Clinician perceptions of the impact of emotions on clinical decision making in child and adolescent eating disorders

Abstract

This thesis will examine the impact of emotions on clinical decision-making in the field of child and adolescent ED. Therapists and medical professionals working with chronic and lifethreatening illnesses, such as ED may be particularly vulnerable to emotional influences on their decision-making. This is evident, as past research studies have identified that high levels of clinician anxiety result in lower adherence to treatment protocol. In a survey, clinicians reported that the top three decision categories they perceive to be the most emotionally charged include: 1. Involvement of the family; 2. Autonomy and Control; and 3. Food and Weight. The decision rated as most negatively influenced by clinician emotion was the decision to include a critical/dismissive parent in treatment. Family-based therapy has the most empirical support in the treatment of child/adolescent ED. A treatment team consists of a physician and therapist at minimum; however, studies examining medical professionals indicated that they were not confident in their training in ED or in the treatment of ED and only 1/3 of medical professionals report always including the family in therapy. As such, interviews were conducted in order to gain a better understanding of the impact of emotions on clinical decision-making in clinicians and medical professionals. 22 participants (16 therapists and 5 medical professionals) working in the field of child and adolescent ED completed a 1hour semi-structured interview that included questions regarding clinician and medical professionals perceptions of the impact of emotions on clinical decision making in themselves and in their colleagues. Transcripts were analyzed using thematic analysis. The themes identified suggest that clinicians and medical professionals perceive emotional influences on their decision-making in clinical practice. The results are discussed in terms of the implications for self-reflective practice.