Service Users’ Conceptualisations of Compassionate Care in an Improving Access to Psychological Therapies Service: A Grounded Theory Study

Background

The clinical relevance of compassionate care is now widely accepted and is currently one of the most cited requirements for best practice in guidelines and policies. The latest Improving Access to Psychological (IAPT) Services manual states that effective and efficient approaches should be balanced with compassionate care (NHS England, 2019). However, despite its current centrality, the concept lacks a consensual definition and a framework for practice in this context.

Aim

Knowledge of relational aspects, such as compassion, is best elicited by exploring individual experiences and perceptions (Robert et al., 2011). Therefore, an empirical understanding of compassionate care in IAPT based on the perspective of service users, the recipients of compassionate care, is essential. To the day, there is limited research investigating service users’ conceptualisations of compassionate care, and studies have generally been based in physical healthcare settings, arising questions regarding the generalisability of the findings to an IAPT service.
To address the identified gap in the literature, this study will investigate service users’ understandings and experiences of compassionate care in an IAPT service.

Method

This grounded theory (GT) study used semi-structured interviews to investigate how service users understand and experience compassionate care in an IAPT service.
Thirteen people who used or had used an IAPT service were interviewed. Drawing from the constructivist GT guidelines of Charmaz (2014), the analysis process was iterative in nature, occurring simultaneously with data collection, using methods of transcription, systematic coding, memo writing and diagramming.

Findings

The analysis yielded five categories, each containing specific themes. Together, they constitute the grounded theory model ‘Humanising Responses to Distress’. This is the first empirically based model of compassionate care in a psychological therapies service in the UK. The model defines compassion as a humanising response to distress. This response involves striving to understand the individual experience, acting to meet the person’s needs, empowering the person and creating a secure relationship with them.

Conclusions

The components of the compassion model provide insight into how service users understand and experience compassionate care in IAPT. The model highlights the importance of prioritising individualised, relational and empowering approaches over rigid and prescriptive interventions that are not tailored to service users’ needs and preferences. Therefore, the current emphasis on standardised approaches and outcome measures may have a negative impact on compassionate care in IAPT as defined by service users.