Emotions documented in clinical notes: An interpretative descriptive study

Hospitalized patients and their families often engage in difficult and emotionally charged conversations with clinicians about their values, goals, and care preferences when facing a serious illness. Understanding when these emotions are distressing for patients, families, and clinicians would enable opportunities for supportive care interventions.

To identify how, and in what context, clinicians document aspects of emotions in clinical notes of seriously ill patients.

Interpretive descriptive qualitative study of a random sample of clinical notes (n = 500) from inpatient adults with serious illness who qualify for palliative care services and were hospitalized at a multi-hospital health system between April 1, 2017 and December 31, 2019. Notes were analyzed with an inductive approach to identify any mention of emotion or emotion-adjacent words or phrases.

We identified emotion documented in four categories: (i) explicit and implicit emotions, (ii) social/interpersonal interactions, (iii) existential and spiritual emotions, and (iv) prognostic-related. From the documented implicit and explicit emotions, we developed a novel lexicon of emotion and emotion-adjacent words.

Clinicians commonly document emotions that emanated from conversations with patients and families in clinical notes. An emotion lexicon from a clinical context could inform large language models increasingly embedded in electronic health records to facilitate timely identification of emotional distress and appropriate supportive care needs.