10.7748/nm.2021.e2028
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111. https://doi.org/10.1002/JRSM.12
Botella, J. & Sánchez Meca, J. (2015). Meta-análisis en ciencias sociales y de la salud. Madrid: Síntesis.
Braun, M., Naor, L., Hasson-Ohayon, I., & Goldzweig, G. (2022). Oncologists’ locus of control, compassion fatigue, compassion satisfaction, and the mediating role of helplessness. Current Oncology, 29(3), 1634–1644. https://doi.org/10.3390/CURRONCOL29030137
Brito, G. (2015). Secular Compassion Training: An Empirical Review. Journal of Transpersonal Research, 6(2), 61–71.
Brito-Pons, G., Waibel, A., Rosenberg, E., & Chun, J. M. (2019). Compassion Cultivation Training (CCT): Program description, research, and potential benefit for health care and palliative care professionals. In L. Galiana & N. Sansó (Eds.), The power of compassion (pp. 133–157). Nova Science Publishers.
Campling, P. (2015). Reforming the culture of healthcare: the case for intelligent kindness. BJPsych bulletin, 39(1), 1–5.
Cajal, B., Jiménez, R., Gervilla Garcia, E., & Montaño, J. J. (2020). Doing a systematic review in health sciences. Clínica y Salud, 31(2), 77–83.
Cetrano, G., Tedeschi, F., Rabbi, L., Gosetti, G., Lora, A., Lamonaca, D., Manthorpe, J., & Amaddeo, F. (2017). How are compassion fatigue, burnout, and compassion satisfaction affected by quality of working life? Findings from a survey of mental health staff in Italy. BMC Health Services Research, 17(1), 755. https://doi.org/10.1186/s12913-017-2726-x
Chachula, K. M. (2022). A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences. Current Psychology, 41(9), 6275–6287. https://doi.org/10.1007/S12144-020-01122-3/FIGURES/3
Chwyl, C., Chen, P., & Zaki, J. (2021). Beliefs about self-compassion: Implications for coping and self-improvement. Personality and Social Psychology Bulletin, 47(9), 1327–1342. https://doi.org/10.1177/0146167220965303
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Academic Press.
Conversano, C., Ciacchini, Ŕ., Orrù, G., Di Giuseppe, M., Gemignani, A., & Poli, A. (2020). Mindfulness, compassion, and self-compassion among health care professionals: What’s new? a systematic review. Frontiers in Psychology, 11, 1683. https://doi.org/10.3389/FPSYG.2020.01683/BIBTEX
Cooper, A. L., Brown, J. A., Rees, C. S., & Leslie, G. D. (2020). Nurse resilience: A concept analysis. International Journal of Mental Health Nursing, 29(4), 553–575. https://doi.org/10.1111/inm.12721
Corrêa, A. (2017). Reflections on the formation of the individual: Considerations about the idea of compassion. Psicologia USP, 28, 239–246. https://doi.org/10.1590/0103-656420160028
Dahl, C. J., Lutz, A., & Davidson, R. J. (2015). Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends in Cognitive Sciences, 19(9), 515. https://doi.org/10.1016/J.TICS.2015.07.001
Delaney, M. C. (2018). Caring for the caregivers: Evaluation of the effect of an eight-week pilot mindful self-compassion (MSC) training program on nurses’ compassion fatigue and resilience. PLoS One, 13(11), 1–20. https://doi.org/10.1371/journal.pone.0207261
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188.
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. Bmj, 315(7109), 629–634.
Elices, M., Carmona, C., Pascual, J. C., Feliu-Soler, A., Martin-Blanco, A., & Soler, J. (2017). Compassion and self-compassion: Construct and measurement. Mindfulness & Compassion, 2(1), 34–40. https://doi.org/10.1016/J.MINCOM.2016.11.003
Fahey, D. M., & Glasofer, A. (2016). An inverse relationship: Compassion satisfaction, compassion fatigue, and critical care nurses. Nursing Critical Care, 11(5), 30–35. https://doi.org/10.1097/01.CCN.0000490957.22107.50
Favrod, C., Jan du Chêne, L., Martin Soelch, C., Garthus-Niegel, S., Tolsa, J.-F., Legault, F., Briet, V., & Horsch, A. (2018). Mental health symptoms and work-related stressors in hospital midwives and NICU nurses: A mixed methods study. Frontiers in Psychiatry, 9, 364. https://doi.org/10.3389/fpsyt.2018.00364
Foerster, K., & Kanske, P. (2021). Exploiting the plasticity of compassion to improve psychotherapy. Current Opinion in Behavioral Sciences, 39, 64–71.
