End-of-Life Conversations

A discussion around end-of-life decisions can never be an easy one, even if it is inevitable in some cases. Shibashis Mukherjee, assistant professor of management and organisation, Amrut Mody School of Management, Ahmedabad University, and Clayton Thomas, assistant professor of teaching, management and entrepreneurship, Iowa State University, conducted a research on how specialised care providers manage these difficult conversations with patients and their families about switching from curative treatments to palliative care. The paper, Feeling Rule Management and Relational Authority: Fostering Patient Compliance in Palliative Care Consultations, has been published in the prestigious FT 50 journal, Organization Studies.

In an interview to the Iowa State University newspaper, co-author Professor Thomas said, “People often think they should fear death. They may not realise 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.” Coining a new term, ‘feeling rule management’, to highlight these challenging, emotional conversations, the researchers concluded that many of the care providers did not dismiss their patients’ emotions or tell patients to feel differently. Rather, they validated their patients’ fear, hope or guilt, and then walked them through the likely outcomes of continuing treatments.

The two found this approach led patients to comply with the care providers’ suggestions for palliative care 73 per cent of the time. The compliance rate was only 43 per cent when providers did not use this style of communication.

Professor Mukherjee and Professor Thomas are planning a follow-up study that would compare this ‘feeling rule management’ in the US and India.

Read the Iowa State University interview here.