An exploratory educational model explores the influence of clinician feelings on referral to hospice

Researchers have recently introduced a behavioral learning model that looks at how physician emotions influence clinical and family decision making at the end of life.

According to a recent study in the social sciences and medicine, physicians’ emotions can influence their decisions regarding the timing and type of care provided to patients and their families at the end of life.

Modern clinical educational models do not properly take into account the socio-ecological factors associated with the provision and use of medical care, the researchers note. This leaves clinicians ill-equipped to navigate the emotional and mental aspects of care, the researchers say, and could lead to unnecessary intensive care later in life.

They indicated that the need for psychological innovation in health policy intervention and clinical education is “critical”.

According to researcher Paul Duberstein, professor and chair of the Department of Behavior, Society, and Health Policy at Rutgers University’s School of Public Health, emotional pressure on physicians, along with complex family dynamics, provokes “excessive” treatment efforts.

“Doctors hate being ‘disappointed’ with patients, so they often recommend treatments with very little chance of success,” Duberstein told local news. “This will not change until we improve medical education and the culture of irrational biomedical abundance.”

To address these socio-emotional gaps in physician training, researchers developed a novel behavioral learning model dubbed Terror Management Theory and Socio-Emotional Selectivity Theory to create the Irrational Biomedical Abundance Transtheoretical Model (TRIBE) model.

The TRIBE model aims to improve the timeliness of hospice referrals and reduce unnecessary and costly care by identifying the role of socio-emotional processes in the care of people with serious illnesses.

“On some level, the death of each patient is a potential source of shame for physicians and a source of guilt for surviving family members,” Duberstein said. “By changing the culture of medical education and the broader cultural attitude towards death, we can deal with the emotions and family dynamics that kept too many patients from receiving quality care in the final days and weeks of their lives.”

Medical education is essential for timely and appropriate access to hospice care. Gaps in clinical education models have been linked to underutilization of these services. In fact, according to a 2021 study by Trella Health, many more patients seek care from hospices than only those who actually receive instructions from a doctor.

The TRIBE educational framework includes an emphasis on how moral emotions can motivate social behavior and decisions made in group settings, not only within the clinical team setting, but also among patients and their families. The model examines how the physician’s emotions are “related to the interests or well-being of either society at large, or at least those other than the judge or agent.”

“This model includes research showing that clinicians are emotional beings, like all people, and these emotions strongly influence the choice of their patients,” Duberstein said. “Once doctors recommend a treatment or procedure, there is tremendous pressure on patients to undergo it.”