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Olszewski AE, Bogetz J, Bradford MC, Mercer A, Scott M, Fields B, Williams K, Rosenberg AR, Trowbridge A. Family Responses to Different Types of Clinician Empathy Expression in Pediatric Care Conferences. J Palliat Med 2024; 27:383-387. [PMID: 38048291 DOI: 10.1089/jpm.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Background: Clinician empathy positively impacts patient outcomes. Few studies have assessed the effects of different types of empathic expression. Objective: To describe how families respond when clinicians express empathy in different ways. Design: Prospective, mixed-methods cohort. Setting/Subjects: English and interpreted pediatric inpatient care conferences at a U.S. quaternary hospital between January 1, 2018 and January 1, 2021. Measurements: Directed content analysis of clinician empathic statements and family responses. Results: Of 29 patient-family dyads, 11 (39%) used language interpretation. In response to 80 clinician empathic statements, families expressed agreement or shared more 84% (67/80) of the time. Families shared more about their perspective in response to explore statements 71.4% (10/14) of the time, in response to validate statements 61% (17/28) of the time, and in response to respect/support statements 39% (11/28) of the time. Conclusion: Certain types of empathic statements may be more effective at prompting families to share more about their perspective, a key element of shared decision-making.
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Affiliation(s)
- Aleksandra E Olszewski
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Division of Critical Care Medicine, Department of Pediatrics, Lurie Children's Hospital and Northwestern University, Chicago, Illinois, USA
| | - Jori Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Amanda Mercer
- Counseling Education Department, Portland State University, Portland, Oregon, USA
| | - Maya Scott
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington, USA
| | - Blanca Fields
- Department of Interpreter Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kelli Williams
- Parent Advisory Council, Seattle Children's Hospital, Seattle, Washington, USA
| | - Abby R Rosenberg
- Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Trowbridge
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Cantrell A, Sworn K, Chambers D, Booth A, Taylor Buck E, Weich S. Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-107. [PMID: 38314750 DOI: 10.3310/vkty5822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Katie Sworn
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | | | - Scott Weich
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
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Kleye I, Sundler AJ, Darcy L, Karlsson K, Hedén L. Children's communication of emotional cues and concerns during a preoperative needle procedure. PATIENT EDUCATION AND COUNSELING 2022; 105:1518-1523. [PMID: 34625321 DOI: 10.1016/j.pec.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study explores children's expressions of emotional cues and concerns during needle procedures, nurses' responses and findings in relation to children's age and sex. METHODS Twenty-six children aged 6-12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences. RESULTS A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences. CONCLUSION Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses' communication focused on practical information during the needle procedure, with less attention to the child's distress. PRACTICE IMPLICATIONS Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.
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Affiliation(s)
- Ida Kleye
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden.
| | - Annelie J Sundler
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Lena Hedén
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
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Qian L, Liu X, Yin M, Zhao Y, Tie B, Wang Q, Zhang Y, Yuan S. Coding the negative emotions of family members and patients among the high-risk preoperative conversations with the Chinese version of VR-CoDES. Health Expect 2022; 25:1591-1600. [PMID: 35447002 PMCID: PMC9327824 DOI: 10.1111/hex.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Little is known about family members' and patients' expression of negative emotions among high‐risk preoperative conversations. Objectives This study aimed to identify the occurrence and patterns of the negative emotions of family members and patients in preoperative conversations, to investigate the conversation themes and to explore the correlation between the negative emotions and the conversation themes. Methods A retrospective study was conducted using the Chinese version of Verona Coding Definitions of Emotional Sequences (VR‐CoDES‐C) to code 297 conversations on high‐risk procedures. Inductive content analysis was used to analyse the topics in which negative emotions nested. The χ2 Test was used to test the association between the cues and the conversation themes. Results The occurrence rate of family members' and patients' negative emotions was very high (85.9%), much higher when compared to most conversations under other medical settings. The negative emotions were mainly expressed by cues (96.4%), and cue‐b (67.4%) was the most frequent category. Cues and concerns were mostly elicited by family members and patients (71.6%). Negative emotions were observed among seven themes, in which ‘Psychological stress relating to illness severity, family's care and financial burden’ (30.3%) ranked the top. Cue‐b, cue‐c and cue‐d had a significant correlation (p < .001) with certain themes. Conclusions Family members and patients conveyed significantly more negative emotions in the high‐risk preoperative conversations than in other medical communications. Certain categories of cues were induced by specific emotional conversation contents. Patient Contribution Family members and patients contributed to data.
