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Schöps AM, Skinner TC, Fosgerau CF. Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention. PATIENT EDUCATION AND COUNSELING 2024; 127:108370. [PMID: 38996574 DOI: 10.1016/j.pec.2024.108370] [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: 11/02/2023] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To explore the relationship between health coaches' responses to emotional cues/concerns and women's subsequent engagement with the health coaching mHealth platform. METHODS 24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. RESULTS In interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. CONCLUSION High goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. PRACTICE IMPLICATIONS Findings can draw coaches' attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective.
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Affiliation(s)
- Antje Maria Schöps
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy Charles Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, La Trobe University, Bendigo, Australia; Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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Richards HL, Fortune DG, Lyons L, Curtin Y, Hennessey DB. Patients' Emotional Talk During Surveillance Cystoscopy for Non-muscle Invasive Bladder Cancer: Opportunities for Improving Communication. Urology 2024; 185:1-7. [PMID: 38160762 DOI: 10.1016/j.urology.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To examine the emotional communication that takes place between patients and health care providers during surveillance cystoscopy for non-muscle invasive bladder cancer (NMIBC). METHODS Participants were 57 patients with a diagnosis of NMIBC attending for surveillance cystoscopy and 10 health care professionals (HCPs). Cystoscopy procedures were audio-recorded and transcribed verbatim. Two approaches to analysis of transcriptions were undertaken: (1) a template analysis and (2) Verona Coding Definitions of Emotional Sequences. RESULTS Communication during cystoscopy generally comprised of "social/small talk," "results of the cystoscopy," and "providing instructions to the patient." Emotional talk was present in 41/57 consultations, with 129 emotional cues and concerns expressed by patients. Typically patients used hints to their emotions rather than stating explicit concerns. The majority (86%) of HCPs responses to the patient did not explicitly mention the patient's emotional concern or cue. Urology trainees were less likely than other HCPs to provide space for patients to explore their emotional concerns (t = -1.78, P <.05). CONCLUSION Emotional communication was expressed by the majority of patients during cystoscopy. While all HCPs responded to patients' emotional communication, there were a number of missed opportunities to "pick-up" on patients' emotional cues and improve communication. Urologists need to be aware of the nuances of patients' emotional communication. Learning to identify and respond appropriately to emotional cues may improve communication with patients.
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Affiliation(s)
- H L Richards
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Ireland; Department of Urology, Mercy University Hospital, Cork, Ireland; Department of Psychology, University of Limerick, Limerick, Ireland.
| | - D G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - L Lyons
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Y Curtin
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Ireland
| | - D B Hennessey
- Department of Urology, Mercy University Hospital, Cork, Ireland
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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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Abstract
Introduction In the last decades, health professions have progressively moved towards person-centredness. Dentistry, however, lags behind the other health professions and remains deeply anchored in a biomedical vision.Aims Our objective was thus to better understand how dentists perceived person-centred care (PCC) and identify the challenges they may face in implementing it.Methods We conducted qualitative descriptive research in the province of Quebec, Canada; it was based on in-depth interviews with 11 general dental practitioners working in private clinics.Results Thematic analyses reveal that dentists had little interest in understanding the life and stories of their patients. Furthermore, their openness to share decision-making was limited to procedures that they considered of relatively low value and less for procedures they considered of higher value, such as indirect restorations.Discussion We argue that dentists' reluctance to understanding and shared decision-making is rooted in the old-established identity of dentistry as an art. Dentists indeed considered the dental craft as sacred - an art form with unbreakable axioms that defined quality of care.Conclusion It is time for the dental profession to reflect on its ideological foundations and reconsider its identity. This reflection is crucial to respond to the needs of a changing society that is losing its confidence in the profession.
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Affiliation(s)
- Nareg Apelian
- Centre Dentaire Jean Talon, 524 Jean Talon W. Suite 1, Montreal, Quebec, H3N 1R5, Canada.
| | - Jean-Noel Vergnes
- Dental Faculty, Department of Epidemiology and Public Health, Paul Sabatier University, Toulouse, France; Faculty of Dentistry, Division of Oral Health and Society, McGill University, Montreal, Quebec, H3A 1G1, Canada
| | - Christophe Bedos
- Faculty of Dentistry, Division of Oral Health and Society, McGill University, Montreal, Quebec, H3A 1G1, Canada; School of Public Health, University of Montreal, Quebec, Canada
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Heyman RE, Baucom KJW, Giresi J, Isaac LJ, Slep AMS. Patient Experience and Expression of Unpleasant Emotions During Health Care Encounters. J Patient Exp 2021; 7:969-972. [PMID: 33457530 PMCID: PMC7786783 DOI: 10.1177/2374373520978869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To examine the concordance between patients' experience and expression of unpleasant emotions in a health care context, 21 patients presenting to a university dental clinic were observed for expressed unpleasant emotions and patients provided the intensity of their experienced unpleasant emotions. We found low convergence between experience and expression. Most of the time that patients experience unpleasant emotions they do not express them, and 80% of the time patients express unpleasant emotions they are not experiencing them at the time. Providers need to frequently check in with patients regarding their emotional experience during appointments, as it is infrequently accessible to providers.
