The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

Objective: To investigate whether fear of failure (FOF) influences a clinician’s perception of their confidence and comfortableness with the delivery of end of life (EOL) care, controlling for gender, role, years of experience, and number of EOL conversations. Design: Cross-sectional questionnaire study. Setting: Two large NHS hospital trusts in the UK, and national UK professional networks. Participants 105 doctors and 104 specialist nurses across 20 hospital specialities. Main outcome measures The Performance Failure Appraisal Inventory, the Self-Efficacy in Palliative Care scale, the Thanatophobia Scale. Analysis A two-step multiple regression. Results: The study validated the use of the PFAI and its subscales within a novel population group of medical professionals. No. of EOL conversations, gender, and role impacted confidence and comfortableness with EOL care. Fearing loss of interest negatively impacted a clinician’s confidence in communicating with patients. Fear of devaluing one’s self-estimate negatively impacted confidence in decision making, working with others, and total self-efficacy. Conclusion: Three aspects of FOF negatively impacted both doctors and nurses delivery of EOL care. Practical Implications Further study should look at how FOF develops, sustaining factors, and other areas of clinical practice that FOF impacts, drawing also from FOF research outside the field of medicine. Techniques developed to manage FOF in other populations can now be investigated with a medical population.