Evaluating physician emotion regulation in serious illness conversations using multimodal assessment

Garrett T. Wasp, Section of Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, NH; Dartmouth Cancer Center (DCC), DHMC, Lebanon, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, NH. Electronic address: Garrett.T.Wasp@hitchcock.org.
Satveer Kaur-Gill, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, NH. Electronic address: Satveer.Kaur@dartmouth.edu.
Eric C. Anderson, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME; Tufts University School of Medicine, Boston, MA. Electronic address: eric.anderson@mainehealth.org.
Maxwell T. Vergo, Section of Palliative Care, Department of Medicine, DHMC, Lebanon, NH. Electronic address: Maxwell.T.Vergo@hitchcock.org.
Julia Chelen, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, NH. Electronic address: julia.chelen@nist.gov.
Tor Tosteson, Dartmouth Cancer Center (DCC), DHMC, Lebanon, NH; Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH. Electronic address: tor.d.tosteson@dartmouth.edu.

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. OBJECTIVE: 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 incomplete understanding of their emotion regulation strategies.