The role of emotion in clinical decision making: an integrative literature review

Abstract

BackgroundTraditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.MethodsA systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.ResultsTwenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour – responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.ConclusionsClinicians’ experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1089-7) contains supplementary material, which is available to authorized users.

Why health professions education needs functional linguistics: the power of ‘stealth words’

“…When used appropriately, reflection can contribute to learning . Yet we are only beginning to carefully evaluate and assess the effects of different approaches to reflective practice . As reflection is usually a relatively open‐ended process, it can be difficult to capture the distinctions among reflections and to determine which of those distinctions may be indicative of some kind of important cognitive, affective or social change.…”

“…In a recent review, Kozlowski and colleagues concluded that although clinicians’ emotions can and do influence clinical reasoning, this influence is often not acknowledged in clinical reasoning research and training . Much of the research, then, focuses on the cognitive components without accounting for the important role of emotions in reasoning.…”

“…40,[42][43][44] Yet we are only beginning to carefully evaluate and assess the effects of different approaches to reflective practice. 41,45,46 As reflection is usually a relatively open-ended process, it can be difficult to capture the distinctions among reflections and to determine which of those distinctions may be indicative of some kind of important cognitive, affective or social change. Functional linguistic tools can be applied to reflections of any format or length, offering potential ways to both describe and quantify reflective practice.…”

“…In a recent review, Kozlowski and colleagues concluded that although clinicians' emotions can and do influence clinical reasoning, this influence is often not acknowledged in clinical reasoning research and training. 46 Much of the research, then, focuses on the cognitive components without accounting for the important role of emotions in reasoning. Kozlowski et al 46 argue that more research is needed in order to 'provide a more thorough and intentional picture' of the ways that emotions (positive and negative) interact with reasoning processes and outcomes.…”

“…46 Much of the research, then, focuses on the cognitive components without accounting for the important role of emotions in reasoning. Kozlowski et al 46 argue that more research is needed in order to 'provide a more thorough and intentional picture' of the ways that emotions (positive and negative) interact with reasoning processes and outcomes. There is a robust tradition of using tools from functional linguistics to investigate emotions.…”