Kindness: Poor cousin or equal kin to Compassion and Empathy in the Healthcare Literature? A Scoping Review.

Objective: This scoping review seeks to understand how kindness, compassion and empathy are defined and conceptualised within existing healthcare services literature.

Introduction: Little consensus exists on how healthcare literature defines and conceptualises kindness. Kindness is often conflated with the terms compassion and empathy, which both have more prominence in the literature. However, evidence would suggest that all three terms are indeed different. To advance kindness as a key tenet of quality improvement and human experience outcomes in healthcare, a consensual definition must be established in the evidence base.

Methods: We reviewed published research identified using search queries across five databases and one search engine. Studies were included in this review if the definition, measurement and/or conceptualisation of kindness, empathy and/or compassion were stated objectives of the work and the research was directly relevant to healthcare settings.

Results: 1348 results were screened, and with additional snowballing of some articles for relevant references, 107 progressed to full-text screening. Forty-two articles were subsequently included in this scoping review. By synthesising this evidence, we establish key commonalities and differences for kindness, compassion and empathy. We present a model for understanding how empathy, compassion and kindness can be viewed on a stimulus-response-action continuum. We also explore the definitional challenges expressed by many authors who call for these terms to be treated as separate concepts.

Conclusions: This review evidence demonstrates that kindness, compassion and empathy have clear themes that stand them apart, and they occupy different places on the stimulus-response-action continuum. Importantly, kindness deserves its own place in literature as a primary concept, not as a second tier to compassion or empathy. By comparing each term, these positions are now highlighted. They can help us to more articulately define, conceptualise and value kindness, compassion and empathy for their unique contributions to the humanity of healthcare.