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National Institutes of Health
Sample size: 560
Field period: 05/01/2016-08/15/2016
Some of life’s most important and difficult decisions are made on behalf of others. However, little is known about how goal conflict influences high-stakes decisions made on behalf of others. A nationally representative sample of U.S. healthcare providers (n = 502) read a statement presenting curative and palliative care goals as conflicting or complementary. We predicted and found that providers who received a goal conflict (vs. complementary) message perceived greater conflict, and rated palliative goals as less important. Moreover, there was an indirect link from goal conflict condition to willingness to provide palliative care, mediated by perceived goal conflict. A self-affirmation manipulation reduced providers’ willingness to provide palliative care, but did not influence the effect of goal conflict on decision-making. Findings suggest that goal conflict is consequential for high-stakes decisions made for others, and that goal conflict lowers importance of, and facilitates disengagement from, the lower priority goal.
Due to prioritization of curative goals among healthcare providers, we predicted that goal conflict would lead providers to disengage from palliative goals, resulting in less willingness to provide or refer to palliative care (Hypothesis 1), consistent with evidence regarding how goal conflict influences choices among participants making decisions for themselves. We also predicted that self-affirmation would attenuate the consequences of goal conflict, increasing importance of palliative care goals and willingness to provide or refer to palliative care (Hypothesis 2). Finally, we predicted that goal conflict and self-affirmation would interact, such that self-affirmation would attenuate effects of goal conflict on importance and willingness (Hypothesis 3).
Goal conflict vs. goal complementarity
Self-affirmation vs. no affirmation
Perceived goal conflict
Perceived goal complementarity
Palliative care goal importance
Curative care goal importance
Palliative care willingness
Curative care willingness
Positive other-directed emotion
Interpersonal empathy gap
Medical Identity Threat
The goal conflict (vs. goal complementarity) condition increased perceived goal conflict, F(1,499)=14.95, p<.001, and decreased perceived goal complementarity, F(1,499)=5.66, p=.018. Goal conflict condition also decreased importance of palliative care, F(1,499)=5.10, p=.024, but not importance of curative care. There was also a causal indirect link between goal conflict condition and importance of palliative goal importance, mediated by perceived goal conflict (β=-0.03, p=.013), such that goal conflict (vs. complementarity) condition increased perceived goal conflict (β=0.31, p=.002) and perceived goal conflict was negatively associated with importance of palliative goals (β=-0.20, p<.001). The indirect link between goal conflict condition and importance of curative care goals, via perceived goal conflict, was not significant.
Although there was no direct effect of goal conflict condition on palliative care willingness, F(1,499)=1.38, p=.240, there was an indirect causal path from goal conflict condition to palliative care willingness, mediated by perceived goal conflict (β=-0.03, p=. 017), such that goal conflict (vs. complementarity) condition increased perceived goal conflict (β=0.30, p=.002) and perceived goal conflict was negatively associated with palliative care willingness (β=-0.19, p<.001). There was no effect of goal conflict condition on willingness to provide curative care.
Self-affirmation did not influence perceived goal conflict or complementarity, nor did it influence the importance of palliative care goals. However, self-affirmation significantly reduced palliative care willingness, F(1,499)=4.37, p=.037. Self-affirmation had no effect on the interpersonal empathy gap, other-directed positive emotions, or medical identity threat. There were no significant interactions between goal conflict condition and self-affirmation on any outcome variables.