Seeing the human behind the sample: How compassion training shaped inner awareness,relationships,and workplace meaning in HIV end-of-life research

What is already known on this topic

• Professionals working in end-of-life healthcare and research settings experience high emotional demands and are at risk for burnout.

There is limited qualitative evidence describing how brief compassion training programs are experienced by interdisciplinary research teams engaged in end-of-life work.

What this paper adds

• This study provides in-depth qualitative insight into how a brief, 4-week compassion training program was experienced by an interdisciplinary team working in an HIV rapid research autopsy program.

Implications for practice, theory or policy

• Brief compassion training programs may be a feasible and acceptable approach to supporting well-being among professionals working in emotionally demanding palliative and end-of-life research settings.

Setting, participants recruitment and data collection

We employed a qualitative study design using focus group discussions (FGDs). Last Gift Study team members and collaborators were invited by email to participate in a compassion training program conducted during work hours. Inclusion criteria were: 1) being a Last Gift Study team member or collaborator, 2) ability to read English, 3) provision of informed consent. Exclusion criteria included any individuals experiencing recent traumatic life circumstances that could cause daily meditation practice to be overwhelming. Participation was voluntary and did not affect employment. Supervisors did not attend the sessions to minimize perceived pressure, coercion, or hierarchical bias.

Following informed consent, willing participants enrolled in a four-week compassion training program led by a facilitator (S.S.) from the UCSD Center for Mindfulness. The program consisted of four 90-minute sessions delivered weekly via Zoom and covered mindfulness, self-compassion, common humanity, and active compassion. The facilitator adapted the Compassion Cultivation Training (CCT™) curriculum to a condensed four-week format to improve feasibility and accessibility for participants while retaining core instructional components. Selected content from self-compassion, compassion for others, and integrated daily compassion practice modules was combined across sessions to preserve key compassion-focused principles and practices.

The intervention was informed by a conceptual theory of change in which mindfulness and compassion practices were expected to help participants become more aware of their own emotions, respond to themselves with greater kindness, and recognize shared human experiences. These changes were expected to support emotional regulation, reduce self-criticism, increase openness to receiving support, and help participants respond more compassionately to colleagues and others. At the team level, the intervention was expected to strengthen communication, connection, shared purpose, and workplace resilience in the emotionally demanding context of end-of-life HIV research.

In addition to facilitator-led sessions, participants were assigned daily guided meditation practices of approximately 15 minutes and were encouraged to integrate informal mindfulness and compassion practices into daily activities.

Upon completion of the compassion training program, all participants were invited to take part in FGDs to share perspectives on their experiences. As a qualitative study, no formal statistical power calculation was performed. Participants were recruited from among individuals who completed the compassion training and were willing to participate in post-intervention FGDs. The recruitment stopping point was determined by participant availability and completion of three FGDs, rather than by prospective use of thematic saturation as a stopping criterion. Among 24 participants who participated in the compassion training, 10 participated in one of three FGDs between December 2024 and June 2025. FGDs were conducted a median of 8 weeks following completion of the training program (range: 3–12 weeks).

Focus group discussion guide

Members of the research team (N.H. and K.D.) developed the FGD guide by drawing from a question bank derived from previously published qualitative studies. ¹³ The question bank was not a previously validated questionnaire; rather, it was adapted for this study context based on prior qualitative literature and expert review by the research team. We reviewed each item for relevance to the context of HIV research at the end of life and compassion training, modified wording as needed, and added new items to address themes specific to the intervention. The full discussion guide is provided in Supplementary Table 1.

Data analysis

Our team stored audio recordings on a secure, access-restricted server and transcribed using an encrypted transcription service. We did not return transcripts to participants for comment; trained research assistants (W.T., R.L., J.L.) reviewed transcripts for accuracy by comparing them with the original recordings and removed any identifying information.

We used conventional content analysis ¹⁵ as the guiding qualitative analytic framework because the study was exploratory and sought to derive codes, categories, and themes inductively from participant narratives rather than apply a pre-existing theoretical framework. To strengthen reporting transparency, we reviewed the manuscript using relevant items from the Consolidated Criteria for Reporting Qualitative Research (COREQ) Supplementary Table 2. ¹⁶ Multiple members of the research team (A.A., W.T., J.L., N.H.) independently coded transcripts without applying a pre-existing coding framework due to the exploratory nature of the study. Research assistants (W.T., J.L.) and the principal investigator (N.H.) developed an initial codebook, which was reviewed and refined by a secondary coder (A.A.). Initial codes were iteratively reviewed, grouped into broader categories, and synthesized into overarching themes. Our team discussed coding discrepancies during bi-weekly meetings (N.H., A.A., K.D.) and resolved them through consensus. We also reviewed less common or divergent accounts during coding and consensus meetings. No deviant themes emerged that contradicted the central interpretation of the intervention as feasible, acceptable, and meaningful to participants. However, variation in participants’ experiences was retained in the analysis and considered during theme development. Throughout the analytic process, the research team engaged in reflexive discussions to acknowledge how prior involvement with the Last Gift study and the principal investigator’s prior experience with compassion-focused work could influence interpretation of participant narratives. Use of multiple coders and consensus discussions helped enhance analytic rigor and minimize the influence of individual perspectives on data interpretation. During analysis, major themes recurred across FGDs, with no substantially new major themes emerging in later discussions. Formal member checking was not performed because of the exploratory nature of the study and the small, workplace-based participant group. Instead, trustworthiness was supported through transcript review for accuracy, independent coding by multiple team members, iterative codebook refinement, reflexive discussions, team-based review of emerging themes, and consensus-based resolution of discrepancies.

