Emotions documented in clinical notes: An interpretative descriptive study

CONTEXT: Hospitalized patients and their families often engage in difficult and emotionally charged conversations with clinicians about their values, goals, and care preferences when facing a serious illness. Understanding when these emotions are distressing for patients, families, and clinicians would enable opportunities for supportive care interventions. OBJECTIVE: To identify how, and in what context, clinicians document aspects of emotions in clinical notes of seriously ill patients. METHODS: Interpretive descriptive qualitative study of a random sample of clinical notes (n = 500) from inpatient adults with serious illness who qualify for palliative care services and were hospitalized at a multi-hospital health system between April 1, 2017 and December 31, 2019. Notes were analyzed with an inductive approach to identify any mention of emotion or emotion-adjacent words or phrases. RESULTS: We identified emotion documented in four categories: (i) explicit and implicit emotions, (ii) social/interpersonal interactions, (iii) existential and spiritual emotions, and (iv) prognostic-related. From the documented implicit and explicit emotions, we developed a novel lexicon of emotion and emotion-adjacent words. CONCLUSION: Clinicians commonly document emotions that emanated from conversations with patients and families in clinical notes. An emotion lexicon from a clinical context could inform large language models increasingly embedded in electronic health records to facilitate timely identification of emotional distress and appropriate supportive care needs.