ORCID

https://orcid.org/0000-0002-5963-5217

Date of Award

2025

Document Type

Dissertation

Degree Name

Psychology (Ph.D.)

Department

Psychology

First Advisor

Elizabeth Brondolo

Second Advisor

Jeffrey Nevid

Third Advisor

Robin Wellington

Abstract

Effective end-of-life communication is essential to patient-centered care, shaping treatment decisions, family well-being, and overall care quality. While patients’ traditional beliefs are often cited as barriers to quality end-of-life care, less is known about how clinicians’ own beliefs affect their communication efficacy and distress tolerance. This study examined how traditional beliefs—specifically those about death and dying (e.g., avoidance of direct discussion due to taboos), emotional expression (e.g., viewing emotion as dangerous or controllable), and filial piety (e.g., respect and deference to elders)—relate to clinicians’ distress intolerance during end-of-life communication. It also tested whether self-efficacy mediates or moderates these relationships. A sample of 244 interdisciplinary healthcare providers (physicians, nurses, social workers, psychologists) completed self-report surveys via Qualtrics. It was hypothesized that beliefs about death, emotional expression, and filial piety would form a single attitudinal dimension. However, only beliefs about death and emotional expression were strongly correlated; filial piety was not. Traditional beliefs about death and emotional expression were associated with greater distress intolerance. Self-efficacy in end-of-life communication, in contrast, was linked to lower distress intolerance. Structural equation modeling (SEM) tested whether a latent “traditional beliefs” construct predicted distress intolerance through self-efficacy. The model did not yield good overall fit, but path analyses showed that traditional beliefs directly predicted distress intolerance. Further, beliefs about death and dying significantly predicted self-efficacy, while beliefs about emotional expression predicted distress intolerance. Mediation analyses indicated that self-efficacy partly mediated the relationship between traditional beliefs and distress intolerance. No moderation effects were found. ANOVA revealed that attending physicians reported higher self-efficacy and lower distress intolerance compared to residents, nurses, and social workers. However, they endorsed more traditional beliefs about death and dying than residents. These findings suggest clinicians’ own beliefs may shape how they experience and manage end-of-life conversations. Training efforts should increase awareness of how personal beliefs about death and emotion influence communication and clinician distress during these sensitive encounters.

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