Responding to Emotion in Family Meetings #224

Background

Family meetings are stressful events, often provoking strong emotional reactions. Fast Fact #29 presents a general outline on the topic of how clinicians can respond to emotions. The Fast Fact provides a more detailed approach to emotions that arise during family meetings.

Consider Your Role

It is important to reflect on the role of clinicians in responding to patient/family emotions at the time life-altering information is shared. The goal is not to prevent a patient/family from having those emotions. Sadness, fear, anger, and loss are normal responses to unwelcome news. Instead your role is: (1) to maintain a trusting therapeutic relationship and safe/supportive environment that allows emotions to be expressed in a way that meets the patient's/family's needs and (2) not to worsen the experience for the patient/family by ignoring or delegitimizing their responses, or confusing them with medical information when they are not ready to hear it. Recognize that most families find clinicians' expressions of empathy tremendously supportive and these are associated with family satisfaction.

Acknowledge that Emotion is Being Expressed

If you have a good sense of what the emotion is, then it is useful to name it. If not, using more general language is preferable.

I can see this is really affecting you.

Legitimize the Appropriateness and Normalcy of the Reaction

Medical professionals are in a powerful position to help patients and families feel that strong emotions under these circumstances are normal and to be expected.

Anyone receiving this news would feel devastated.

Explore More About What is Underneath the Emotion

It is tempting to try to limit the emotion, and be prematurely reassuring. But it is generally more helpful and ultimately more time-efficient to allow the patient and family to explore their feelings and reactions more deeply.

Tell me what is the scariest (most difficult) part for you.

Empathize (If You Genuinely Feel It)

Empathy means being able to imagine emotionally what the patient is going through. Clinicians can initiate the prior responses (acknowledge, legitimize, explore) without having a clear feeling for the patient's experience. These responses can be adequate in themselves. If the clinician cannot imagine the patient's experience, he or she can still sensitively explore the experience and provide care and support. But if you have a strong sense of what the patient is experiencing, it can be very therapeutic to express it.

This seems really unfair.

Explore Strengths/Coping Strategies

This may occur at this phase of the interview, or it may be postponed to a later phase when planning for the next steps to begin.

In past circumstances, what has helped?