The Risks And Benefits Of Integrating Emotions In End Of Life Communication
Sofia C. Zambrano R., Phd
Background
There is growing evidence that patient-physician relationships benefit from physicians who develop a degree of emotional closeness to their patients. However, displaying emotional closeness can be conflicting for physicians, as it requires a degree of personal involvement that has long been taboo in medicine. At the end of life in particular, the medical encounter is laden with emotions; patients are confronted with their mortality and physicians must find the right time and the appropriate words for these discussions. Despite efforts to upskill health professionals in end of life communication, studies show that families and patients continue to be informed late in the disease progression, and that even after these discussions they remain misinformed. Although emotions and the inner life of the physician have been known to influence communication and the doctor-patient relationship, their effect remains largely unexplored. Moreover, despite a shift in training efforts to teach empathy and patient-centred models to younger physicians, the workplace exposes them to the traditional practice of emotional distance. How physicians reconcile these two seemingly incompatible worlds across their career remains unknown.
Overall Objectives And Aims
In the research projects for the Eccellenza Professorial Fellowship, the overarching aim is to explore the role of emotions in medical practice. The main focus is on understanding how are physician emotions present in everyday practice, how are they managed, what is their impact on physician’s wellbeing and on patient care, what do families expect, and whether emotions and communication can be influenced by self-reflection. These questions will be answered in general, but also in the end of life context. The proposed projects are divided into five themes: 1) emotions, physicians, and patients, 2) physician emotions and public expectations, 3) physician emotions and experiences of bereaved family members, 4) physicians and the role of emotions in practice, and 5) the place of emotions in medical education.
Methodology
The main component of the research is a cohort study in which a nested randomised clinical trial will test whether a self-reflection intervention or an anxiety-reducing intervention can affect the wellbeing of physicians, and whether these interventions can impact communication with patients and the physicians’ comfort with communication. Within the cohort, longitudinal changes in constructs such as burnout, emotional intelligence and comfort about end of life discussions will be tracked during 3 years. To further explore the proposed areas, mixed methods analyses, and qualitative and quantitative single designs will be employed to analyse data from in-depth interviews, cross-sectional surveys, and factorial surveys. The target participant groups will reflect the complexity of roles and actors involved at the end of life: physicians, patients, families, the public, other clinicians, and educators.
Expected Results And Impact
The main significance of this study lies in its timeliness and in its comprehensive approach to a complex subject in medicine. It responds to current and future challenges of caring for an ageing population at a time when medical developments can prolong life almost indefinitely, and where new technologies such as artificial intelligence provide increasingly accurate diagnoses and thus place a greater emphasis on the physician’s ability to communicate with their patients. Ultimately, the proposed projects will provide a deeper understanding of the risks and benefits associated with integrating emotions in the practice of medicine, in order to facilitate end of life discussions with patients and their family members.
Short Bio
Sofia C. Zambrano is a Postdoctoral Researcher at the University Centre for Palliative Care at the Inselspital, Switzerland, where she has worked since 2016. She is also a Visiting Research Fellow in the School of Psychology at the University of Adelaide in Australia. Sofia obtained her PhD from The University of Adelaide in 2012 and her dissertation on how physicians experience the death of their patients was awarded the Dean’s Commendation for Research Excellence. Trained as a psychologist in Colombia, she has had experience counselling patients and their families in the palliative care setting in Colombia and in Australia. She has also taught and mentored health professionals in end of life topics in Australia and Switzerland at the undergraduate and postgraduate levels.
Her research interests lie predominantly in psychological aspects of end-of-life care. Specifically, in understanding the attitudes, experiences, and emotions of health professionals and btrainees when dealing with the death and dying of their patients. She has obtained funding from the SNSF as principal investigator and from the FOPH and the Swiss Cancer League as a co-investigator.
Sofia will start her Eccellenza Professorial Fellowship as Assistant Professor at the ISPM in autumn 2021.
