Clinical Scorecard: Clinicians’ Emotional Responses During Conversations About Serious Illness

At a Glance

Key Highlights

• Brief physician self-disclosure and verbal expressions of sadness were associated with higher ratings of comfort, trust, compassion, and professionalism.
• Sadness accompanied by tears was associated with greater comfort, trust, and compassion and did not significantly lower perceived professionalism.
• Ratings differed between language groups, indicating that responses may vary by linguistic and cultural context.
• The survey provides indirect, hypothesis-generating evidence because participants evaluated written hypothetical scenarios rather than real conversations.
• The authors advise against scripted emotional expression and emphasize keeping attention on the patient’s suffering and needs.

Guideline-Based Recommendations

Diagnosis

Management

• The authors advise against treating self-disclosure or emotional expression as scripted communication techniques.
• When expressing emotion or disclosing personal information, direct it toward meeting the patient’s needs rather than serving the clinician.
• Keep the focus on the patient’s suffering; avoid expressions that shift emotional responsibility to the patient or require the patient to comfort the clinician.
• The authors note that a concise remark such as “I am truly sorry that we have reached this point” may acknowledge the seriousness of the circumstances.

Monitoring & Follow-up

• Attend to how the patient responds, recognizing that the meaning and acceptability of clinician emotion may vary by individual and context.

Risks

• The source states that performed or clinician-focused emotion may be perceived as insincere or as sympathy rather than empathy or compassion.
• The study did not assess uncontrolled distress, prolonged crying, or situations in which patients felt obligated to comfort the clinician.
• Written vignettes cannot represent tone, silence, facial expression, eye contact, gestures, or other body language.

Patient & Prescribing Data

No treatment or prescribing population was studied. Survey respondents were members of the Swiss general public; 10.8% reported a chronic illness and 23.0% reported that someone close to them had one.

Not applicable: the article reports a communication survey, not a treatment or prescribing study.

Clinical Best Practices

• Recognize patients as people with fears, hopes, relationships, and sources of meaning.
• Use emotional expression, if appropriate, to acknowledge the patient’s experience without redirecting attention to the clinician.
• A patient-informed framework cited in the source distinguishes sympathy, described as a pity-based response focused on the observer, from empathy and compassion, which involve understanding suffering and a commitment to address the person’s needs.
• Interpret findings cautiously because responses to clinician emotion were context-dependent and the study did not involve actual clinical encounters.

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