We present representative quotes in the Results section, with additional supporting quotes provided in Supplementary Table 3.

Ethical considerations

The UC San Diego Office of Institutional Review Board Administration reviewed the Last Gift Compassion Training protocols (#810327 and #811193) and determined that the study met criteria for exempt status.

1. Intrapersonal growth and inner awareness

FGDs reflected pronounced internal changes resulting from the compassion training. Participants reported deeper engagement in mindfulness, stronger self-compassion, and broadened ability to respond to compassion.

2. Interpersonal and community connections

Participants also reflected on noticeable shifts in navigating interpersonal dynamics. Focus group participants described heightened awareness of common humanity, enhanced ability to extend compassion to others, and improved interpersonal conflict management.

3. Applying compassion skills to work and everyday life

Participants noted feeling a stronger sense of community and team functioning among Last Gift colleagues. They described these relational changes as being both individually supportive and beneficial to the entire team. This strengthened sense of collective effort was associated with increased workplace satisfaction and diminished stress among participants.

Supporting stress management, resilience & workplace satisfaction

Participants reported no change or a reduction in stress following the compassion training. Normalizing challenges and fostering mutual understanding among colleagues appeared to mitigate stress by easing feelings of isolation at work.

Additionally, discussion recurrently highlighted how the training equipped participants with self-compassion strategies to set boundaries between work demands and personal life. Several mentioned improved abilities to prioritize personal needs without guilt:

Before I'd be like… really frustrated, and, you know, anxious about leaving a little bit early to meet friends on a busy clinic day, but I'm like, “You know what? No, this is what I need to do for me, and that's okay.” I can tell myself that I will get it done, and that's okay… It's a lot more compassion for myself and what I need versus what the external needs to take from me. It's like I need to fill my cup first in order to give my best to everyone, to everything and everyone else, and without feeling guilty about it, and then allowing myself to be present when I am in the presence of people that I care about as well.— LG-CT-FGD-16

Moreover, focus group participants reported increased pleasure from performing their job well. Participants described reconnecting to the humanistic and participant-centered dimensions of the Last Gift program, deepening a feeling of purpose in daily tasks.

It helps me… see the sample as… somebody that was a human… it makes me see it with some more intent, even with… emotional purpose. It helps me to have some sort of, like dedication to the sample and make sure that… I'm doing my work with integrity so that the best results are produced and we can contribute the most… to like find a cure to HIV. — LG-CT-FGD-02

Connection with the broader mission of their work was reinforced as the compassion training exposed participants to colleagues outside their immediate teams. Recognizing the collective effort and shared purpose behind the Last Gift program helped participants derive renewed energy and meaning from their work, buffering against burnout and enhancing overall workplace satisfaction.

Main findings

Given the emotional intensity and ethical complexity of end-of-life research, there is a need to better understand how brief compassion-based interventions may support the well-being and functioning of research professionals. Participants shared rich narrative data which suggest that even short compassion programs can still have meaningful impact, linking practices to personal wellbeing and team functioning. Participants described the impact of the compassion training program on personal growth and inner awareness. Responses reflect deepened engagement in mindfulness, improved self-compassion and emotional resilience, and greater openness to accept compassion from others. These emergent outcomes facilitated emotional regulation in interpersonal dynamics and stress resilience at work. Participants discussed the importance of formal and informal practices. They described how turning inward allowed for reflective awareness and a renewed commitment to the Last Gift research mission. Enhanced self-compassion helped to create healthy boundaries, to improve work-life balance, and to strengthen emotional resilience. In addition, the ability to more freely accept compassion, as noted by our participants, could allow one’s distress to become shared and normalized. This process directly counters isolation and over-identification (i.e., the tendency to get carried away by negative emotions), two elements that are linked to burnout and emotional exhaustion. ¹⁷ Thus, compassion-based interventions can change one’s relationship with difficult emotions and stress, which invariably affects how one relates to others.

