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

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.

My Life, My Way: A Quality Improvement Program to Increase Advance Care Planning in a Racially and Ethnically Diverse Patient Population.

BACKGROUND: A multilevel quality improvement program was implemented at an urban community hospital, serving a racially and ethnically pluralistic patient population, to increase participation in advance care planning (ACP). MEASURES: Number of eligible patients who completed an ACP form. INTERVENTION: Projects were implemented over the course of two years that targeted patients, health care providers, the organization, and the community. OUTCOMES: The intervention resulted in increased completion of four unique ACP forms. Completion of the Living Will increased by 60%, Health Care Proxy increased by 9%, Medical Orders for Life-Sustaining Treatment increased by 5%, and Do-Not-Resuscitate/Do-Not-Intubate orders increased by 3%. CONCLUSION: Multilevel interventions can increase ACP participation in a racially and ethnically pluralistic patient population.

Introduction to Hospice and Palliative Care.

Palliative care is a field of medicine that delivers patient-centered care for individuals and their families suffering from serious illness at all stages of the disease trajectory. It addresses the major priorities of relieving suffering, establishing goals of care, and managing physical symptoms while integrating the psychosocial, cultural, spiritual, and existential complexities of coping with chronic illness. This article discusses the role of palliative care in the health care system. It reviews the importance of prognostication, disease trajectory, and communication. The role of the primary care physician as part of a multidisciplinary team member delivering primary palliative care is emphasized.

The perceived ethnic discrimination questionnaire--community version: validation in a multiethnic Asian sample.

This study evaluated the validity and reliability of the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV) Lifetime Exposure scale in a multiethnic Asian sample (N = 509). The 34-item scale measures perceived interpersonal racial/ethnic discrimination and includes four subscales assessing different types of discrimination: Social Exclusion, Stigmatization, Discrimination at Work/School, and Threat/Aggression. The Lifetime Exposure scale demonstrated excellent reliability across the full group and in all major subgroups. Subscales displayed good reliability across the full group and moderate-to-good reliability in each subgroup. The Lifetime Exposure scale was significantly correlated with the depression and anxiety subscales of the SCL-90-R, providing preliminary evidence of construct validity. The data suggest the Lifetime Exposure scale, previously validated in Black and Latino adults, is also appropriate for use with Asian samples, and can be used to examine both within-group and between-groups differences in discrimination.

Approach to the adult patient with fever of unknown origin.

Fever of unknown origin (FUO) in adults is defined as a temperature higher than 38.3 degrees C (100.9 degrees F) that lasts for more than three weeks with no obvious source despite appropriate investigation. The four categories of potential etiology of FUO are classic, nosocomial, immune deficient, and human immunodeficiency virus-related. The four subgroups of the differential diagnosis of FUO are infections, malignancies, autoimmune conditions, and miscellaneous. A thorough history, physical examination, and standard laboratory testing remain the basis of the initial evaluation of the patient with FUO. Newer diagnostic modalities, including updated serology, viral cultures, computed tomography, and magnetic resonance imaging, have important roles in the assessment of these patients.