Man with oxygen tube lying in hospital bed

Patients and family members are better able to consider end-of-life care recommendations when their healthcare provider focuses on changing expectations rather than on changing emotions, a new study finds.

Investigators examined six months of palliative care data from a Midwestern town that measured how clinicians addressed conversations about continuing curative treatments or switching to pain management and comfort care. 

Patients complied with care suggestions 73% of the time when providers first validated their fears, hope or guilt before walking them through the likely outcomes of continued treatment. But when they dismissed the patients’ emotions or told them to feel differently, patients accepted suggestions only 43% of the time.

Managed conversations

The researchers highlighted a concept that they call “feeling rule management.” This is a conversation with the patients that is not aimed at changing emotions but changing their expectations, they said.

“People often think they should fear death,” said Clayton Thomas, Ph.D., of Iowa State University.  “They may not realize that they should fear the cure, that the treatment to prolong life could cause more suffering or lead to other health problems during a patient’s final days.”

U.S. palliative care providers may also be best served by accepting a major shift that has occurred in the patient-physician relationship, Thomas and colleagues added. In these cases, titles and education no longer confer the same status that they did in the past, they said. 

“The idea of doctor’s orders doesn’t carry the same weight as it used to, so providers have to use extra strategies to communicate their expert recommendations to patients,” Thomas explained.

The study was published in Organization Studies.