Photo Credit: iStock.com/Pornpak Khunatorn

A recent review reports that compassionate care in the ED may improve outcomes, and authors urge expanded ED-specific compassionate care research and training.

A narrative review in The American Journal of Emergency Medicine suggests that compassionate care in emergency departments (EDs) may yield significant and enduring health benefits and advocates for expanded research and targeted training on compassionate care in EDs.

“Moments of human connection can feel like a rarity in an often cacophonous and overcrowded ED—besieged on one side by patients suffering the consequences of overburdened primary care and public health systems and on the other by a boarding crisis without apparent end,” observed corresponding author Clifford M. Marks, MD, of Beth Israel Deaconess Medical Center’s Department of Emergency Medicine and colleagues. “Indeed, demonstrating compassion may even seem inconsequential when weighed against an avalanche of clinical tasks. Yet, the research … suggests compassion may matter far more than many suspect in the moment.”

Researching the Impact of Compassionate ED Care

Although compassion has long been valued in clinical practice, research focusing specifically on ED settings has been sparse, “even though the acuity and uncertainty inherent in this environment arguably make compassion particularly vital,” the authors wrote. Most existing investigations have examined compassion’s influence on anxiety and post-traumatic stress disorder (PTSD) symptoms, leaving a notable gap in the understanding of how compassionate interactions shape broader patient outcomes.

The authors noted an ED-focused prospective study of 113 adult patients who presented in the ED with a life-threatening medical emergency. Findings showed that patient perception of greater healthcare provider compassion in the ED was independently associated with fewer PTSD symptoms at 1 month: a 1-point increase in the Consultation and Relational Empathy (CARE) score was associated with a 7% decrease in the odds of developing PTSD symptoms.

Complementing this quantitative evidence, the authors cited a qualitative analysis of 54 survivors’ experiences of emergency care after a major bus crash. The study found that lack of compassion in the ED “led to great discomfort and distress among survivors,” and survivors’ memories of ED provider compassion—or its absence—dominated their narratives 5 years after the event. One patient in the study stated, “I had to go home in my bloodstained shirt and the jacket I wore in the accident, and then to be told to take the bus home … It was so terribly wrong.”

Insights From Other Clinical Settings

Although ED-specific data remain limited, studies in ambulatory and inpatient environments suggest that compassion may also modulate pain perception and medication adherence. A prospective study cohort of 63 patients with migraine showed positive correlations between CARE scores and symptom improvement, suggesting that perceived empathy may enhance therapeutic efficacy.

Similarly, a retrospective analysis of 891 patients with diabetes found that those under the care of physicians with high empathy scores were more likely to achieve target A1c levels (<7%) compared with patients whose physicians scored lower on empathy assessments.

Measuring Compassionate Care Outcomes

The authors advocated for patient-reported outcome measures rather than third-party evaluations for future assessments of compassionate care in the ED. They highlighted the 5-Item Compassion Measure—recently validated for use in the ED—as a tool capable of reliably quantifying compassionate behaviors in high-pressure settings.

Expanding Compassionate Care Training

“It is vitally important to better understand both the teaching of compassion and its myriad potential impacts,” the authors wrote, adding that the field of compassion training in medicine is “very much in its infancy.”

They highlighted a recent review of 52 studies—spanning didactic lectures, standardized patient role-play, and real patient interactions—noting that only two of the 52 studies specifically addressed emergency medicine physicians.

Rigorous Research Required

Given the fast-paced, high-stakes nature of the ED environment, the urgent need for more evidence regarding the effects of compassion is vital, according to the review.

“Delivering on the promise of compassion requires rigorous research—no less than assessing the effects of a drug,” the authors wrote. “Otherwise, it will remain easy to dismiss compassion as noble but unimportant beside the medications, care interventions, and procedures that dominate medical literature.”