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BackgroundThe acceleration of technology-based primary care during the COVID-19 pandemic outpaced the ability to understand whether and how it impacts care delivery and outcomes. As technology-based care continues to evolve, focusing on the core construct of compassion in a primary care context will help ensure high-quality patient care and increased patient autonomy and satisfaction. The ability to successfully operationalize the use of technology in patient-clinician interactions hinges on understanding not only how compassionate care is experienced in this context but also how clinicians can create it. ObjectiveThe objectives of this study were to understand whether and how compassionate behaviors are experienced in technology-based primary care interactions and identify the individual and contextual drivers that influence whether and how these behaviors occur. MethodsWe conducted a series of qualitative one-on-one interviews with primary care physicians, nurses, and patients. Qualitative data were initially analyzed using an inductive thematic analysis approach to identify preliminary themes for each participant group independently. We then looked across participant groups to identify areas of alignment and distinction. Descriptions of key behaviors that participants identified as elements of a compassionate interaction and descriptions of key drivers of these behaviors were inductively coded and defined at this stage. ResultsA total of 74 interviews were conducted with 40 patients, 20 nurses, and 14 primary care physicians. Key behaviors that amplified the experience of compassion included asking the patient’s modality preference, using video to establish technology-based presence, sharing the screen, and practicing effective communication. Participants’ knowledge or skills as well as their beliefs and emotions influenced whether or not these behaviors occurred. Contextual elements beyond participants’ control influenced technology-based interactions, including resource access, funding structures, culture, regulatory standards, work structure, societal influence, and patient characteristics and needs. A high-yield, evidence-based approach to address the identified drivers of compassion-focused clinician behavior includes a combination of education, training, and enablement. ConclusionsMuch of the patient experience is influenced by clinician behavior; however, clinicians need a supportive system and adequate supports to evolve new ways of working to create the experience of compassionate care. The current state of technology-based care operationalization has led to widespread burnout, societal pressure, and shifting expectations of both clinicians and the health system more broadly, threatening the ability to deliver compassionate care. For clinicians to exhibit compassionate behaviors, they need more than just adequate supports; they also need to receive compassion from and experience the humanity of their patients.

Background. Critical Care Response Teams (CCRTs) represent an important interface between end-of-life care (EOLC) and critical care medicine (CCM). The aim of this study was to explore the roles and interactions of CCRTs in the provision of EOLC from the perspective of CCRT members. Methods. Twelve registered nurses (RNs) and four respiratory therapists (RTs) took part in focus groups, and one-on-one interviews were conducted with six critical care physicians. Thematic coding using a modified constructivist grounded theory approach was used to identify emerging themes through an iterative process involving a four-member coding team. Results. Three main perspectives were identified that spoke to CCRT interactions and perceptions of EOLC encounters. CCRT members felt that they provide a unique skill set of multidisciplinary expertise in treating critically ill patients and evaluating the utility of intensive care treatments. However, despite feeling that they possessed the skills and resources to deliver quality EOLC, CCRT members were ambivalent with respect to whether EOLC was a part of their mandate. Challenges were also identified that impacted the ability of CCRTs to deliver quality EOLC. Conclusions. This research aids in understanding for the first time CCRT roles in EOLC from the perspectives of individual CCRT members themselves. While CCRTs provide unique multidisciplinary expertise to evaluate the utility of intensive care treatments, opportunities exist to support CCRTs in EOLC, such as dedicated EOLC training, protocols for advance care planning, documentation, and transitions to palliative care.

As awareness grows of the catastrophic implications of global environmental change, multiple scholarly fields addressing health-environment relationships have advocated 'transformative' educational strategies. Holistic Indigenous health-environment models inspire and inform many such efforts, but related land-based learning initiatives involving universities are often impeded by the competitive processes of academia. In this article we report on a community-university partnership – Pedagogy for the Anthropocene (P4A) – aimed at developing transformative educational responses to pressing global crises, inspired by land-based approaches. We integrate political ecologies of health, education, and knowledge to understand the troubled production of pedagogical knowledge in P4A, participant experiences in the resulting educational programs and the role of health and bodies in both. We first trace the production of knowledge as shaped by macroscopic and localized institutional forces; organizational and occupational dynamics; interacting knowledges and individuals; and material factors. Next, we explore participant experiences in the resulting educational programming. In both steps, affect-laden bodies of academics, trainees and community members reveal entanglements with human communities and more-than-human elements, shaped in variable ways by institutional forces such as settler colonialism and university neoliberalization. One key finding involves the role of universities in relation to land dispossession at home and abroad; another includes the challenges of pursuing transformational community-university research within contemporary universities. Tracing such entanglements yields implications for future land-based learning efforts in university settings, and broader praxis for environmental justice in the shadow of higher education's complicity with settler colonialism and globally extractive neoliberal capitalism.