Gilbert, P., Catarino, F., Duarte, C., Matos, M., Kolts, R., Stubbs, J., Ceresatto, L., Duarte, J., Pinto-Gouveia, J., & Basran, J. (2017). The development of compassionate engagement and action scales for self and others. Journal of Compassionate Health Care, 4(1), 1–24. https://doi.org/10.1186/S40639-017-0033-3
Gilbert, P., & Choden. (2014). Mindful compassion: How the science of compassion can help you understand your emotions, live in the present, and connect deeply with others. New Harbinger Publications.
Goldin, P., & Jazaieri, H. (2017). The Compassion Cultivation Training (CCT) Program. https://doi.org/10.1093/oxfordhb/9780190464684.013.18
Guo, L., Zhang, J., Mu, L., & Ye, Z. (2020). Preventing postpartum depression with mindful self-compassion intervention: A randomized control study. Journal of Nervous and Mental Disease, 208(2), 101–107. https://doi.org/10.1097/NMD.0000000000001096
Gustafsson, T., & Hemberg, J. (2022). Compassion fatigue as bruises in the soul: A qualitative study on nurses. Nursing Ethics, 29(1), 157–170. https://doi.org/10.1177/09697330211003215
Hao, J., Liu, C., Feng, S., & Luo, J. (2022). Imagination-based loving-kindness and compassion meditation: A new meditation method developed from Chinese Buddhism. Journal of Religion and Health, 61(4), 2753–2769. https://doi.org/10.1007/S10943-021-01409-0/FIGURES/1
Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories. Journal of Clinical Nursing, 29(19-20), 3597.
Hevezi, J. (2015). Evaluation of a meditation intervention to reduce the effects of stressors associated with compassion fatigue among nurses. Journal of Holistic Nursing, 34(4), 343–350.
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., & Sterne, J. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, 7829. https://doi.org/10.1136/BMJ.D5928
IBM Corp. (2023). IBM SPSS Statistics for Windows, Version 29.0. IBM Corp.
Irons, C., & Heriot-Maitland, C. (2021). Compassionate mind training: An 8-week group for the general public. Psychology and Psychotherapy: Theory, Research and Practice, 94(3), 443–463. https://doi.org/10.1111/PAPT.12320
Jinpa, T. L. (2015). A fearless heart: How the courage to be compassionate can transform our lives. Hudson Street Press.
Jinpa, T. L., & Weiss, L. (2013). Compassion cultivation training (CCT). In T. Singer & M. Boltz (Eds.), Compassion: bridging practice and science. Leipzig: Max Planck Institute for Human Cognitive and Brain Sciences.
Kartsonaki, M. G., Georgopoulos, D., Kondili, E., Nieri, A. S., Alevizaki, A., Nyktari, V., & Papaioannou, A. (2022). Prevalence and factors associated with compassion fatigue, compassion satisfaction, burnout in health professionals. Nursing in Critical Care, 28(2), 225–235. https://doi.org/10.1111/NICC.12769
Kelly, L. A., Baker, M. E., & Horton, K. L. (2017). Code compassion: A caring fatigue reduction intervention. Nursing Management, 48(5), 18–22. https://doi.org/10.1097/01.NUMA.0000515800.02592.D4
Ko, C. M., Grace, F., Chavez, G. N., Grimley, S. J., Dalrymple, E. R., & Olson, L. E. (2018). Effect of seminar on compassion on student self-compassion, mindfulness and well-being: A randomized controlled trial. Journal of American College Health, 66(7), 537–545. https://doi.org/10.1080/07448481.2018.1431913
Kotera, Y., Green, P., & Sheffield, D. (2021). Positive psychology for mental wellbeing of UK therapeu-tic students: Relationships with engagement, motivation, resilience and self-compassion. International Journal of Mental Health and Addiction, 1-16.
