Connecting Through Emotions: A Social Constructivist Grounded Theory on How Palliative Care Clinicians Use Their...

Palliative care clinicians are regularly exposed to emotionally laden situations. While emotions are an intrinsic part of their encounters with patients and relatives, the role of clinicians' own emotions has remained understudied.

We aimed to explore how palliative care clinicians use their emotions during end-of-life care consultations.

We conducted a qualitative study using individual interviews with palliative care clinicians from different backgrounds and countries.

Twenty-two palliative care clinicians from 10 different countries participated: two psychologists, four social workers, five nurses, and 11 physicians. Fourteen were women. Participants had an average age of 45 years and 13 years of palliative care experience.

We analyzed the data using a social constructivist grounded theory approach.

The process of using emotions could be understood as a three-phase process which was set off by a difficult end-of-life encounter (e.g., ethical dilemmas or conflicts, confrontations with the emotions of patients/relatives) that triggered a strong emotion. Subsequently, clinicians became aware of the specific emotion via its physiological and/or psychological cues. Secondly, an assessment of the appropriateness of sharing the emotion followed, in which facilitators and barriers (e.g., the self-perceived level of emotional skills, the feeling of safety in the team) interplayed, influencing the clinicians to, in a final phase, decide to share their own emotions in a verbal and/or non-verbal way. All phases of the process were interconnected by the shared value of using emotions to build connection, the core category of the theory.

Our findings suggest that palliative care clinicians use their strong emotions during consultations to build connection. When met with awareness and reflection, these emotions can serve as a valuable resource for delivering patient- and relationship-centered palliative care. Future research should explore clinicians' training needs and attitudes towards emotional skills training more broadly.