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

Published online by Cambridge University Press:  04 April 2022

Elizabeth Brondolo Open the ORCID record for Elizabeth Brondolo [Opens in a new window] ,
Luke Keating Open the ORCID record for Luke Keating [Opens in a new window] ,
Abigail Crete ,
Amandeep Kaur ,
Rina Randrianarivony ,
David Statman ,
Joseph E. Schwartz ,
Gina Basello  and
Alan R. Roth
Elizabeth Brondolo*
Affiliation:
Department of Psychology, St. John's University, Queens, NY Department of Family Medicine, Jamaica Hospital Medical Center, Jamaica, NY
Luke Keating
Affiliation:
Department of Psychology, St. John's University, Queens, NY
Abigail Crete
Affiliation:
Department of Psychology, St. John's University, Queens, NY
Amandeep Kaur
Affiliation:
Department of Psychological Sciences, University of California, Irvine, CA
Rina Randrianarivony
Affiliation:
Department of Psychology, St. John's University, Queens, NY
David Statman
Affiliation:
Department of Psychiatry, St. John's Episcopal Hospital, New York City, NY
Joseph E. Schwartz
Affiliation:
Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
Gina Basello
Affiliation:
Department of Family Medicine, Jamaica Hospital Medical Center, Jamaica, NY
Alan R. Roth
Affiliation:
Department of Family Medicine, Jamaica Hospital Medical Center, Jamaica, NY
*
Author for correspondence: Elizabeth Brondolo, Department of Psychology, St. John's University, Queens, NY, USA. E-mail: BRONDOLE@stjohns.edu
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Abstract

Context

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.

Objectives

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.

Method

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.

Results

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.

Significance of results

The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.

Keywords

End-of-life carePhysician-patient communicationDistress toleranceAdvance care planningEmotion regulation
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 399 - 410
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

The first and second authors contributed equally to this work.

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