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Background: Compassionate communities are part of an international public health movement aiming to address social determinants of death by fostering supportive environments. Yet, empirical research on community engagement in this field is still limited, particularly the influence of local contexts on engagement patterns. Objectives: This study aimed to identify effective engagement practices and contextual factors influencing the development and sustainability of compassionate communities. Research design and method: A comparative ethnographic method was used to examine community engagement processes in two culturally distinct compassionate communities in Montréal (Canada): Centre-Sud and West Island. Data collection included participant observation, semistructured interviews, and logbooks. Informed by developmental evaluation, the analysis was guided by a thematic lens approach and the Ecology of Engagement framework. Results: Two distinct, context-sensitive paths to community engagement emerged, shaped by the sociocultural realities of each setting. In Centre-Sud, a grassroots, community-led approach focused on shared leadership and building trust fostered a resilient network that achieved sustainability through the creation of an independent nonprofit organization. In contrast, West Island’s institutionally led strategy was a pragmatic response to navigate contextual barriers like preexisting community distrust, achieving sustainability by embedding the initiative within the lead organization via a permanent staff role. Conclusion: This comparative ethnography demonstrates that success is not defined by a single model but by adapting engagement strategies to local dynamics of trust and power. It highlights that while community-led approaches can foster deep ownership, institutionally led strategies can provide a crucial pathway to sustainability in contexts facing systemic barriers. The study offers a practical framework for practitioners and key lessons for developing evidence-based policy to support compassionate communities in diverse settings. Plain language summary Developing compassionate communities: Lessons from two different Montréal neighborhoods Developing ‘compassionate communities’—local networks that support people through serious illness, grief, and the end of life—is a shared effort. This research explored the most effective ways to engage communities in this work by comparing two distinct Montréal neighborhoods: the downtown Centre-Sud area and the suburban West Island. We found that there’s no single recipe for success. In the downtown Centre-Sud area, community groups took the lead, building a strong, trusted network that eventually became its own non-profit organization to ensure sustainability. In the suburban West Island, a local palliative care residence guided the process, creating a permanent staff role to secure a lasting impact. The key lesson is that the best approach depends on a community’s unique character and history. Success comes from adapting the strategy to fit the local reality.

Background: Compassionate communities build on health promoting palliative care that aims to address gaps in access, quality, and continuity of care in the context of dying, death, loss, and grief. While community engagement is a core principle of public health palliative care, it has received little attention in empirical studies of compassionate communities. Objectives: The objectives of this research are to describe the process of community engagement initiated by two compassionate communities projects, to understand the influence of contextual factors on community engagement over time, and assess the contribution of community engagement on proximal outcomes and the potential for sustaining compassionate communities. Research Approach and Design: We use a community-based participatory action-research approach to study two compassionate communities initiatives in Montreal (Canada). We develop a longitudinal comparative ethnographic design to study how community engagement evolves in different compassionate communities contexts. Methods and Analysis: Data collection includes focus groups, review of key documents and project logbooks, participant observation, semi-structured interviews with key informants, and questionnaires with a focus on community engagement. Grounded in the ecology of engagement theory and the Canadian compassionate communities evaluation framework, data analysis is structured around longitudinal and comparative axes to assess the evolution of community engagement over time and to explore the contextual factors influencing the process of community engagement and its impacts according to local context. Ethic: This research is approved by the research ethics board of the Centre hospitalier de l’Université de Montréal (approval certificate #18.353). Discussion: Understanding the process of community engagement in two compassionate communities will contribute to a deeper understanding of the relationships between local context, community engagement processes, and their effect on compassionate communities outcomes.

Context Engaging with peers is gaining increasing interest from healthcare systems in numerous countries. Peers are people who offer support by drawing on lived experiences of significant challenges or ‘insider’ knowledge of communities. Growing evidence suggests that peers can serve as a bridge between underserved communities and care providers across sectors, through their ability to build trust and relationships. Peer support is thus seen as an innovative way to address core issues of formal healthcare, particularly fragmentation of care and health inequalities. The wide body of approaches, goals and models of peer support speaks volumes of such interest. Navigating the various labels used to name peers, however, can be daunting. Similar terms often hide critical differences. Objectives/Background This article seeks to disentangle the conceptual multiplicity of peer support, presenting a conceptual map based on a 3‐year knowledge synthesis project involving peers and programme stakeholders in Canada, and international scientific and grey literature. Synthesis/Main Results The map introduces six key questions to navigate and situate peer support approaches according to peers' roles, pathways and settings of practice, regardless of the terms used to label them. As a tool, it offers a broad overview of the different ways peers contribute to integrating health and community care. Discussion We conclude by discussing the map's potential and limitations to establish a common language and bridge models, in support of knowledge exchange among practitioners, policymakers and researchers. Patient or Public Contribution Our team includes one experienced peer support worker. She contributed to the design of the conceptual map and the production of the manuscript. More than 10 peers working across Canada were also involved during research meetings to validate and refine the conceptual map.