Lang, A. J., Malaktaris, A. L., Casmar, P., Baca, S. A., Golshan, S., Harrison, T., & Negi, L. (2019). Compassion meditation for posttraumatic stress disorder in veterans: A randomized proof of concept study. Journal of Traumatic Stress, 32(2), 299–309. https://doi.org/10.1002/JTS.22397
Lee, T. W., Tsang, V. W. K., & Birch, N. P. (2008). Synaptic plasticity-associated proteases and protease inhibitors in the brain linked to the processing of extracellular matrix and cell adhesion molecules. Neuron Glia Biology, 4(3), 223–234. https://doi.org/10.1017/S1740925X09990172
Li, S. Y. H., & Bressington, D. (2019). The effects of mindfulness-based stress reduction on depression, anxiety, and stress in older adults: A systematic review and meta-analysis. International Journal of Mental Health Nursing, 28(3), 635–656. https://doi.org/10.1111/inm.12568
López, A., Sanderman, R., Ranchor, A. V., & Schroevers, M. J. (2018). Compassion for others and self-compassion: Levels, correlates, and relationship with psychological well-being. Mindfulness, 9(1), 325–331. https://doi.org/10.1007/S12671-017-0777-Z
Lown, B. A., Rosen, J., & Marttila, J. (2011). An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health affairs (Project Hope), 30(9), 1772–1778. https://doi.org/10.1377/hlthaff.2011.0539
Lown, B. A., Muncer, S. J., & Chadwick, R. (2015). Can compassionate healthcare be measured? The Schwartz Center Compassionate Care Scale™. Patient Education and Counseling, 98(8), 1005–1010. https://doi.org/10.1016/J.PEC.2015.03.019
Malenfant, S., Jaggi, P., Hayden, K. A., & Sinclair, S. (2022). Compassion in healthcare: an updated scoping review of the literature. BMC Palliative Care, 21(1), 1–28. https://doi.org/10.1186/S12904-022-00942-3/FIGURES/2
Martin-Allan, J., Leeson, P., & Lovegrove, W. (2021). The effect of mindfulness and compassion meditation on state empathy and emotion. Mindfulness, 12(7), 1768–1778. https://doi.org/10.1007/S12671-021-01639-Z/TABLES/3
McKnight, J., Nzinga, J., Jepkosgei, J., & English, M. (2020). Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya. Social Science & Medicine, 245, 112698. https://doi.org/10.1016/J.SOCSCIMED.2019.112698
Montero-Orphanopoulos, C. (2019). La compasión: diálogo con M. Nussbaum y E. Levinas. Pensamiento. Revista De Investigación E Información Filosófica, 75(285), 947–961. https://doi.org/10.14422/pen.v75.i285.y2019.008
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44. https://doi.org/10.1002/jclp.21923
Neff, K. D., Knox, M. C., Long, P., & Gregory, K. (2020). Caring for others without losing yourself: An adaptation of the mindful self-compassion program for healthcare communities. Journal of Clinical Psychology, 76(9), 1543–1562. https://doi.org/10.1002/JCLP.23007
Okoli, C. T. C., Seng, S., Otachi, J. K., Higgins, J. T., Lawrence, J., Lykins, A., & Bryant, E. (2020). A cross-sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre. International Journal of Mental Health Nursing, 29(3), 476–487. https://doi.org/10.1111/inm.12682
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 372, 71.