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Affiliation(s)
- Liru Qian
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinchun Liu
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Meng Yin
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ya Zhao
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bingyu Tie
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qingyan Wang
- Department of International Exchange and Cooperation, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zhang
- Department of Medical Administration, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyang Yuan
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
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Tie B, Liu X, Yin M, Humphris G, Zhang Y, Liu H, Zhao Y, Wang Q. How physicians respond to negative emotions in high-risk preoperative conversations. PATIENT EDUCATION AND COUNSELING 2022; 105:606-614. [PMID: 34304952 DOI: 10.1016/j.pec.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate physicians' responses to negative emotions in high-risk preoperative conversations; and to explore the influencing factors of these responses. METHODS One hundred and sixty-two audio recordings were coded using the Chinese Verona Coding Definition of Emotional Sequences (VR-CoDES). Big Five Personality Inventory Brief Version and Emotional Intelligence Scale were administered to explore the influencing factors of physicians' responses. SPSS 24.0 and R 3.6.3 LME4 Package were used for data analysis. RESULTS Reduce Space (83%), referring to physicians' responses reducing the opportunities of patients to disclose emotions, was physicians' most frequent response to patients or families' emotions. The main responses were Information-advice (ERIa) and Ignoring (NRIa). Younger age, female, Agreeableness and Openness were factors positively associated with Explicit Provide Space (EP); Neuroticism was negatively correlated with EP. Extroversion was negatively correlated with Explicit Reduce Space (ER); Conscientiousness was negatively correlated with both EP and ER responses. Emotional intelligence had no significant influence on physicians' responses. CONCLUSION The majority of physicians were inclined to reduce space by providing information advice or ignoring. Physicians' responses were correlated with their gender, age and personality traits. PRACTICE IMPLICATIONS The trainees' gender, age and personality should be considered when conducting doctor-patient communication skills training.
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Affiliation(s)
- Bingyu Tie
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xinchun Liu
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Meng Yin
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Gerald Humphris
- Division of Population and Behavioural Sciences, Medical School, University of St. Andrews, Scotland, UK
| | - Yi Zhang
- Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huaqing Liu
- Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ya Zhao
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Qingyan Wang
- The Third Xiangya Hospital of Central South University, Changsha, China
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Leu GR, Links AR, Park J, Beach MC, Boss EF. Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children. JAMA Otolaryngol Head Neck Surg 2021; 148:145-154. [PMID: 34882170 DOI: 10.1001/jamaoto.2021.3530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Little is known about emotional communication between parents and surgeons. Understanding the patterns and correlates of emotional communication may foster collaboration during surgical consultations. Objective To describe the emotional expressions by parents when bringing their child for evaluation of obstructive sleep-disordered breathing (SDB) as well as surgeon responses to these emotional expressions and to evaluate the association between parental demographic characteristics and surgeon response types. Design, Setting, and Participants This cross-sectional study analyzed the audio-recorded consultations between otolaryngologists and parents of children who underwent their initial otolaryngological examination for obstructive SDB at 1 of 3 outpatient clinical sites in Maryland from April 1, 2016, to May 31, 2017. Data analysis was performed from November 1 to December 31, 2019. Main Outcomes and Measures Emotional expressions by parents and surgeon responses were audio recorded, transcribed, and coded using the Verona Coding Definitions of Emotional Sequences. Results A total of 59 consultations, of which 40 (67.8%) contained at least 1 emotional expression, were included. Participants included 59 parents (53 women [89.8%]; mean [SD] age, 33.4 [6.4] years) and 7 surgeons (4 men [57.1%]; mean [SD] age, 42.8 [7.9] years). Parents made 123 distinct emotional expressions (mean [SD], 3.08 [2.29] expressions per visit), which were often expressed as subtle cues (n = 103 of 123 [83.7%]) vs explicit concerns (n = 20 [16.3%]). Most expressions (n = 98 [79.7%]) were related to medical issues experienced by the child (eg, symptoms and surgical risks). Most surgeon responses provided parents space for elaboration of emotional expressions (n = 86 [69.9%]) and were nonexplicit (n = 55 [44.7%]). Surgeons were less likely to explore the emotions of parents from racial and ethnic minority groups compared with White parents (OR, 0.47; 95% CI, 0.18-0.98). Conclusions and Relevance This cross-sectional study found that emotional communication occurs between surgeons and parents of pediatric patients with obstructive SDB. However, surgeon responses varied according to parental race and ethnicity, suggesting the existence of implicit biases in surgeon-patient communication and calling for further research to inform efforts to promote family-centered, culturally competent communication in surgery.
