Eccellenza: The Risks And Benefits Of Integrating Emotions In End Of Life Communication

Period

November 2021 - November 2026

Summary

BACKGROUND AND RATIONALE
There is growing evidence that patient-physician relationships benefit from physicians who develop a degree of emotional closeness to their patients. These benefits are seen in improved outcomes for the patient, the health system, and the physician. 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. Traditionally, training in these skills was not part of medical education and it has only been in the past two decades that significant progress has been made in upskilling health professionals in end of life communication. Despite these efforts, 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. The reason is largely because decision-making and the physicians’ role in medicine has traditionally been seen to require objectivity. 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, which is often incompatible with their training. How physicians reconcile these two seemingly incompatible worlds across their career remains unknown.

OVERALL OBJECTIVES AND AIMS
In the proposed 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 and the physician, 2) physician emotions and public expectations, 3) physician emotions and experiences of bereaved family members, 4) how emotions are used in current 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 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.

Funding

SNF eccellenza