Highlight
– Palliative care clinicians experience strong emotions triggered by complex end-of-life encounters such as ethical dilemmas and emotional confrontations.
– They consciously recognize these emotions through physical and psychological cues.
– A critical assessment determines whether and how to share these emotions, influenced by factors like emotional skills and team safety.
– Sharing emotions strategically aids in building a deeper connection with patients and families, enhancing patient- and relationship-centered care.
Study Background
Palliative care, centered on alleviating suffering and improving quality of life for patients with serious illnesses, involves emotionally charged encounters. Clinicians frequently confront ethical conflicts, patient and family distress, and existential issues while providing end-of-life care. Despite the emotional intensity inherent to these consultations, the role of clinicians’ own emotions remains underexplored in clinical research and training. Understanding how clinicians use their feelings can inform strategies to support emotional resilience and optimize patient-clinician relationships, which are pivotal to achieving compassionate, holistic care.
Study Design
This qualitative study employed a social constructivist grounded theory methodology to explore how palliative care clinicians use their emotions during patient consultations. Researchers conducted individual interviews with 22 clinicians from diverse professional backgrounds—including two psychologists, four social workers, five nurses, and eleven physicians—across 10 countries, ensuring a wide cultural and disciplinary representation. Most participants were women (14 of 22), with a mean age of 45 years and an average of 13 years’ experience in palliative care. The study aimed to capture authentic experiences and interpret the processes surrounding clinicians’ emotional use in consultations.
Key Findings
Three-Phase Process of Using Emotions
The study identified a dynamic process consisting of three interconnected phases that clinicians undergo when managing their emotions during difficult end-of-life encounters:
1. Emotional Triggering and Awareness
Clinicians encountered emotionally challenging situations such as ethical dilemmas, conflicting opinions, or direct exposure to patients’ and families’ strong emotions, which triggered intense feelings. They became mindful of these emotions through physiological signals (e.g., changes in heart rate, muscle tension) or psychological cues (e.g., intrusive thoughts, mood shifts). This awareness was the foundational step allowing clinicians to engage with their emotions intentionally.
2. Assessment of Emotional Sharing
Following awareness, clinicians evaluated whether it was appropriate to express their emotions. This assessment was influenced by various facilitators and barriers including their self-perceived emotional competence, previous experiences, and the perceived psychological safety within their clinical teams. For instance, in a supportive environment where emotional expression was normalized and valued, clinicians felt more confident sharing feelings.
3. Decision and Mode of Sharing
Clinicians then decided how and if to share their emotions—either verbally, through explicit statements, or non-verbally via body language, tone, or facial expressions. This sharing aimed to validate patient and family feelings, foster mutual understanding, and deepen relational connections essential for patient-centered end-of-life care. Strategic emotional disclosure thus emerged as a deliberate tool for strengthening therapeutic alliances.
Core Concept: Building Connection Through Emotions
Across all phases, the underlying value linking the process was the intention to foster connection. Clinicians viewed using their emotions not as a vulnerability but as a resource to enhance empathy, trust, and communication with patients and relatives, thereby improving the quality and depth of care.
Expert Commentary
The findings resonate with the growing recognition in literature that emotional competence is a key component of effective palliative care. Emotional awareness and regulation skills are essential for clinicians to navigate intense clinical situations without burnout while maintaining compassionate caregiving. Experts highlight that training programs should incorporate emotional skills development to better prepare clinicians for the interpersonal demands of palliative care. Stem from social constructivist theory, this study also acknowledges that emotional expression is shaped by cultural and social contexts, advising that interventions be contextually sensitive. However, limitations include the self-reported nature of interviews and potential selection bias of participants already attuned to emotional aspects of care.
Conclusion
This study enriches understanding of how palliative care clinicians consciously use their emotions during consultations to form meaningful connections with patients and families. The proposed three-phase model underscores that awareness, assessment, and intentional sharing of emotions serve as an effective relational strategy. Integrating emotional skills training tailored to palliative contexts holds promise for enhancing clinician well-being and improving patient-centered outcomes. Future research should explore organizational and cultural factors shaping emotional use and address longitudinal impacts of emotional competence education on clinical practice.
References
1. Moens K, Bilsen J, Zambrano SC. Connecting Through Emotions: A Social Constructivist Grounded Theory on How Palliative Care Clinicians Use Their Emotions During Consultations. J Gen Intern Med. 2026 Jun 15. PMID: 42298201.
2. Sinclair S, Raffin-Bouchal S, Venturato L, et al. Compassion training in healthcare: what are patients’ perspectives on training healthcare providers? A scoping review. BMC Med Educ. 2020;20(1):45.
3. Gentry MT, Webster J, Godfrey KM. Emotional intelligence and empathy in palliative care clinicians: A systematic review. Palliat Med. 2019;33(5):501-512.