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Affiliation(s)
- Grace R Leu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenny Park
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Catherine Beach
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Haukeland YB, Fjermestad KW, Mossige S, Vatne TM. Parent-child communication about emotions during SIBS: a joint intervention for siblings and parents of children with chronic disorders. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.1986850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Krister Westlye Fjermestad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Frambu Competence Center for Rare Disorders, Siggerud, Norway
| | - Svein Mossige
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Sisk BA, Friedrich AB, DuBois J, Mack JW. Characteristics of uncertainty in advanced pediatric cancer conversations. PATIENT EDUCATION AND COUNSELING 2021; 104:1066-1074. [PMID: 33109428 PMCID: PMC8052385 DOI: 10.1016/j.pec.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To describe the initiation, response, and content of communication about uncertainty in advanced pediatric cancer. METHODS Qualitative analysis of 35 audio-recorded outpatient consultations between physicians and families of children whose cancer recently progressed. We defined uncertainty as "future-oriented lack of clarity in which answers are unknown to all participants involved in the conversation." RESULTS Conversations contained a median of 14 (interquartile range 8.5-19) uncertainty statements related to 6 topics: appropriateness of treatments, acute toxicities and morbidities, prognosis or response to treatment, diagnostic uncertainty, logistical uncertainty, and long-term toxicities. Physicians initiated 63 % of statements (303/489), parents initiated 33 % (165/489), and children initiated 2% (10/489). We identified 14 unique responses to uncertainty: 11 responses provided space for discussion, 3 responses reduced space. Physicians most commonly responded by providing additional information (38 %, 361/947). Parents most often responded with continuing statements, such as "um" or "yeah" (50 %, 313/622). Children seldom responded (<1%, 12/1697). CONCLUSION Physicians initiated most uncertainty discussions, and their responses often provided space for further discussion. Children were seldom involved in these conversations. PRACTICE IMPLICATIONS Clinicians should consider maintaining open conversations about uncertainties in advanced pediatric cancer, and consider engaging children in these discussions.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annie B Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, MO, USA
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer W Mack
- Pediatric Oncology and Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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Sisk BA, Friedrich AB, DuBois J, Mack JW. Emotional Communication in Advanced Pediatric Cancer Conversations. J Pain Symptom Manage 2020; 59:808-817.e2. [PMID: 31733356 PMCID: PMC7096262 DOI: 10.1016/j.jpainsymman.2019.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Cancer is a life-changing diagnosis accompanied by significant emotional distress, especially for children with advanced disease. However, the content and processes of discussing emotion in advanced pediatric cancer remain unknown. OBJECTIVES To describe the initiation, response, and content of emotional communication in advanced pediatric cancer. METHODS We audiorecorded 35 outpatient consultations between oncologists and families of children whose cancer recently progressed. We coded conversations based on Verona Coding Definitions of Emotional Sequences. RESULTS About 91% of conversations contained emotional cues, and 40% contained explicit emotional concerns. Parents and clinicians equally initiated cues (parents: 48%, 183 of 385; clinicians: 49%) and concerns (parents: 51%; clinicians: 49%). Children initiated 3% of cues and no explicit concerns. Emotional content was most commonly related to physical aspects of cancer and/or treatment (28% of cues and/or concerns, present in 80% of conversations) and prognosis (27% of cues and/or concerns, present in 60% of conversations). Clinicians mostly responded to emotional cues and concerns implicitly, without specifically naming the emotion (85%). Back channeling (using minimal prompts or words that encourage further disclosure, e.g., uh-huh) was the most common implicit response that provided space for emotional disclosure (32% of all responses). Information advice was the most common implicit response that reduced space for further emotional disclosure (28%). CONCLUSION Emotional communication in advanced pediatric cancer appears to be a subtle process where parents offer hints and clinicians respond with non-emotion-laden statements. Also, children were seldom engaged in emotional conversations. Clinicians should aim to create an environment that allows families to express emotional distress if and/or when ready.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Annie B Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri, USA
| | - James DuBois
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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Bittencourt Romeiro F, Felizardo DDF, Kern de Castro E, Figueiredo-Braga M. Physicians privilege responding to emotional cues in oncologic consultations: A study utilizing Verona Coding Definitions of Emotional Sequences. J Health Psychol 2020; 26:2220-2230. [DOI: 10.1177/1359105320909862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to describe emotional cues and concerns expressed by cancer patients and their physicians using video-recorded regular oncology consultations. The consultations were divided into units of analysis and coded according to the Verona Coding Definitions of Emotional Sequences system. The study design was mixed, descriptive, and exploratory. Twelve patients and eight oncologists participated in the study. The patients expressed 349 cues/concerns during the 12 consultations. The majority (68.8%) of the content consisted of non-explicit description of physiological and stress episodes in the disease and treatment. Physicians demonstrated that they recognized fewer underlying cues than those related to physiological complaints.
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Dicé F, Dolce P, Maiello A, Freda MF. Exploring emotions in dialog between health provider, parent and child. An observational study in pediatric primary care. PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Krystallidou D, Bylund CL, Pype P. The professional interpreter's effect on empathic communication in medical consultations: A qualitative analysis of interaction. PATIENT EDUCATION AND COUNSELING 2020; 103:521-529. [PMID: 31623946 DOI: 10.1016/j.pec.2019.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it. METHODS We coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters. RESULTS We identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor. CONCLUSION In IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction. PRACTICE IMPLICATIONS Doctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other's communicative goals.
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Affiliation(s)
- Demi Krystallidou
- KU Leuven, Faculty of Arts, Antwerp Sint Jacob Campus, Antwerp, Belgium.