Introduction: Intercultural collaboration in integrated community care faces a paradox. Some view community care as a ‘local craft’, intimately embedded within its socio-cultural context, and therefore it cannot be exported. Others view it as ‘interventions’ that are transferable and scalable, like other health innovations. This article proposes a middle-ground approach, highlighting the role of interpersonal relationships as a foundation for intercultural collaboration in integrated community care. Description: Over a five-year period, we pursued an intercultural collaboration between two integrated community care initiatives in Canada and Japan. Both initiatives are grounded in the principles of community empowerment, linkages across health and social care, and complementarity of lived experience and professional knowledge. Our collaboration evolved in three interrelated phases: 1) intercultural discovery and exploration; 2) intercultural relationship-building and strengthening; and 3) intercultural explicitation and influence. Discussion: While the implementation science literature largely focuses on cognitive processes of knowledge exchange, our experience highlights deeper relational dimensions that are essential to intercultural learning and impact across community care initiatives, including socialisation among collaborators, beyond their professional roles and identities. Conclusion: Relational and socialisation processes should be recognised, nurtured and valued as integral components of intercultural collaborative efforts in integrated community care. Knowledge gained from this experience can inform cross-cultural efforts to support the global integrated community care movement.

Background Peer support has been extensively studied in specific areas of community-based primary care such as mental health, substance use, HIV, homelessness, and Indigenous health. These programs are often built on the assumption that peers must share similar social identities or lived experiences of disease to be effective. However, it remains unclear how peers can be integrated in general primary care setting that serves people with a diversity of health conditions and social backgrounds. Methods A participatory qualitative study was conducted between 2020 and 2022 to explore the feasibility, acceptability, and perceived effects of the integration of a peer support worker in a primary care setting in Montreal, Canada. A thematic analysis was performed based on semi-structured interviews ( n  = 18) with patients, relatives, clinicians, and a peer support worker. Findings Findings show that peers connect with patients through sharing their own hardships and how they overcame them, rather than sharing similar health or social conditions. Peers provide social support and coaching beyond the care trajectory and link identified needs with available resources in the community, bridging the gap between health and social care. Primary care clinicians benefit from peer support work, as it helps overcome therapeutic impasses and facilitates communication of patient needs. However, integrating a peer into a primary care team can be challenging due to clinicians’ understanding of the nature and limits of peer support work, financial compensation, and the absence of a formal status within healthcare system. Conclusion Our results show that to establish a relationship of trust, a peer does not need to share similar health or social conditions. Instead, they leverage their experiential knowledge, strengths, and abilities to create meaningful relationships and reliable connections that bridge the gap between health and social care. This, in turn, instills patients with hope for a better life, empowers them to take an active role in their own care, and helps them achieve life goals beyond healthcare. Finally, integrating peers in primary care contributes in overcoming obstacles to prevention and care, reduce distrust of institutions, prioritize needs, and help patients navigate the complexities of healthcare services.

Background Compassionate communities are rooted in a health promotion approach to palliative care, aiming to support solidarity among community members at the end of life. Hundreds of compassionate communities have been developed internationally in recent years. However, it remains unknown how their implementation on the ground aligns with core strategies of health promotion. The aim of this review is to describe the practical implementation and evaluation of compassionate communities. Methods We undertook a scoping review of the empirical peer-reviewed literature on compassionate communities. Bibliographic searches in five databases were developed with information specialists. We included studies in English describing health promotion activities applied to end-of-life and palliative care. Qualitative analysis used inductive and deductive strategies based on existing frameworks for categorization of health promotion activities, barriers and facilitators for implementation and evaluation measures. A participatory research approach with community partners was used to design the review and interpret its findings. Results Sixty-three articles were included for analysis. 74.6% were published after 2011. Health services organizations and providers are most often engaged as compassionate community leaders, with community members mainly engaged as target users. Adaptation to local culture and social context is the most frequently reported barrier for implementation, with support and external factors mostly reported as facilitators. Early stages of compassionate community development are rarely reported in the literature (stakeholder mobilization, needs assessment, priority-setting). Health promotion strategies tend to focus on the development of personal skills, mainly through the use of education and awareness programs. Few activities focused on strengthening community action and building healthy public policies. Evaluation was reported in 30% of articles, 88% of evaluation being analyzed at the individual level, as opposed to community processes and outcomes. Conclusions The empirical literature on compassionate communities demonstrates a wide variety of health promotion practices. Much international experience has been developed in education and awareness programs on death and dying. Health promotion strategies based on community strengthening and policies need to be consolidated. Future research should pay attention to community-led initiatives and evaluations that may not be currently reported in the peer-review literature.

ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

Peer support workers-people with a significant lived and living experience of a social or health condition-use their experiential knowledge and obtain training to help and care for others. They are integrated in different clinical settings, including those for people experiencing homelessness. Most research on peer support implementation in homelessness has not considered the of the implementation, particularly in periods of crisis. During the COVID-19 pandemic crisis, a participatory research project examined the integration of a peer support worker in a primary and community care clinic that serves people experiencing homelessness in Montreal (Canada). This article presents a narrative case study analysis of the specific data on implementation derived from this project. Three main learning points are of interest regarding implementation: 1) crises can precipitate challenges but also particular opportunities for the implementation of peer support initiatives in homelessness; 2) even during a crisis, certain key steps cannot be skipped when the goal is a successful implementation; and 3) research can be an external asset for clinical teams as they struggle to deliver care during periods of crisis. Peer support initiatives in homelessness can be implemented in the Canadian context during periods of crisis-for example, the COVID-19 pandemic-for health and social care services. Moreover, the concept of itself can be reexamined by clinical and research teams worldwide as potentially enabling the implementation of novel initiatives.

Background Patient engagement is attracting considerable interest as a potential strategy to improve the conduct of clinical trials, with evidence of significant improvement in research participant recruitment. However, impact on the retention and adherence of clinical trial participants requires further studies. Embedded studies are specific research designs where a secondary study is “embedded” into a larger host study. We aimed to investigate the feasibility of embedding a study of patient partnership in research, within an ongoing multi-center clinical trial on drug treatment. Methods We developed and embedded a patient engagement intervention (embedded study) into a phase 3 randomized clinical drug trial (host study). The patient engagement intervention consisted of discussions between host study participants and a patient partner, to improve research participants’ experience and retention in the clinical trial. We carried out individual semi-structured interviews with patient partners and other research team members involved in the development and implementation of the embedded study, as well as an analysis of project documents. Data were analyzed using qualitative thematic analysis. Results Factors impacting feasibility and lessons learned for future embedded studies on engagement science were identified. Barriers that curtailed the implementation of patient engagement into an ongoing clinical trial included: the late integration of the embedded study into the host clinical trial, different visions of patient partnership and its potential benefits, differences in communication style and preferences, a lack of fit between the specific needs of the host study and the proposed engagement model, and an overall sense of burden. Integrating patient partners into the host clinical trial was seen as potentially beneficial in improving the experience of participants in the host clinical trial through experience sharing, providing support for the consent process, and improving knowledge transfer. Conclusions This feasibility study offers insights into how contextual factors and decisions made during the design phase can impact the implementation of patient engagement studies embedded in a clinical trial. Findings suggest that knowledge of the clinical trial context (e.g., organizational, administrative, regulatory, ethics) and early collaboration among embedded study and host study teams before initiation of both studies are key conditions for success. Plain English Summary Clinical studies aim to find out if a new treatment or intervention works well. For the results of these studies to be trustworthy, it is important to enlist many participants, and for these participants to remain in the study until it is over. Studies show that involving patients as partners in clinical studies can help enlist participants. This study aimed at exploring the feasibility of creating a collaboration between research nurses and patient partners to enlist and keep clinical study participants. Two teams, one working on patients in research and another conducting a clinical drug study, worked together on a detailed research plan. Through interviews and documents used in the study, we learned about the challenges of including a patient partner into the clinical study team. For example, it is difficult to include a project into a clinical study that is already underway, when the teams working together have different visions of patient engagement in research, when these teams use different ways of communicating, and when the intervention offered to participants does not meet their needs well. However, patient partners could improve participants’ experience by sharing their experiences and providing information about the study and its results. We have drawn several important lessons from this study. The key conditions for success seem to be: knowing the context of the clinical study, like the organization’s culture, working to build a partnership between the teams involved in the project, and working together early in the research process.

Breaking the silence: How safe spaces help communities connect through death and loss This study explored the social and cultural transformations within “compassionate communities,” local initiatives supporting those experiencing serious illness, death, and grief. We aimed to understand how these projects change the way people relate to mortality. For three years, our research team followed two distinct Montréal projects: a grassroots, community-led effort and an institutionally-led initiative. We analyzed their impact through 84 hours of participant observation and 26 interviews with 22 participants. We found that local settings acted as active forces, shaping how each community addressed its unique needs. For instance, programs tackled challenges such as the stigma of drug overdoses or “social death”—the profound separation from community life caused by the shame and isolation felt by victims of senior fraud. Despite their different paths, both projects successfully created “safe spaces” to bridge the gap between private loss and grief and a society that often lacks the rituals or social “scripts” needed to discuss loss. In these spaces, a powerful process we call “death sociability” emerged. Participants formed reciprocal relationships to learn from one another’s experiences, building lasting community resources like new skills for discussing loss and shared rituals to honor the dead. By addressing both the physical and social aspects of mortality, these initiatives foster the human connection needed for a more equitable and human-centered approach to death, dying, and grief.