Provider Concerns About Emotional Regulation Are Negatively Associated with Advance Care Planning in Patients with Chronic Complex Illness (S778)

Abstract

•Facilitate research in palliative care and advanced care planning.•Identity opportunities for enhanced self-care and resilience. One salient barrier to advanced care planning (ACP) includes the emotional demands of discussions about end-of-life issues. We conducted 3 studies to investigate the relationship between providers’ concerns about emotion regulation and the degree to which they initiate (or delay) ACP conversations with their patients with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Participants in Studies 1 (n = 152) and 2 (n = 77) included resident and attending physicians in internal and family medicine at two medical centers; participants in Study 3 (n = 79) were nurses serving general medicine and surgery patients. Measures: Participants read two vignettes describing patients with moderate or high intensity symptoms. Vignettes described patients with COPD (Study 1) or CHF (Studies 2 and 3). The ACP-CARE scale assessed providers’ initiation of communication about ACP-related topics (e.g., illness course and prognosis, advance directives). The ACP –DELAY scale assessed providers’ preference for delaying ACP discussions. The Provider Concerns about Advanced Care Planning scale (PCACP: Physician and Nurse Versions) was used to assess provider emotion regulation. The PCACP yields a total score, and two subscale scores, assessing providers’ concerns about managing their own emotions during ACP conversations and providers’ concerns about managing their patients’ emotions during ACP conversations. All scales had good reliability (Cronbach’s alphas > .79) and evidence of construct validity. In study 1, providers’ concerns about their own emotion regulation capacities were negatively correlated with initiating ACP (r = -.31, p < .001). Provider concerns about managing patients’ emotions were positively correlated with delaying ACP (r = .25, p < .01). These relationships remained significant controlling for trait anxiety, and other variables, and were replicated in studies 2 and 3. Provider emotion regulation concerns are significantly associated with ACP.