| | - Carma L Bylund
- University of Florida, Department of Public Relations, College of Journalism and Communications, Gainesville, USA
| | - Peter Pype
- Ghent University, Department of Public Health and Primary Care, Ghent, Belgium
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatr Rheumatol Online J 2020; 18:13. [PMID: 32033566 PMCID: PMC7007654 DOI: 10.1186/s12969-020-0406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Treatment of rheumatic diseases in children often includes long-term needle injections, which represent a risk for refusing medication based on potential needle-fear. How nurses manage children's fear and pain during the initial educational training session of subcutaneous injections, may affect the management of the subsequent injections in the home settings. The aim of this study was to explore how children expressed fear and pain during these training sessions, and how adults' communication affected children's expressed emotions. METHODS This qualitative explorative study used video observations and short interviews during training sessions in a rheumatic hospital ward. Participants were children between five and fifteen years (n = 8), their parents (n = 11) and nurses (n = 7) in nine training sessions in total. The analysis followed descriptions of thematic analysis and interaction analysis. RESULTS The children expressed fears indirectly as cues and nonverbal signs more often than direct statements. Three children stated explicit being afraid or wanting to stop. The children worried about needle-pain, but experienced the stinging pain after the injection more bothersome. The technical instructions were detailed and comprehensive and each nurse shaped the structure of the sessions. Both nurses and parents frequently offered coping strategies unclearly without sufficient time for children to understand. We identified three main adult communication approaches (acknowledging, ambiguous and disregarding) that influenced children's expressed emotions during the training session. CONCLUSIONS Children's expression of fear was likely to be indirectly, and pain was mostly related to the injection rather than the needle stick. When adults used an acknowledging communication and offered sufficient coping strategies, children seemed to become involved in the procedure and acted with confidence. The initial educational training session may have a great impact on long-term repeated injections in a home setting by providing children with confidence at the onset.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Yin L, Yin M, Wang Q, Yan Y, Tang Q, Deng Y, Liu X. Can Verona Coding Definitions of Emotional Sequences (VR-CoDES) be applied to standardized Chinese medical consultations? - A reliability and validity investigation. PATIENT EDUCATION AND COUNSELING 2019; 102:1460-1466. [PMID: 30981409 DOI: 10.1016/j.pec.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the reliability and validity of the Chinese version of VR-CoDES. METHODS The VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns. RESULTS ICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences. CONCLUSION The Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation. PRACTICE IMPLICATION More consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation.
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Affiliation(s)
- Lanyi Yin
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Meng Yin
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Qingyan Wang
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Yaxin Yan
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Qiuping Tang
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Yunlong Deng
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Xinchun Liu
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States.
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15
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Carter T, Walker GM, Aubeeluck A, Manning JC. Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review. J Child Health Care 2019; 23:178-199. [PMID: 30058359 DOI: 10.1177/1367493518787925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
There are increasing numbers of children presenting to paediatric hospital settings in mental health crisis. Typically, non-mental health professionals are responsible for the initial assessment of these children and are required to identify immediate physical and emotional health needs. To ensure the safety of these children, immediate risk of suicide and self-harm should be assessed. However, no standardized assessment tool is used in clinical practice, and for those tools that are used, their validity and reliability is unclear. A scoping review was conducted to identify the existing assessment tools of immediate self-harm and suicide risk. Searches of electronic databases and relevant reference lists were undertaken. Twenty-two tools were identified and most assessed acute risk of suicide with only four tools incorporating a self-harm assessment. The tools varied in number of items (4-146), subscales (0-11) and total scores (16-192). Half incorporated Likert-type scales, and most were completed via self-report. Many tools were subject to limited psychometric testing, and no single tool was valid or reliable for use with children presenting in mental health crisis to non-mental health settings. As such, a clinically appropriate, valid and reliable tool that assesses immediate risk of self-harm and suicide in paediatric settings should be developed.
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Affiliation(s)
- Tim Carter
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Gemma M Walker
- 2 Nottingham Children's Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals, Nottingham, UK
| | - Aimee Aubeeluck
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Joseph C Manning
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.,2 Nottingham Children's Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals, Nottingham, UK.,3 Children and Families Research, Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
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16
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Piccolo LD, Finset A, Mellblom AV, Figueiredo-Braga M, Korsvold L, Zhou Y, Zimmermann C, Humphris G. Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions. PATIENT EDUCATION AND COUNSELING 2017; 100:2303-2311. [PMID: 28673489 DOI: 10.1016/j.pec.2017.06.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To discuss the theoretical and empirical framework of VR-CoDES and potential future direction in research based on the coding system. METHODS The paper is based on selective review of papers relevant to the construction and application of VR-CoDES. RESULTS VR-CoDES system is rooted in patient-centered and biopsychosocial model of healthcare consultations and on a functional approach to emotion theory. According to the VR-CoDES, emotional interaction is studied in terms of sequences consisting of an eliciting event, an emotional expression by the patient and the immediate response by the clinician. The rationale for the emphasis on sequences, on detailed classification of cues and concerns, and on the choices of explicit vs. non-explicit responses and providing vs. reducing room for further disclosure, as basic categories of the clinician responses, is described. CONCLUSIONS Results from research on VR-CoDES may help raise awareness of emotional sequences. Future directions in applying VR-CoDES in research may include studies on predicting patient and clinician behavior within the consultation, qualitative analyses of longer sequences including several VR-CoDES triads, and studies of effects of emotional communication on health outcomes. PRACTICE IMPLICATIONS VR-CoDES may be applied to develop interventions to promote good handling of patients' emotions in healthcare encounters.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Margarida Figueiredo-Braga
- Faculty of Medicine, University of Porto, Portugal; I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yuefang Zhou
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
| | - Christa Zimmermann
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gerald Humphris
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
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17
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Vijfhuizen M, Bok H, Matthew SM, Del Piccolo L, McArthur M. Analysing how negative emotions emerge and are addressed in veterinary consultations, using the Verona Coding Definitions of Emotional Sequences (VR-CoDES). PATIENT EDUCATION AND COUNSELING 2017; 100:682-689. [PMID: 27884573 DOI: 10.1016/j.pec.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/06/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the applicability, need for modifications and reliability of the VR-CoDES in a veterinary setting while also gaining a deeper understanding of clients' expressions of negative emotion and how they are addressed by veterinarians. METHODS The Verona Coding Definitions of Emotional Sequences for client cues and concerns (VR-CoDES-CC) and health provider responses (VR-CoDES-P) were used to analyse 20 audiotaped veterinary consultations. Inter-rater reliability was established. The applicability of definitions of the VR-CoDES was identified, together with the need for specific modifications to suit veterinary consultations. RESULTS The VR-CoDES-CC and VR-CoDES-P generally applied to veterinary consultations. Cue and concern reliability was found satisfactory for most types of cues, but not for concerns. Response reliability was satisfactory for explicitness, and for providing and reducing space for further disclosure. Modifications to the original coding system were necessary to accurately reflect the veterinary context and included minor additions to the VR-CoDES-CC. CONCLUSION Using minor additions to the VR-CoDES including guilt, reassurance and cost discussions it can be reliably adopted to assess clients' implicit expressions of negative emotion and veterinarians' responses. PRACTICE IMPLICATIONS The modified VR-CoDES could be of great value when combined with existing frameworks used for teaching and researching veterinary communication.
