Physician Emotion and Self-disclosure in Serious Illness Conversations: Impact on Trust, Compassion, Professionalism and Comfort.

Abstract

Physicians often avoid emotional expression or personal self-disclosure due to concerns about unprofessionalism. Understanding how patients perceive these behaviours is important for guiding communication in serious illness care. To assess how physician self-disclosure and emotional expression affect perceptions of compassion, trust, professionalism and comfort. Clinical vignette study in which 11 aspects of consultations were systematically varied, including self-disclosure, emotional expression and communication clarity using a population-based survey of the Swiss general public. Data were analysed using multilevel linear regression with random intercepts and selected interactions. Marginal means and 95% CIs were reported. A total of 1572 participants (51.4% women) rated 5 vignettes each. Participants were recruited using a convenience sample applying quotas for age, gender and language. Ratings of compassion, trust, professionalism and comfort on 11-point scales. Participants' mean age was 50.6 years (range, 16-94 years of age). Emotional expression, especially when visible, and self-disclosure were associated with higher compassion, trust and comfort ratings (p < 0.05), while visible emotion did not significantly influence perceived professionalism (p = 0.349). Significant interactions indicated that effects varied with consultation context and participant characteristics (e.g. age, language, education). Physician self-disclosure and emotional expression improved perceptions of compassion, trust and comfort without reducing professionalism. These findings challenge prevailing assumptions in medical culture and suggest such behaviours may strengthen physician-patient relationships in serious illness care.