Patient Experience of Clinician Compassion Is Associated With Healthcare System Distrust Among Emergency Department Patients

BACKGROUND: Healthcare system distrust-patients' belief that the healthcare system may not act in their best interests-is a recognized social determinant of health and is associated with poor health outcomes, decreased adherence to treatment, and heightened health disparities, especially among marginalized populations. Compassion from clinicians may be a modifiable factor that can foster trust in healthcare systems, but its association with system-level distrust, particularly in emergency department (ED) settings, remains underexplored. METHODS: We conducted a nested cross-sectional study enrolling adult patients treated at two urban academic EDs in the United States between September 2023 to May 2024. We separately measured patient experience of physician and nursing staff compassion using the validated 5-item compassion measure, and patient healthcare system distrust using the Healthcare System Distrust Scale. Multivariable linear regression models, adjusted for demographics and study site, tested associations between perceived compassion and distrust, including subgroup analyses by race, gender, and other sociodemographic factors. RESULTS: The primary analysis included 779 patients. Both physician (median score 20 [IQR 17-20]) and nursing staff compassion (median score 20 [IQR 17-20]) were highly rated. Higher compassion scores for both physicians (β = -0.62, 95% CI 0.80 to -0.44) and nursing staff (β = -0.24, 95% CI 0.38 to -0.09) were independently associated with lower healthcare system distrust. Compared to non-Hispanic White patients, Black patients reported higher healthcare system distrust, driven by values (i.e., honesty, motives, and equity)-based distrust rather than competency-based distrust, but did not report lower compassion scores. The association between compassion and reduced distrust was consistent across demographic subgroups. CONCLUSION: Greater experience of compassion from ED physicians and nursing staff is independently associated with lower healthcare system distrust. Interventions to enhance clinician compassion have the potential to foster trust and may reduce health disparities in emergency care settings.