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Affiliation(s)
- Malou Vijfhuizen
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, Australia.
| | - Harold Bok
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Susan M Matthew
- College of Veterinary Medicine, Washington State University, Pullman, USA; Faculty of Veterinary Science, The University of Sydney, Sydney, Australia.
| | - Lidia Del Piccolo
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy.
| | - Michelle McArthur
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, Australia.
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18
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Ortwein H, Benz A, Carl P, Huwendiek S, Pander T, Kiessling C. Applying the Verona coding definitions of emotional sequences (VR-CoDES) to code medical students' written responses to written case scenarios: Some methodological and practical considerations. PATIENT EDUCATION AND COUNSELING 2017; 100:305-312. [PMID: 27597160 DOI: 10.1016/j.pec.2016.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate whether the Verona Coding Definitions of Emotional Sequences to code health providers' responses (VR-CoDES-P) can be used for assessment of medical students' responses to patients' cues and concerns provided in written case vignettes. METHODS Student responses in direct speech to patient cues and concerns were analysed in 21 different case scenarios using VR-CoDES-P. RESULTS A total of 977 student responses were available for coding, and 857 responses were codable with the VR-CoDES-P. In 74.6% of responses, the students used either a "reducing space" statement only or a "providing space" statement immediately followed by a "reducing space" statement. Overall, the most frequent response was explicit information advice (ERIa) followed by content exploring (EPCEx) and content acknowledgement (EPCAc). DISCUSSION VR-CoDES-P were applicable to written responses of medical students when they were phrased in direct speech. The application of VR-CoDES-P is reliable and feasible when using the differentiation of "providing" and "reducing space" responses. Communication strategies described by students in non-direct speech were difficult to code and produced many missings. PRACTICE IMPLICATIONS VR-CoDES-P are useful for analysis of medical students' written responses when focusing on emotional issues. Students need precise instructions for their response in the given test format.
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Affiliation(s)
- Heiderose Ortwein
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Alexander Benz
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Goethestr. 31, 80336 Munich, Germany
| | - Petra Carl
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Goethestr. 31, 80336 Munich, Germany
| | - Sören Huwendiek
- Institute for Medical Education, Assessment und Evaluation, Konsumstrasse 13, 3010 Bern, Switzerland
| | - Tanja Pander
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstrasse 1, 80336 München, Germany
| | - Claudia Kiessling
- Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
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19
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Sundler AJ, Höglander J, Eklund JH, Eide H, Holmström IK. Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care. PATIENT EDUCATION AND COUNSELING 2017; 100:276-282. [PMID: 27692492 DOI: 10.1016/j.pec.2016.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns. METHODS A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES). RESULTS Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n=292) rather than explicit concerns (n=24). Utterances with hints to hidden concerns (63,9%, n=202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n=50). Most of these were elicited by the nursing staff (63%, n=200). CONCLUSION Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open. PRACTICE IMPLICATIONS The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-50190 Borås, Sweden.
| | - Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden.
| | - Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden.
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Postbox 7053, N-3007 Drammen, Norway,.
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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20
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Kohlsdorf M, Costa Junior ÁL. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology. PSICOLOGIA-REFLEXAO E CRITICA 2016. [DOI: 10.1186/s41155-016-0028-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Griep ECM, Noordman J, van Dulmen S. Practice nurses mental health provide space to patients to discuss unpleasant emotions. J Psychiatr Ment Health Nurs 2016; 23:77-85. [PMID: 26710237 DOI: 10.1111/jpm.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with mild psychosocial and psychological problems provide signs of worrying or express a clear unpleasant emotion in 94% of consultations with a practice nurse mental health. Nurses' responses to patients' signs of worrying or clear unpleasant emotions were mostly characterized by providing space for patients to talk about these emotions, by using minimal responses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Practice nurses' mental health have passive listening skills, and to a lesser extent, use active listening techniques. Accurate emotion detection and the ability to pick out emotional signs during consultations must also be considered as an important skill for health providers to improve patient-centred communication. AIM Patients with physical problems are known to express their emotional concerns in an implicit way only. Whether the same counts for patients presenting mental health problems in primary care is unknown. This study aims to examine how patients with mild psychosocial and psychological complaints express their concerns during consultations with the practice nurse mental health and how practice nurses respond to these expressions. METHOD Fifteen practice nurses mental health working in Dutch general practices participated in the study. Their consultations with 116 patients with mild psychosocial or psychological complaints were video recorded. patients' explicitly expressed emotional concerns and more implicit expressions of underlying emotional problems (cues) as well as nurses' responses to these expressions were rated using the Verona Coding Definition of Emotional Sequences. RESULTS Almost all consultations contained at least one cue or concern (94%). Nurses' responses were mostly characterized by providing space for patients to talk about their cue or concern in a non-explicit way (62%), by using minimal responses (42%). DISCUSSION Practice nurses mental health have passive listening skills, and to a lesser extent, use active listening techniques. However, there are no strict rules which way of responding is the best and patients value responses differently.
