Abstract P195: Cardiovascular Practitioner's Perspectives on Guilt as a Motivational Tool

Objective: Encouraging lifestyle change is a key facet of cardiovascular care, but health professionals report frustration and frequently feel ineffective in efforts to engage patients in behavior modification. In this study, we sought to define cardiovascular practitioners' perspectives on using guilt as a motivational tool. Methods: We conducted and audio recorded semi-structured interviews with 24 cardiovascular practitioners. Subjects were given a definition of guilt, asked to comment on how often they encountered patients who felt guilty, describe how they responded to those patients, and describe how guilt as a motivational tool might or might not promote lifestyle changes. Interviews were transcribed and coded to identify major themes. Results: Most (n=23/24) practitioners reported encountering patients who felt guilty for not taking better care of themselves. There was no consistent response to guilt: 3 practitioners used fear, 6 induced further guilt, 8 provided education, 5 reassured, and 9 used a ‘starting over’ approach. Practitioners did not agree on whether guilt was an effective motivator; some believed it was (‘My thing is ‘do you want to see your kids grow up, do you want to walk your daughter down the aisle?’ that's guilt, that's healthy guilt and I do use it. And it hits them right in the best spot.'), others did not (“I do think it's harmful because it lowers the self-esteem.”). Several practitioners (n= 8) referenced their own personal experiences or background; only one subject referenced literature on behavior change. Conclusions: Most cardiovascular practitioners encountered guilt in patients over lifetyle. There was no standard approach to the use of guilt in motivation, suggesting the need for more research and training on how to address guilt in cardiovascular patients.