Papadopoulos, I., Taylor, G., Ali, S., Aagard, M., Akman, O., Alpers, L.-M., Apostolara, P., Biglete-Pangilinan, S., Biles, J., García, Á. M., González-Gil, T., Koulouglioti, C., Kouta, C., Krepinska, R., Kumar, B. N., Lesińska-Sawicka, M., Diaz, A. L. L., Malliarou, M., Nagórska, M., … Zorba, A. (2017). Exploring nurses’ meaning and experiences of compassion: An international online survey involving 15 countries. Journal of Transcultural Nursing, 28(3), 286–295. https://doi.org/10.1177/1043659615624740
Pavlova, A., & Consedine, N.S. (2023). Caring for the carer – Self-compassion in the health professions. In: Finlay-Jones, A., Bluth, K., Neff, K. (eds) Handbook of Self-Compassion. Mindfulness in Behavioral Health. Springer. https://doi.org/10.1007/978-3-031-22348-8_14
Perez-Bret, E., Altisent, R., & Rocafort, J. (2016). Definition of compassion in healthcare: a systematic literature review. International Journal of Palliative Nursing, 22(12), 599–606. https://doi.org/10.12968/IJPN.2016.22.12.599
Pérula-de Torres, L. A., Verdes-Montenegro, J. C., Melús-Palazón, E., García-de Vinuesa, L., Valverde, F. J., Rodríguez, L. A., Lietor-Villajos, N., Bartolomé-Moreno, C., Moreno-Martos, H., García-Campayo, J., González-Santos, J., Rodríguez-Fernández, P., León-Del-barco, B., Soto-Cámara, R., González-Bernal, J. J., Borao-Zabala, L., Grande, T., & Velarde Morillo-Moreno, C. (2021). Comparison of the effectiveness of an abbreviated program versus a standard program in mindfulness, self-compassion and self-perceived empathy in tutors and resident intern specialists of family and community medicine and nursing in Spain. International Journal of Environmental Research and Public Health, 18(8), 4340. https://doi.org/10.3390/IJERPH18084340
R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/
Radey, M., & Figley, C. R. (2007). The social psychology of compassion. Clinical Social Work Journal, 35(3), 207–214. https://doi.org/10.1007/S10615-007-0087-3/FIGURES/1
Ratu, D., & Tondol, M. (2022). Efektivitas program mindful self-compassion: Tinjuan Pustaka Sistematis (Effectiveness of mindful self-compassion programs: A systematic literature review). Psycho Idea, 20(2), 153–164. https://doi.org/10.30595/psychoidea.v20i2.11862
Rashid, S., Jehan, N., Khan, N., Gul, S., & Khan, H. (2020). Relationship between self-compassion and compassion for others. Ilkogretim Online - Elementary Education Online, 19(4), 5193–5200. https://doi.org/10.17051/ilkonline.2020.04.764928
Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86(3), 638–664. https://doi.org/10.1037/0033-2909.86.3.638
Ruiz-Fernández, M. D., Ortíz-Amo, R., Ortega-Galán, Á. M., Ibáñez-Masero, O., del Mar Rodríguez-Salvador, M., & Ramos-Pichardo, J. D. (2020a). Mindfulness therapies on health professionals. International Journal of Mental Health Nursing, 29(2), 127–140. https://doi.org/10.1111/inm.12652
Ruiz-Fernández, M. D., Ramos-Pichardo, J. D., Ibáñez-Masero, O., Cabrera-Troya, J., Carmona-Rega, M. I., & Ortega-Galán, Á. M. (2020b). Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. Journal of Clinical Nursing, 29(21–22), 4321–4330.
Ruiz-Fernández, M. D., Ramos-Pichardo, J. D., Ibáñez-Masero, O., Carmona-Rega, M. I., Sánchez-Ruiz, M. J., & Ortega-Galán, Á. M. (2021). Professional quality of life, self-compassion, resilience, and empathy in healthcare professionals during COVID-19 crisis in Spain. Research in Nursing & Health., 44, 620–632.
Sansó, N., Galiana, L., González, B., Sarmentero, J., Reynes, M., Oliver, A., & García-Toro, M. (2019). Differential effects of two contemplative practice-based programs for health care professionals. Psychosocial Intervention, 28(3), 131–138. https://doi.org/10.4135/9781446221211.n11
Scarlet, J., Altmeyer, N., Knier, S., & Harpin, R. E. (2017). The effects of Compassion Cultivation Training (CCT) on health-care workers. Clinical Psychologist, 21(2), 116–124. https://doi.org/10.1111/cp.12130
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469–e2036469. https://doi.org/10.1001/JAMANETWORKOPEN.2020.36469
Sinclair, S., Norris, J. M., McConnell, S. J., Chochinov, H. M., Hack, T. F., Hagen, N. A., McClement, S., & Bouchal, S. R. (2016). Compassion: A scoping review of the healthcare literature knowledge, education and training. BMC Palliative Care, 15(1), 1–16. https://doi.org/10.1186/S12904-016-0080-0/TABLES/4
Soto-Rubio, A., & Sinclair, S. (2018). In defense of sympathy, in consideration of empathy, and in praise of compassion: A history of the present. Journal of Pain and Symptom Management, 55(5), 1428–1434. https://doi.org/10.1016/j.jpainsymman.2017.12.478
Sorenson, C., Bolick, B., Wright, K., & Hamilton, R. (2016). Understanding compassion fatigue in healthcare providers: A review of current literature. Journal of Nursing Scholarship, 48(5), 456–465.