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Affiliation(s)
| | | | - S van Dulmen
- NIVEL, Utrecht, The Netherlands.,Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.,Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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22
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Del Piccolo L, Pietrolongo E, Radice D, Tortorella C, Confalonieri P, Pugliatti M, Lugaresi A, Giordano A, Heesen C, Solari A. Patient expression of emotions and neurologist responses in first multiple sclerosis consultations. PLoS One 2015; 10:e0127734. [PMID: 26030822 PMCID: PMC4452259 DOI: 10.1371/journal.pone.0127734] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anxiety and depression are common in people with multiple sclerosis (MS), but data on emotional communication during MS consultations are lacking. We assessed patient expressions of emotion and neurologist responses during first-ever MS consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES). METHODS We applied VR-CoDES to recordings/transcripts of 88 outpatient consultations (10 neurologists, four MS Italian centers). Before consultation, patients completed the Hospital Anxiety and Depression Scale (HADS). Multilevel sequential analysis was performed on the number of cues/concerns expressed by patients, and the proportion of reduce space responses by neurologists. RESULTS Patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The commonest cues were verbal hints of hidden worries (cue type b, 41%) and references to stressful life events (type d, 26%). Variables independently associated with number of cues/concerns were: anxiety (HADS-Anxiety score >8) (incidence risk ratio, IRR 1.08, 95% CI 1.06-1.09; p<0.001); patient age (IRR 0.98, 95% CI 0.98-0.99; p<0.001); neurologist age (IRR 0.94, 95% CI 0.92-0.96; p=0.03); and second opinion consultation (IRR 0.72, 95% CI 0.60-0.86; p=0.007). Neurologists reacted to patient emotions by reducing space (changing subject, taking no notice, giving medical advice) for 58% of cues and 76% of concerns. Anxiety was the only variable significantly associated with 'reduce space' responses (odds ratio 2.17, 95% CI 1.32-3.57; p=0.003). CONCLUSIONS Patient emotional expressions varied widely, but VR-CoDES cues b and d were expressed most often. Patient anxiety was directly associated with emotional expressions; older age of patients and neurologists, and second opinion consultations were inversely associated with patient emotional expression. In over 50% of instances, neurologists responded to these expressions by reducing space, more so in anxious patients. These findings suggest that neurologists need to improve their skills in dealing with patient emotions.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Medicine and Public Health, University of Verona, Verona, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Carla Tortorella
- Departments of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Maura Pugliatti
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Christoph Heesen
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
- * E-mail:
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Lundy JM, Bikker A, Higgins M, Watt GC, Little P, Humphries GM, Mercer SW. General practitioners’ patient-centredness and responses to patients’ emotional cues and concerns: relationships with perceived empathy in areas of high and low socioeconomic deprivation. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40639-015-0011-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zhou Y, Collinson A, Laidlaw A, Humphris G. How Do medical students respond to emotional cues and concerns expressed by simulated patients during OSCE consultations?--a multilevel study. PLoS One 2013; 8:e79166. [PMID: 24194960 PMCID: PMC3806849 DOI: 10.1371/journal.pone.0079166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 09/19/2013] [Indexed: 12/30/2022] Open
Abstract
Objectives How medical students handle negative emotions expressed by simulated patients during Objective Structured Clinical Examinations (OSCE) has not been fully investigated. We aim to explore (i) whether medical students respond differently to different types of patients’ emotional cues; and (2) possible effects of patients’ progressive disclosure of emotional cues on students’ responses. Methods Forty OSCE consultations were video recorded and coded for patients’ expressions of emotional distress and students’ responses using a validated behavioural coding scheme (the Verona Coding Definitions of Emotional Sequence). Logistic multilevel regression was adopted to model the probability of the occurrence of student reducespace response behaviour as a function of the number of patients’ expressions of emotional cues. Results We found that medical students offered responses that differed to emotional cue types expressed by simulated patients. Students appeared to providespace to emotional cues when expressed in vague and unspecific words and reducespace to cues emphasizing physiological or cognitive correlates. We also found that medical students were less likely to explore patients’ emotional distress nearer the end of the consultation and when the duration of a patient speech turn got larger. Cumulative frequency of patients’ emotional cues also predicted students’ reducespace behaviour. Practical Implications Understanding how medical students manage negative emotions has significant implications for training programme development focusing on emotion recognition skills and patient-centred communication approach. In addition, the statistical approaches adopted by this study will encourage researchers in healthcare communication to search for appropriate analytical techniques to test theoretical propositions.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
