title: Emotional distress and compassionate responses in palliative care decision-making consultations.
abstract: BACKGROUND
  Seriously ill hospitalized patients and their loved ones are frequently faced with complex treatment decisions laden with expressions of emotional distress during palliative care (PC) consultations. Little is known about these emotional expressions or the compassionate responses providers make and how common these are in PC decision-making conversations.
  
  
  OBJECTIVE
  To describe the types and frequency of emotional distress that patients and loved ones express and how providers respond to these emotions during PC decision-making consultations with seriously ill hospitalized patients.
  
  
  METHODS
  We used a quantitative descriptive approach to analyze 71 audio-recorded inpatient PC decision-making consultations for emotional distress and clinicians' responses to those emotions using reliable and established methods.
  
  
  RESULTS
  A total of 69% of conversations contained at least one expression of emotional distress. The per-conversation frequency of expressions of emotional distress ranged from 1 to 10. Anxiety/fear were the most frequently encountered emotions (48.4%) followed by sadness (35.5%) and anger/frustration (16.1%). More than half of the emotions related to the patient's feelings (53.6%) and 41.9% were related to the loved ones' own emotions. The majority of emotions were moderate in intensity (65.8%) followed by strong (20.7%) and mild (13.5%). Clinicians responded to a majority of emotions with a compassionate response (75.7%) followed by those with medical content (21.9%) and very few were ignored (1.3%).
  
  
  CONCLUSIONS
  Expressions of emotional distress are common during PC consultations and are usually met with compassionate responses by the clinician.
authors.affiliation: 1 Department of Medicine, Duke University Medical Center , Durham, North Carolina.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Susan
authors.initials: S
authors.lastname: Ladwig
authors.forename: Sally A
authors.initials: SA
authors.lastname: Norton
authors.forename: David
authors.initials: D
authors.lastname: Gramling
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Davis
authors.forename: Maureen
authors.initials: M
authors.lastname: Metzger
authors.forename: Jane
authors.initials: J
authors.lastname: DeLuca
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D004645:Empathy; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D013315:Stress, Psychological / Q000209:etiology*; D013637:Tape Recording