by Adena Cohen-Bearak, M.Ed., MPH – Project Manager, IPEP
Clinicians often must convey difficult, and life-altering information to their patients. A new diagnosis, a poor prognosis, uncertain outcomes – day in and day out, health care providers spend their days communicating with their patients, and sometimes the news isn’t good. Research has shown how receiving “bad news” affects patients, but current research shows that clinicians are profoundly affected as well when giving such news. How do health care providers cope with the responsibility of having to give bad news to patients? What strategies do they use to manage their own emotions?
These questions are the focus of a recently published article – Clinicians’ Strategies for Managing Their Emotions During Difficult Healthcare Conversations – led by IPEP’s Associate Director, Donna Luff.
The research team collected data from IPEP’s Program to Enhance Relational and Communication Skills (PERCS) professional training workshops. Via self-report questionnaires, clinicians from a range of specialties and with varying levels of experience were asked to describe the strategies they use to tend to their emotions during difficult conversations with patients and families.
The team’s findings suggest that, from experience and practice, clinicians develop a personal “toolbox” for regulating and tending to their emotions in these situations. Some of the strategies described by the workshop participants included:
1. Self-care – taking care of oneself before, during, and after a difficult conversation. Specific strategies prior to a difficult conversation included: identifying their own emotions, taking deep breaths, or simply taking a moment; strategies for after the difficult conversation included exercise, venting about the experience with others, or even crying.
2. Preparatory and relational skills – specific strategies included preparing for the conversation by reviewing the chart, rehearsing what one will say, thinking about what the family might want to hear and how it should be delivered; several participants also mentioned allowing silence during the conversation as a strategy.
3. Empathic presence – keeping the focus on the family and their needs, and temporarily forgetting about their own (clinician) needs or emotions.
4. Team approach – speaking with the family along with others on the team as support, or talking with others on the team before or afterwards for support and advice.
5. Professional identity – separating their personal and professional self to better maintain equilibrium during a difficult conversation; leaving work problems at work.
Further research on the effectiveness of these strategies is planned, as well as work on developing additional strategies to enhance clinicians’ “toolbox.”