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

Abstract

Abstract Background 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. Objective To assess how physician self-disclosure and emotional expression affect perceptions of compassion, trust, professionalism and comfort. Design 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. Participants 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. Main Measures Ratings of compassion, trust, professionalism and comfort on 11-point scales. Key Results 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). Conclusions 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.