Is compassion fatigue a self-fulfilling prophecy in health care? A preregistered experimental study of manipulated expectations in doctors and medical trainees

Abstract

Objectives: To test the possibility that narratives regarding compassion as tiring (compassion fatigue) in health care represent a form of self-fulfilling prophecy by experimentally testing whether perceptions of compassion can be manipulated and whether such manipulations change ratings of compassion toward hypothetical patients. Design: Preregistered experimental study of medical practitioners and trainee doctors conducted anonymously and online using a mixed between-groups and repeated within-person design. Methods: New Zealand doctors and medical trainees were randomized to watch a video positioning compassion as positive or negative (or a control video). Perceptions of compassion were rated before and after the manipulation, before participants rated standardized vignettes depicting patients who systematically varied in terms of presentation and responsibility for condition. Data were analysed using factorial analysis of variance (ANOVA). Results: Factorial ANOVA revealed that perceptions of compassion were influenced by the video manipulation but group differences in ratings of care, compassion, and desire to help hypothetical patients were not found. Patient presentation and responsibility manipulations showed large effects and there was evidence for the influence of social desirability. Conclusions: This study provides ‘proof of principle’ that perceptions of compassion are malleable lending support to the possibility that a focus on compassion fatigue may be contributing to a self-fulfilling prophecy. Perceptions of compassion were readily altered following a short video intervention. While group differences in responses to hypothetical patients were not seen, the findings (particularly the large effect of patient factors) support the view that multiple factors contribute to the emergence of compassion in health care.