- * E-mail:
| | - Alex Collinson
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Anita Laidlaw
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
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25
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Kale E, Skjeldestad K, Finset A. Emotional communication in medical consultations with native and non-native patients applying two different methodological approaches. PATIENT EDUCATION AND COUNSELING 2013; 92:366-374. [PMID: 23880525 DOI: 10.1016/j.pec.2013.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/20/2013] [Accepted: 06/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the potential agreement between two different methods to investigate emotional communication of native and non-native patients in medical consultations. METHODS The data consisted of 12 videotaped hospital consultations with six native and six non-native patients. The consultations were coded according to coding rules of the Verona Coding definitions of Emotional Sequences (VR-CoDES) and afterwards analyzed by discourse analysis (DA) by two co-workers who were blind to the results from VR-CoDES. RESULTS The agreement between VR-CoDES and DA was high in consultations with many cues and concerns, both with native and non-native patients. In consultations with no (or one cue) according to VR-CoDES criteria the DA still indicated the presence of emotionally salient expressions and themes. CONCLUSION In some consultations cues to underlying emotions are communicated so vaguely or veiled by language barriers that standard VR-CoDES coding may miss subtle cues. Many of these sub-threshold cues could potentially be coded as cues according to VR-CoDES main coding categories, if criteria for coding vague or ambiguous cues had been better specified. PRACTICE IMPLICATIONS Combining different analytical frameworks on the same dataset provide us new insights on emotional communication.
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Affiliation(s)
- Emine Kale
- Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, Oslo, Norway.
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Noordman J, van Dulmen S. Shared Medical Appointments marginally enhance interaction between patients: an observational study on children and adolescents with type 1 diabetes. PATIENT EDUCATION AND COUNSELING 2013; 92:418-425. [PMID: 23830238 DOI: 10.1016/j.pec.2013.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 06/03/2013] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine informational and emotional patient-provider and patient-patient communication sequences (i.e. cues and subsequent responses) during Shared Medical Appointments (SMAs) for children and adolescents with type 1 Diabetes Mellitus (T1DM) and their parents. METHODS 57 children/adolescents with T1DM and 36 healthcare providers participated in ten SMAs in seven Dutch hospitals. Parents were present in six SMAs. Video-recordings were made. Communication sequences, including informational and emotional cues and responses were rated using an adaptation of the Medical Interview Aural Rating Scale. RESULTS 143 patient-initiated cues were identified, followed by 140 provider responses and 30 patient responses. Patients gave more informational than emotional cues. Informational cues were mostly medical-related. Subsequent responses provided by providers and patients contained mostly appropriate information. We identified 17 patient and four parent cues with multiple responses. CONCLUSIONS Almost all cues were identified by healthcare providers and responded to in an appropriate manner. Cues not followed by a provider's response were picked up by other patients. Providers acted as mediator between a patient cue and another patient's response, thereby stimulating the interaction during SMAs. PRACTICE IMPLICATIONS Professionals could more explicitly invite all participants to interact with each other, and enable them to have their share in the communication process.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Grimsbø GH, Ruland CM, Finset A. Cancer patients' expressions of emotional cues and concerns and oncology nurses' responses, in an online patient-nurse communication service. PATIENT EDUCATION AND COUNSELING 2012; 88:36-43. [PMID: 22326865 DOI: 10.1016/j.pec.2012.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 01/11/2012] [Accepted: 01/14/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To (1) investigate emotional cues and concerns (C&C) of cancer patients expressed in e-mail communication with oncology nurses in an online patient-nurse communication service (OPNC), and (2) explore how nurses responded to patients' C&C. METHODS 283 e-messages sent from 38 breast and 22 prostate cancer patients and 286 e-responses from five oncology nurses were coded with the Verona Coding Definitions of Emotional Sequences. RESULTS We identified 102 cues and 33 concerns expressed in patients' messages. Cues indicating expression of uncertainty or hope, occurred most frequently (in 38.5% of messages), followed by concerns (in 24.4% of messages). Nurses responded to 85.2% of patients' C&Cs; more than half of patients' C&Cs were met with a mixture of information giving and empathic responses. CONCLUSION Patients with breast and prostate cancer express many C&C in e-mail communications with oncology nurses, who demonstrated satisfactory sensitivity to patients' emotions in their responses to patients. PRACTICE IMPLICATIONS Offering e-communication with oncology nurses to cancer patients is a promising and feasible supplement to usual care to address and relieve patients' concerns and emotional distress during illness and recovery.