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Affiliation(s)
- Richard E Heyman
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, NY, USA
| | | | - Jill Giresi
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, NY, USA
| | - Liza J Isaac
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, NY, USA
| | - Amy M Smith Slep
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, NY, USA
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Yuan S, Freeman R, Hill K, Newton T, Humphris G. Communication, Trust and Dental Anxiety: A Person-Centred Approach for Dental Attendance Behaviours. Dent J (Basel) 2020; 8:dj8040118. [PMID: 33066178 PMCID: PMC7712465 DOI: 10.3390/dj8040118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 11/17/2022] Open
Abstract
Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental attendance behaviours using person-centred and socio-economic position factors. A secondary data analysis was conducted on a cross-sectional representative survey of a two-stage cluster sample of adults including England, Wales and Northern Ireland. Data were drawn from structured interview. Path analysis of proposed model was calculated following measurement development and confirmation of reliable constructs. The findings show model fit was good. Dental anxiety was predicted negatively by patient’s trust and positively by reported dentist communication. Patient’s shame was positively associated with dental anxiety, whereas self-reported dental attendance was negatively associated with dental anxiety. Both patient’s trust and dentist’s communication effects were moderated by social class. Manual classes were most sensitive to the reported dentist’s communications. Some evidence for the proposed model was found. The relationships reflected in the model were illuminated further when social class was introduced as moderator and indicated dentists should attend to communication processes carefully across different categories of patients.
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Affiliation(s)
- Siyang Yuan
- School of Dentistry, University of Dundee, Dundee DD1 4HN, UK;
- Correspondence:
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Dundee DD1 4HN, UK;
| | - Kirsty Hill
- School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK;
| | - Tim Newton
- Dental Institute, King’s College, London SE1 1UL, UK;
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK;
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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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Emotional Communication in HIV Care: An Observational Study of Patients' Expressed Emotions and Clinician Response. AIDS Behav 2019; 23:2816-2828. [PMID: 30895426 DOI: 10.1007/s10461-019-02466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.
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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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Yuan S, Humphris G, Ross A, MacPherson L, Zhou Y, Freeman R. A mixed-methods feasibility study protocol to assess the communication behaviours within the dental health professional-parent-child triad in a general dental practice setting. Pilot Feasibility Stud 2018; 4:136. [PMID: 30123526 PMCID: PMC6088393 DOI: 10.1186/s40814-018-0331-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background The promotion of twice yearly application of fluoride varnish (FVA) to the teeth of pre-school children in the dental practice is one component of Scotland’s child oral health improvement programme (Childsmile). Nevertheless, evidence shows that application rates of FVA are variable and below optimal levels. The reasons are complex, with many contextual factors influencing activity. However, we propose that one possible reason may be related to the communication challenges when interacting with younger children. Therefore, the primary aim of the study is to assess the feasibility of conducting a video observational study in primary dental care. The secondary aim is to assess the communication behaviours of dental professionals and those of the parents to predict child cooperation when receiving FVA using this video observational study design. Methods Approximately 50 eligible pairs of parents and child patients aged between 2 years and 5 years from general dental practices will be recruited to participate in the study. The consecutive mixed-method study will consist of two parts. The first part will be cross-sectional observations of the dental health professional-child-parent communication during dental appointments conducted in the general dental practice setting, using video recording. The second part will be a post-observation, semi-structured interview with parents and dental health professionals respectively. This will be implemented to explore their views on the acceptability and feasibility of being observed using video cameras during treatment provision. Discussion The mixed-methods study will allow for directly observing the communication behaviours in the clinical setting and uncovering the views of participating dental health professionals and parents. Therefore, the study will enable us to [i] explore new ways to study the nature of triadic interaction of dental health professional-child-parent, [ii] identify dental health professionals’ effective communication behaviours that promote child patient and parent’s experience of using preventive dental service and [iii] to assess the feasibility of the study through uncovering the views of dental health professionals and parents.