Our findings further demonstrate that compassion training can create changes in interpersonal relationships and ignite shared purpose, functioning as a social intervention in the workplace, rather than simply an individual one. Participants described a stronger sense of community, enhanced communication, and an improved ability to manage interpersonal conflict. The meaningful changes that participants experienced also appeared to strengthen collaboration, workplace efficiency (e.g., during rapid research autopsies), in addition to well-being. Discussion responses also conveyed positive team dynamics, which contributed to greater workplace satisfaction and stress resilience. In a systematic review of healthcare professionals, compassion-related interventions showed improvements in interpersonal conflict scores. ¹⁸ Other studies have shown that shared experiences and compassion practices can strengthen interpersonal relationships and create a sense of community.^19,20 Responses further reflect the relevance of collective purpose as a means of mitigating personal and professional burnout. Notably, mission-focused intentionality has been described as a key element in decreasing burnout and increasing compassion satisfaction in emotionally intense work environments. ²¹

While our results align with a growing body of evidence that brief compassion and mindfulness-based interventions can support professionals working in emotionally intense settings^22,23 they further extend the compassion-training literature to end-of-life research contexts. Our qualitative findings complement and expand results from our previously published quantitative evaluation of the Last Gift Compassion Training program, which identified improvements in overidentification, workplace joy, and the perception of a supportive work environment. ²⁴ While the quantitative data detected measurable changes over 12 weeks, the current qualitative data offer insight into how participants experienced these changes, including shifts in emotional awareness, interpersonal interactions and approaches to emotionally demanding work. Emerging themes from the FGDs shed light on how participants integrated compassion practices within, and balancing between, their professional and personal lives.

Beyond individual coping strategies, organizational context can play a role in reducing staff burnout. One retrospective study explored antecedents (e.g., workload, fairness, reward, community) of burnout in two clinical trial call centers. ²⁵ Lower turnover and higher consent rates were observed when staff received fair compensation, experienced less pressure to make a certain number of calls, were given a greater variety of responsibilities, and participated in project decisions. Among oncology professionals, leadership endorsement and active facilitation were essential to participation in compassion training. ²² In a national study of clinical research professionals working in mental health, the perception of a supportive organizational climate, particularly one that prioritized research ethics and team support, buffered the effects of moral stress and burnout. Similarly, the Last Gift study presents ethical commitments at the end of life and emotional demands that may extend beyond staff roles and can deeply affect research professionals. The Last Gift program has long prioritized team well-being through supportive leadership practices, including positive reinforcement, fair compensation, community engagement, and cultivating a shared sense of purpose through direct connection with participants and their families. This positive organizational climate may have amplified the impact of the compassion training by reinforcing mutual respect, recognition, and collective meaning in an emotionally demanding work environment. Thus, compassion-based interventions must be paired with a broader institutional commitment to staff wellbeing.

Considerations for implementation

These findings informed a set of practical recommendations for teams working in emotionally demanding settings (Table 2). Although our results reflect experiences during a 4-week intervention, participants described the mechanisms through which this training improved mindfulness, self-compassion, and team dynamics. Thus, there are potential applications that extend beyond the study timeframe. These examples are informed by the Last Gift Compassion Training program; participant experiences could vary and should be adapted to meet the needs of other teams.

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Table 2.

Insights from the Last Gift Compassion Training and practical applications.

Themes	Key Insights	Practical Applications	Implementation Considerations
Intrapersonal Growth and Inner Awareness	Participants described how practicing mindfulness formally and informally encouraged intentional presence at work.	Teams may consider offering brief, mindful moments into existing workflow (e.g. minute of silence, intention setting at the start of week).	Participation should be voluntary; benefit beyond 4 weeks was not assessed in this study.
Interpersonal and Community Connections	Recognizing common humanity helped participants to navigate challenging interactions.	Teams may offer skill-based workshops on compassion which could include teaching members about common humanity. Guided meditation and informal exercises (e.g. “just like me”) could be used to strengthen one’s ability to give compassion to others.	Ensuring psychological safety is critical.
Applying Compassion Skills to Work and Everyday Life	Opportunities for shared vulnerability strengthened a sense of community among team members.	Teams may consider creating structured opportunities for voluntary sharing; normalizing reflection; using team building/connection activities focused on shared purpose (the ‘why’ the work matters).	Explore ideas for sustained engagement (e.g. accountability partners, monthly meet-ups).
Interpersonal and Community Connections	Participants described feeling safer acknowledging emotional experiences when supported by shared practices and peer connection.	Examples include accountability buddies, drop-in reflection sessions, inviting reflection during meetings (e.g. one-word check-ins, mood check-ins), structured, facilitated debriefs during emotionally intense events (e.g. deaths, rapid research autopsies).	Accountability buddies should be self-selected.
			Leadership should model behavior.
			During reflections and debriefs, group facilitators should prioritize listening versus problem solving (e.g. no fixing).