Evaluating Physician Emotion Regulation in Serious Illness Conversations Using Multimodal Assessment

Garrett T Wasp; Satveer Kaur-Gill; Eric C Anderson; Maxwell T Vergo; Julia Chelen; Tor Tosteson; Paul J Barr; Amber E Barnato

doi:10.1016/j.jpainsymman.2023.07.001

Evaluating Physician Emotion Regulation in Serious Illness Conversations Using Multimodal Assessment

J Pain Symptom Manage. 2023 Oct;66(4):351-360.e1. doi: 10.1016/j.jpainsymman.2023.07.001. Epub 2023 Jul 9.

Authors

Garrett T Wasp¹, Satveer Kaur-Gill², Eric C Anderson³, Maxwell T Vergo⁴, Julia Chelen², Tor Tosteson⁵, Paul J Barr⁶, Amber E Barnato⁷

Affiliations

¹ Section of Oncology, Department of Medicine (G.T.W.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (DCC) (G.T.W., T.T., A.E.B.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA; The Dartmouth Institute for Health Policy & Clinical Practice (G.T.W., S.K.G., J.C., P.J.B., A.E.B.), Geisel School of Medicine, Lebanon, New Hampshire, USA. Electronic address: [email protected].
² The Dartmouth Institute for Health Policy & Clinical Practice (G.T.W., S.K.G., J.C., P.J.B., A.E.B.), Geisel School of Medicine, Lebanon, New Hampshire, USA.
³ Center for Interdisciplinary Population and Health Research (E.C.A), Maine Health Institute for Research, Portland, Maine, USA; Tufts University School of Medicine (E.C.A.), Boston, MA, USA.
⁴ Section of Palliative Care, Department of Medicine (M.T.V., A.E.B.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA.
⁵ Dartmouth Cancer Center (DCC) (G.T.W., T.T., A.E.B.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA; Biomedical Data Science (T.T., P.J.B.), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
⁶ The Dartmouth Institute for Health Policy & Clinical Practice (G.T.W., S.K.G., J.C., P.J.B., A.E.B.), Geisel School of Medicine, Lebanon, New Hampshire, USA; Biomedical Data Science (T.T., P.J.B.), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Center for Technology and Behavioral Health (P.J.B.), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
⁷ Dartmouth Cancer Center (DCC) (G.T.W., T.T., A.E.B.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA; The Dartmouth Institute for Health Policy & Clinical Practice (G.T.W., S.K.G., J.C., P.J.B., A.E.B.), Geisel School of Medicine, Lebanon, New Hampshire, USA; Section of Palliative Care, Department of Medicine (M.T.V., A.E.B.), Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA.

Abstract

Context: Emotion regulation by the physician can influence the effectiveness of serious illness conversations. The feasibility of multimodal assessment of emotion regulation during these conversations is unknown.

Objectives: To develop and assess an experimental framework for evaluating physician emotion regulation during serious illness conversations.

Methods: We developed and then assessed a multimodal assessment framework for physician emotion regulation using a cross-sectional, pilot study on physicians trained in the Serious Illness Conversation Guide (SICG) in a simulated, telehealth encounter. Development of the assessment framework included a literature review and subject matter expert consultations. Our predefined feasibility endpoints included: an enrollment rate of ≥60% of approached physicians, >90% completion rate of survey items, and <20% missing data from wearable heart rate sensors. To describe physician emotion regulation, we performed a thematic analysis of the conversation, its documentation, and physician interviews.

Results: Out of 12 physicians approached, 11 (92%) SICG-trained physicians enrolled in the study: five medical oncology and six palliative care physicians. All 11 completed the survey (100% completion rate). Two sensors (chest band, wrist sensor) had <20% missing data during study tasks. The forearm sensor had >20% missing data. The thematic analysis found that physicians': 1) overarching goal was to move beyond prognosis to reasonable hope; 2) tactically focused on establishing a trusting, supportive relationship; and 3) possessed incomplete awareness of their emotion regulation strategies.

Conclusion: Our novel, multimodal assessment of physician emotion regulation was feasible in a simulated SICG encounter. Physicians exhibited an incomplete understanding of their emotion regulation strategies.

Keywords: Emotion regulation; communication; oncology; physician; prognosis.

Publication types

Review
Research Support, N.I.H., Extramural

MeSH terms

Communication
Cross-Sectional Studies
Emotional Regulation*
Humans
Physician-Patient Relations
Physicians* / psychology
Pilot Projects

Abstract

Publication types

MeSH terms

Grants and funding