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Affiliation(s)
- Siyang Yuan
- 1Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN UK
| | - Gerry Humphris
- 2Health Psychology, School of Medicine, University of St Andrews, St Andrews, UK
| | - Al Ross
- 3School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Lorna MacPherson
- 3School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Yuefang Zhou
- 2Health Psychology, School of Medicine, University of St Andrews, St Andrews, UK
| | - Ruth Freeman
- 1Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN UK.,4Public Health, NHS Tayside, Dundee, UK
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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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12
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Höglander J, Eklund JH, Eide H, Holmström IK, Sundler AJ. Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care. J Adv Nurs 2017; 73:2923-2932. [PMID: 28586520 DOI: 10.1111/jan.13356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/11/2017] [Accepted: 05/23/2017] [Indexed: 01/12/2023]
Abstract
AIM This study aims to explore nurse assistants' and Registered Nurses' responses to older persons' expressions of emotional needs during home care visits. BACKGROUND Communication is a central aspect of care. Older persons might express different emotions and needs during home care visits and such expressions can be challenging to respond to. Little is known about communication in home care or nursing staff responses to older persons' expressed emotional needs. DESIGN Descriptive, cross-sectional design on nursing staff responses to older persons' negative emotions in home care. METHODS Collected data consisted of audio recordings of home care visits between older persons and nursing staff. Data were collected between August 2014-November 2015. The nursing staff responses to older persons' negative emotions in the communication were analysed with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). RESULTS The nursing staff most often give non-explicit responses, providing space for further disclosure of older persons' expressed negative emotions. Such responses were more frequent if the nursing staff had elicited the older persons' expressions of a negative emotion than if such expressions were elicited by the older persons themselves. Most frequent types of responses were backchannel, active invitation or information advice. CONCLUSION The nursing staff responses were mainly non-explicit responses providing space for older persons to tell more about their experiences. Such responses can be discussed in terms of person-centred communication and is important for the comfort of emotional concerns.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | | | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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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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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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Humphris G, Spyt J, Herbison AG, Kelsey TW. Adult Dental Anxiety: Recent Assessment Approaches and Psychological Management in a Dental Practice Setting. DENTAL UPDATE 2016; 43:388-394. [PMID: 29148691 DOI: 10.12968/denu.2016.43.4.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dental anxiety of patients is a common feature of the everyday experience of dental practice. This article advocates the use of regular assessment of this psychological construct to assist in patient management. Various tools, such as the Modified Dental Anxiety Scale (MDAS), are available to monitor dental anxiety that are quick to complete and easy to interpret. Patient burden is low. A new mobile phone assessment system (DENTANX) is being developed for distribution. This application and other psychological interventions are being investigated to assist patients to receive dental care routinely. Clinical relevance: This article provides evidence and expert opinion on the worth of regular dental anxiety assessment in dental practice using structured tools, such as the Modified Dental Anxiety Scale, and consideration of psychological intervention development.
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Schouten BC, Schinkel S. Emotions in primary care: Are there cultural differences in the expression of cues and concerns? PATIENT EDUCATION AND COUNSELING 2015; 98:1346-1351. [PMID: 26092767 DOI: 10.1016/j.pec.2015.05.018] [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: 03/20/2015] [Revised: 05/12/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. METHODS 82 audiotaped encounters with native-Dutch and 38 with Turkish-Dutch GP patients were coded using the VR-CoDES and VR-CoDES-P. Patients filled out a survey before each consultation to assess their cultural identification, Dutch language proficiency and health-related variables. GPs filled out a survey after each consultation to assess their perceptions of the patient's health complaint. RESULTS Turkish-Dutch patients expressed more cues than native-Dutch patients, which was explained by higher worries about their health and worse perceived general health. GPs responded more often with space-providing responses to Turkish-Dutch patients compared to native-Dutch patients. Turkish-Dutch patients' cue expression strongly influenced GPs' perceptions about the presence of psychosocial problems. CONCLUSION Migrant patient-related factors influence the amount of emotional cue expression in primary care. GPs perceive these cues as indicating the presence of psychosocial problems and provide space for patients to elaborate on their emotional distress. PRACTICE IMPLICATIONS GPs should be trained in using more affective communication techniques to enhance elicitation of the underlying reasons for migrant patients' enhanced emotional cue expression.
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Affiliation(s)
- Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, The Netherlands.
