COMMENTARY

Fuming Patients, Calm Clinicians: How Clinicians Respond to Anger in the Clinical Setting

Betty R. Ferrell, PhD, RN

Disclosures

December 21, 2017

Facing and Responding to Anger in the Clinical Setting

Anger is a common emotion in patients and families facing serious illness and yet is seldom addressed in research or literature.[1]

A recent study[1] tested a novel training program designed to prepare clinicians to respond to anger in the clinical setting and provided practical guidance as to how to support angry patients and families. Of importance, the training addresses the clinician's own responses when confronting angry patients.

The project, known as "Managing Anger for Providers and Patients (MAPP)," was based on cognitive behavioral models of anger and principles of patient-centered communication. The educational content focused on understanding patient anger, responding to anger, and managing clinicians' own stress and recovery from angry encounters.

Clinician participants (n=12) included physicians, nurse practitioners, nurses, and physician assistants from stem cell transplant and oncology units, areas known for intense and distressing treatments, presenting a fertile ground for patient anger. The study assessed outcomes of the training program in 10 areas of clinician self-efficacy, using the Self-Efficacy in Responding to Patient Anger Scale.

The items of the tool reflect the complexity of this clinical problem, including such issues as being respectful when addressing angry patients, acknowledging one's own stressful responses to anger, and the expression of that stress. An unfortunate spiraling scenario can ensue when angry patients alienate clinicians, leading to even worse communication and more alienation. These factors are critical because when such a scenario arises, the clinician must leave a stressful, angry-patient situation and within moments be present and therapeutic with another seriously ill patient.[2,3]

Viewpoint

Palliative care literature is rich in examples of protocols and training programs to address such common patient emotions as anxiety, depression, hopelessness, and grief. Attention to anger as a response to illness and treatment is far less likely to be addressed.[4–6]

In this article, the study authors provided a detailed agenda for their training program, with time allocation for each topic. The training was impressive in that it included participative learning (videos, role playing, communication demonstrations, and stress management experiences). Another commendable detail is that the training was only 1 hour in duration and could realistically be accomplished in a demanding clinical setting.

Although the study was small in the number of clinicians trained, it is a valuable model for others to build on, and the findings contribute significantly to addressing this critical yet often overlooked problem of response to patient anger.

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