Evaluating Physician Emotion Regulation in Serious Illness Conversations Using Multimodal Assessment

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.

Figure 1

Gross’s Process Model of Emotion Regulation Situation Selection refers to actions that make it more or less likely to give rise to an emotion (e.g. initiating versus avoiding a serious illness conversation). Situation modification refers to modifying context to alter emotional impact (e.g. conducting the conversation alone versus with the patient’s caregiver). Attention deployment refers to directing one’s attention towards or away from emotion (e.g. redirecting conversation towards versus away from emotion). Cognitive change refers to how one appraises the situation (e.g. viewing the expression of negative emotion as caused by physician behavior versus a natural response to bad news). Response modulation refers to changes in experiential, behavioral or physiologic responses (e.g. physician’s internal experience, communication behavior or autonomic changes).