Researchers' Educational Model Examines Impact of Physician Feelings on Hospice Referrals

Researchers’ Educational Model Examines Impact of Physician Feelings on Hospice Referrals

Researchers recently introduced a behavioral education model that addresses how physician emotions drive clinical and family decision-making at the end of life.

Physicians’ emotions can influence their decisions around the timing and type of care provided to patients and families at the end of life, according to a recent study in Social Science & Medicine.

Current clinical educational models do not adequately integrate the social-ecological factors involved in health care delivery and utilization, researchers indicated. This leaves physicians ill-equipped to navigate the emotional and mental aspects of providing care, and can lead to unnecessary, intensive treatment at end of life, according to researchers.

The need for psychological innovation in interventions in health care policy and clinical education is “critical,” they indicated.

Emotional pressures on doctors alongside complex family dynamics provoke “excessive” treatment efforts, according to researcher Paul Duberstein, professor and chair of the department of health behavior, Society, and policy at Rutgers University School of Public Health.

“Doctors hate to ‘give up’ on patients, so they often recommend treatments with very little chance of success,” Duberstein told local news. “That won’t change until we improve medical education and the culture of irrational biomedical exuberance.”

To address these socioemotional gaps in physician training, researchers developed a new behavioral education model, dubbed the Terror Management Theory and Socioemotional Selectivity Theory to create the Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE) model.

The TRIBE model aims to improve timely hospice referrals and reduce unnecessary, high-cost care by outlining the role of socioemotional processes in the care of persons with serious conditions.

“At some level, every patient death is a potential source of shame for doctors and a source of guilt for surviving family members,” Duberstein said. “By changing the culture of medical education and broader cultural attitudes toward death, we can address the emotions and family dynamics that have prevented too many patients from receiving quality care in their final days and weeks of life.”

Physician education is essential to timely and appropriate access to hospice care. Gaps in clinical education models have been associated with under-utilization of these services. In fact, a much higher number of patients seek out hospice care than just those that actually receive physician instructions for it, according to a 2021 study from Trella Health.

The TRIBE education’s framework includes an emphasis on how moral emotions can motivate social behaviors and decisions made in group settings not only in clinical team settings, but also among patients and their families. The model examines how physician emotions are “linked to the interests or welfare either of society as a whole or at least of persons other than the judge or agent.”

“This model incorporates research showing that clinicians are emotional beings, like all people, and these emotions strongly impact their patients’ choices,” Duberstein said. “Once doctors have recommended a treatment or procedure, there’s enormous pressure on patients to undergo it.”

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