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Affiliation(s)
- Gro Hjelmeland Grimsbø
- Center for Shared Decision Making and Collaborative Care, Oslo University Hospital, Rikshospitalet, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
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People-centred care: new research needs and methods in doctor-patient communication. Challenges in mental health. Epidemiol Psychiatr Sci 2012; 21:145-9. [PMID: 22789161 DOI: 10.1017/s2045796012000091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Communication in psychiatry is nowadays called to create bridges between different levels of observation (biological, functional and relational levels) and therapeutic intervention (social and educational) with important implications for therapeutic practice and communication research in the mental health context. New research challenges and windows of opportunity for therapeutic practice will be addressed in this contribution, as they relate to the three main tasks that psychiatrists have to meet when talking with their patients: understanding patient's problems and concerns; establishing the therapeutic alliance by acknowledging and responding to patient's emotion; informing and involving patients and their families, when appropriate. Therapeutic decisions need the elaboration of valid strategies of shared decision-making, which still have to be implemented and adapted to psychiatric context. Moreover, in the research field, emerging biomarker research may contribute to better explain what makes the difference in an empathic relationship either in terms of psycho-physiological reactions and in brain changes. Finally, the influence of new technologies and of Internet has to be more and more considered during clinical consultations.
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Mjaaland TA, Finset A, Jensen BF, Gulbrandsen P. Patients' negative emotional cues and concerns in hospital consultations: a video-based observational study. PATIENT EDUCATION AND COUNSELING 2011; 85:356-362. [PMID: 21392928 DOI: 10.1016/j.pec.2010.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 12/17/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments. METHODS Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders. RESULTS Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician. CONCLUSIONS More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early. PRACTICE IMPLICATIONS Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.
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Vatne TM, Ruland CM, Ørnes K, Finset A. Children's expressions of negative emotions and adults' responses during routine cardiac consultations. J Pediatr Psychol 2011; 37:232-40. [PMID: 21908544 DOI: 10.1093/jpepsy/jsr074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE One function of expressing emotion is to receive support. The aim of this study was to assess how children with heart disease express negative emotions during routine consultations, and examine the interaction between children's expressions and adults' responses. METHODS Seventy children, aged 7-13 years, completed measures of anxiety and were videotaped during cardiology visits. Adult-child interactions were analyzed using the Verona Definitions of Emotional Sequences. RESULTS Children expressed negative emotion, mainly in subtle ways; however, adults rarely recognized and responded to these expressions. The frequency of children's expressions and adults' responses were related to the child's age, level of anxiety, and verbal participation. CONCLUSION Children do not openly express negative emotions frequently during routine cardiac consultations; they are more likely to provide subtle cues of negative emotion. When expression of negative emotions does occur, adults may consider using the opportunity to explore the child's emotional experiences.
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Affiliation(s)
- Torun M Vatne
- Centre for Shared Decision Making and Nursing Research, Oslo University Hospital, Forskningsveien 2b, 0027 Oslo, Norway.
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Kale E, Finset A, Eikeland HL, Gulbrandsen P. Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: an exploratory study. PATIENT EDUCATION AND COUNSELING 2011; 84:325-331. [PMID: 21652163 DOI: 10.1016/j.pec.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify potential barriers in communication with non-Western immigrant patients by comparing the frequency and nature of emotional cues and concerns, as well as physician responses during consultations, between ethnically Norwegian patients and immigrant patients in a general hospital setting. METHODS Consultations with 56 patients (30 non-Western immigrants and 26 ethnic Norwegians) were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P). RESULTS There were no significant differences in frequencies of cues and concerns between immigrant and Norwegian patients. However, the immigrant patients with high language proficiency expressed more concerns compared to immigrant patients with language problems and Norwegian patients. Moreover, more concerns were expressed during consultations with female physicians than with male physicians. CONCLUSION Expression of cues and concerns in immigrant patients is dependent on the patient's language proficiency and the physician's gender. PRACTICE IMPLICATIONS Providers should recognize that immigrant patients may have many emotional cues and concerns, but that language problems may represent a barrier for the expression of these concerns.
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Affiliation(s)
- Emine Kale
- Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway.
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De Maesschalck S, Deveugele M, Willems S. Language, culture and emotions: exploring ethnic minority patients' emotional expressions in primary healthcare consultations. PATIENT EDUCATION AND COUNSELING 2011; 84:406-412. [PMID: 21733654 DOI: 10.1016/j.pec.2011.04.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/31/2011] [Accepted: 04/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study explores ethnic minority patients' expression of emotional cues and concerns in primary healthcare, and examines relationships with patient, provider and consultation attributes. METHODS 191 video-recorded consultations were analyzed using the VR-CoDES. Patients were interviewed before the consultation. Generalized Estimating Equations models (GEE) were used to test for associations. RESULTS Psychosocial versus bio-medically oriented encounters contained significantly more cues (p≤0.05). Patients with poor versus good language proficiency expressed significantly less cues (p≤0.001). No significant correlations were found with patients' cultural values, patients' or physicians' gender or the presence of an interpreter. Female patients express more concerns (p≤0.05), female physicians have a higher number of concerns expressed by patients (p≤0.02). CONCLUSION This study shows that independent of physician and diagnosis, patients' language proficiency has a more important impact on the number of cues expressed by the patient than cultural difference. PRACTICE IMPLICATIONS Medical schools and Continuing Medical Education should focus on training programs for recognizing and handling linguistic barriers between physicians and patients. Patient education programs should encourage patients who experience language barriers to open up to physicians. In situations where language is a barrier, physicians and patients should be encouraged to use interpreters to enhance the expression of emotions.
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Broome M, Farrell M, Visser A. Decision making is an important aspect of health communication research. PATIENT EDUCATION AND COUNSELING 2010; 80:285-287. [PMID: 20691555 DOI: 10.1016/j.pec.2010.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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