Development and preliminary validation of a scale to assess physicians' emotional distress intolerance in end-of-life care communication

• Published in: Palliative & supportive care Vol. 21; no. 3; pp. 399 - 410
• Main Authors: Brondolo, Elizabeth, Keating, Luke, Crete, Abigail, Kaur, Amandeep, Randrianarivony, Rina, Statman, David, Schwartz, Joseph E, Basello, Gina, Roth, Alan R
• Format: Journal Article
• Language: English
• Published: England Cambridge University Press 01.06.2023
• Subjects: Advance directives; Chronic obstructive pulmonary disease; Communication; Costs; Emotional regulation; Emotions; Humans; Iatrogenesis; Illnesses; Internal medicine; Medicine; Palliative care; Patients; Physicians; Physicians - psychology; Psychological Distress; Pulmonary Disease, Chronic Obstructive - complications; Reproducibility of Results; Terminal Care; Validity; Distress tolerance; Physician-patient communication; Advance care planning; End-of-life care; Emotion regulation
• ISSN: 1478-9515; 1478-9523
• DOI: 10.1017/S1478951522000219

End-of-life care (EOLC) communication is beneficial but underutilized, particularly in conditions with a variable course such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Physicians' emotional distress intolerance has been identified as a barrier to EOLC communication. However, studies of emotional distress intolerance in EOLC have largely relied on anecdotal reports, qualitative data, or observational studies of physician-patient communication. A free-standing measure of multiple dimensions of distress tolerance is warranted to enable the identification of individuals experiencing distress intolerance and to facilitate the effective targeting of interventions to improve distress tolerance. This study provides preliminary data on the reliability and validity of the Physician Distress Intolerance (PDI) scale. We examine potential subdimensions of emotional distress intolerance. Family medicine and internal medicine physicians completed the PDI, read vignettes describing patients with COPD or CHF, and indicated whether they initiated or delayed EOLC communication with their patients with similar conditions. Exploratory and confirmatory factor analyses were performed on separate samples. Confirmatory factor analysis confirmed that a three-factor solution was superior to a two- or one-factor solution. Three subscales were created: Anticipating Negative Emotions, Intolerance of Uncertainty, and Iatrogenic Harm. The full scale and subscales had adequate internal consistency and demonstrated evidence of validity. Higher scores on the PDI, indicating greater distress intolerance, were negatively associated with initiation and positively associated with delay of EOLC communication. Subscales provided unique information. The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.