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 will provide 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 experiencing strong emotions from difficult to hear clinical information.  Sadness, fear, anger, and loss are normal responses to unwelcome news.  Instead, your role is 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;
• Avoid worsening 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.

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.”
• “This information is very upsetting.” 

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.”
• “It is completely expected to be very distressed by this kind of news.” 

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 more deeply explore their feelings and reactions. 

• “Tell me what the scariest (most difficult) part for you is.”
• “Tell me more about that… “(Keep the exploration going until it is fully expressed and understood.)
• Remember that each patient and family comes to the meeting with their own previous experiences. For example, many Black patients with serious illness report having experienced significant racism in health care settings.  This can be associated with medical mistrust and challenge decision-making during serious illness and end of life (4). 

Empathize (if you genuinely feel it).  Empathy means being able to emotionally imagine 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.” 
• “I can imagine that you might feel very disappointed.” 

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 next steps begins.   

• “In past circumstances, what has helped?”
• “How have you adapted to difficult circumstances in the past?”
• “What are you hoping for now?”

References 

1. Back A, Arnold R, Tulsky J.   Mastering communication with seriously ill patients: balancing honesty with empathy and hope.  New York, NY: Cambridge University Press; 2009.
2. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997; 277:678-682.
3. Brown CE, Marshall AR, Synder CR, et al.  Perspectives About Racism and Patient-Clinician Communication Among Black Adults With Serious Illness.  Jama Network Open.  2023;6(7):e2321746.  Doi:10.1001/jamanetworkopen.2023.21746.

Version History:   Originally published October 2009; copy-edited August 2015; reviewed and updated in March 2025 by Heidi Ludtke MD.