Spurlock, D. (2020). The nursing shortage and the future of nursing education is in our hands. Journal of Nursing Education, 59(6), 303–304. https://doi.org/10.3928/01484834-20200520-01
Strauss, C., Lever-Taylor, B., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27. https://doi.org/10.1016/J.CPR.2016.05.004
Su, J. J., Masika, G. M., Paguio, J. T., & Redding, S. R. (2020). Defining compassionate nursing care. Nursing Ethics, 27(2), 480–493. https://doi.org/10.1177/0969733019851546
Tala, T. A. (2023). Compassion in health: A view of its past, present and future. Revista Chilena de Neuro-Psiquiatría, 61(1), 127–134. https://doi.org/10.4067/S0717-92272023000100127
Thapa, D. K., Levett-Jones, T., West, S., & Cleary, M. (2021). Burnout, compassion fatigue, and resilience among healthcare professionals. Nursing and Health Sciences, 23(3), 565–569. https://doi.org/10.1111/NHS.12843
The Cochrane Collaboration. (2020). Review Manager (RevMan) [Computer program]. Version 5.4. The Nordic Cochrane Centre.
Wasson, R. S., Barratt, C., & O’Brien, W. H. (2020). Effects of mindfulness-based interventions on self-compassion in health care professionals: a meta-analysis. Mindfulness, 11(8), 1914–1934. https://doi.org/10.1007/S12671-020-01342-5/TABLES/6
Watts, K. J., O’Connor, M., Johnson, C. E., Breen, L. J., Kane, R. T., Choules, K., Doyle, C., Buchanan, G., & Yuen, K. (2021). Mindfulness-based compassion training for health professionals providing end-of-life care: Impact, feasibility, and acceptability. Journal of Palliative Medicine, 24(9), 1364–1374. https://doi.org/10.1089/JPM.2020.0358
Weingartner, L. A., Sawning, S., Shaw, M. A., & Klein, J. B. (2019). Compassion cultivation training promotes medical student wellness and enhanced clinical care. BMC Medical Education, 19(1), 1–11. https://doi.org/10.1186/S12909-019-1546-6/TABLES/5
Xie, W., Chen, L., Feng, F., Okoli, C. T. C., Tang, P., Zeng, L., Jin, M., Zhang, Y., & Wang, J. (2021). The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis. International Journal of Nursing Studies, 120, 103973. https://doi.org/10.1016/J.IJNURSTU.2021.103973
Zimmermann, F. F., Burrell, B., & Jordan, J. (2018). The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: A systematic review. Complementary Therapies in Clinical Practice, 30, 68–78. https://doi.org/10.1016/j.ctcp.2017.12.014
Acknowledgements
We thank the research groups CTS-500 HIGIA of the University of Huelva and the research group CTS-451 Health Sciences of the University of Almeria for their collaboration. We would also like to thank the Fundación Progreso y Salud (FIBAO) for their support.
Funding
Funding for open access publishing: Universidad de Almería/CBUA.
Author information
Authors and Affiliations
Contributions
All authors have participated in the development of this study. Ruiz-Fernández, Alcaraz-Córdoba and Ortega-Galán conceived the study and participated in the data collection, data analysis and in writing the manuscript. Ventura-Miranda and García-Navarro managed the data, created the database and participated in the data analysis. Ibañez-Masero participated in the interpretation of the data and in writing the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that there are no conflicts of interest in this investigation.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020208619.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Alcaraz-Córdoba, A., Ruiz-Fernández, M.D., Ibáñez-Masero, O. et al. The efficacy of compassion training programmes for healthcare professionals: a systematic review and meta-analysis. Curr Psychol 43, 18534–18551 (2024). https://doi.org/10.1007/s12144-024-05618-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-024-05618-0