Table 3.

Extrinsic (Patient-focused) Physician Emotion Regulation Strategies

	Physician strategies	Illustrative Quotes from the Simulated Encounter
Theme 1. Goal as reasonable hope	Situation Selection Prognostic Confrontation	From the information I have, iťs something that could become life-threatening within months to a year potentially, so iťs pretty serious. [Physician 9, Oncology]
	Situation Modification Softening the blow	I see that you’re feeling good now and have energy and are tolerating the treatment, and I’m hoping that that will go on for a good long time…I think that we can probably anticipate that at some point things will progress. The timeline can be difficult to predict, but probably on the order of somewhere between months to a year, we may see the cancer come back. [Physician 11, Palliative Care]
	Cognitive Change Positive Reframe	Patient: I know [my son] is planning on getting married, but they’re not thinking next week, certainly. So I would really, really love to just see that. To be… to be around for that. Physician: Thaťs important. And I can imagine and I’d like us to think together as we keep talking about ways for you to fill him in about what you’ve just heard so that maybe we can make that a reality so in some way have you be able to be there somehow? [Physician 1, Palliative Care]
	Emphasize quality-of-life	The goal of treatment is quality of life. I want you to be as good as possible. [Physician 3, Oncology]
	Response Modulation Pivot to more treatment	You had shared that the first one stopped working, so you switched to another one. He did share that there are others, so if this one that you’re on is found to not be working well, there are others that can be tried. [Physician 4, Palliative Care]
	Selecting achievable goals	Actually, iťs maybe a realistic hope. If he were three years old, and to marry … I mean, we can work together to help you achieve most of these goals. [Physician 5, Oncology]
	Pivot to advance care planning	One place to start may be to talk with his physician about making a long-term care plan. [Physician 6, Palliative Care]
Theme 2. Trusting, supportive relationship	Situation Selection Prognostic Avoidance	Physician: What you’re hoping for over the future with your illness. Patient: Well, yeah, I guess before we kind of go into those questions, I’m wondering if there’s anybody--I donť know, maybe you’re not the person to ask this, but I donť really have a way of assessing goals until I understand my prognosis, actually, and I feel like I donť. [Physician 4, Palliative Care]
	Situation Modification Obtaining permission	“Do you need a minute or are you okay if we keep chatting a little bit?” [Physician 9, Oncology]
	Attention Deployment Pointing to a positive	I really hope that you will do better than these average numbers that I mentioned earlier. [Physician 5, Oncology]
	Warning shot	But some of the questions are a little heavy, so if any of them make you uncomfortable, donť sweat it. [Physician 9, Oncology]
	Response Modulation Rapport building	I see that there’s a lot of sunlight there coming through your window, so I’m glad to see that. [Physician 7, Palliative Care]
	Praise	Those are pretty amazing things. Yeah. Makes you a pretty resilient person I can imagine. [Physician 1, Palliative Care]
	Validation	Right. Definitely, that kind of thing can be really important. [Physician 9, Oncology]
	Use of Empathy	I can imagine I would feel a lot of feeling about that and I just wonder how you’re feeling. [Physician 8, Palliative Care]