| | - Sanne Schinkel
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, The Netherlands
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Humphris G. Summary of: Understanding emotionally relevant situations in primary dental practice. 2. Reported effects of emotionally charged situations. Br Dent J 2015; 219:448-9. [DOI: 10.1038/sj.bdj.2015.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Harding A, Vernazza CR, Wilson K, Harding J, Girdler NM. What are dental non-attenders' preferences for anxiety management techniques? A cross-sectional study based at a dental access centre. Br Dent J 2015; 218:415-20; discussion 421. [PMID: 25858739 DOI: 10.1038/sj.bdj.2015.249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Dental anxiety is a barrier to attendance. Dental non-attenders may seek emergency care and may prefer to receive anxiety management measures for treatment required. Little is known about the preferences of these dental non-attenders for different anxiety management techniques. Understanding such preferences may inform management pathways, improve experiences, alleviate anxieties and encourage a more regular attendance pattern. As such, the aim of this study was to gain a greater understanding of the dental anxiety of patients attending a dental access centre for emergency dental treatment and to ascertain preferences for different anxiety management techniques. DESIGN Cross-sectional study involving self-completed questionnaires and clinical observation. SETTING NHS Dental Access Centre, York, UK. SUBJECTS AND METHODS Two hundred participants not registered with a general dental practitioner, aged 18 years or over, experiencing pain and self-referred were recruited on a consecutive sampling basis. Participants completed a questionnaire eliciting demographic and dental history details, dental anxiety and preferences for dental anxiety management options. MAIN OUTCOME MEASURES Correlation of the modified dental anxiety scale with preference for different dental anxiety management techniques. RESULTS No significant predictive factors were found that explained preferring local anaesthetic to sedation, or general anaesthesia for restorations or extractions. Those highly anxious were less likely to consider tell-show-do techniques (p=0.001) or watching explanatory videos (p=0.004) to be helpful for overcoming their anxieties than the low or moderate anxiety groups. CONCLUSIONS People attending access centres may represent a group who are unwilling to explore non-pharmacological methods to overcome their anxieties. This supports the need for sedation to provide treatment. Future work may include exploring in more depth the thoughts and opinions of this group of patients to improve understanding of their complex dental attitudes. From this, more effective strategies may be developed to encourage regular dental attendance.
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Affiliation(s)
- A Harding
- Monkgate Dental Department, 31-33 Monkgate, York
| | - C R Vernazza
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle
| | - K Wilson
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle
| | - J Harding
- 1] Department of Social Sciences and Languages, University of Northumbria, Ellison Place, Newcastle [2] Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle
| | - N M Girdler
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle
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Zhou Y, Black R, Freeman R, Herron D, Humphris G, Menzies R, Quinn S, Scott L, Waller A. Applying the Verona coding definitions of emotional sequences (VR-CoDES) in the dental context involving patients with complex communication needs: An exploratory study. PATIENT EDUCATION AND COUNSELING 2014; 97:180-187. [PMID: 25085550 DOI: 10.1016/j.pec.2014.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/01/2014] [Accepted: 07/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The VR-CoDES has been previously applied in the dental context. However, we know little about how dental patients with intellectual disabilities (ID) and complex communication needs express their emotional distress during dental visits. This is the first study explored the applicability of the VR-CoDES to a dental context involving patients with ID. METHODS Fourteen dental consultations were video recorded and coded using the VR-CoDES, assisted with the additional guidelines for the VR-CoDES in a dental context. Both inter- and intra-coder reliabilities were checked on the seven consultations where cues were observed. RESULTS Sixteen cues (eight non-verbal) were identified within seven of the 14 consultations. Twenty responses were observed (12 reducing space) with four multiple responses. Cohen's Kappa were 0.76 (inter-coder) and 0.88 (intra-coder). CONCLUSION With the additional guidelines, cues and responses were reliably identified. Cue expression was exhibited by non-verbal expression of emotion with people with ID in the literature. Further guidance is needed to improve the coding accuracy on multiple providers' responses and to investigate potential impacts of conflicting responses on patients. PRACTICE IMPLICATIONS The findings provided a useful initial step towards an ongoing exploration of how healthcare providers identify and manage emotional distress of patients with ID.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Rolf Black
- School of Computing, University of Dundee, Dundee, UK
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Dundee, UK
| | - Daniel Herron
- School of Computing, University of Dundee, Dundee, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Sandra Quinn
- School of Dentistry, University of Dundee, Dundee, UK
| | - Lesley Scott
- School of Computing, University of Dundee, Dundee, UK
| | - Annalu Waller
- School of Computing, University of Dundee, Dundee, UK
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Schouten BC, Schinkel S. Turkish migrant GP patients' expression of emotional cues and concerns in encounters with and without informal interpreters. PATIENT EDUCATION AND COUNSELING 2014; 97:23-29. [PMID: 25107514 DOI: 10.1016/j.pec.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/26/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to compare patients' expressions of emotional cues and concerns, and GPs' responses during consultations with and without informal interpreters. Furthermore, informal interpreters' expression of emotional cues and concerns and their responses were examined too. METHODS Twenty-two audiotaped medical encounters with Turkish migrant patients, eleven with and eleven without an informal interpreter, were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (VR-CoDES-P). RESULTS In encounters with informal interpreters, patients expressed less emotional concerns than in encounters without informal interpreters. Only half of all patients' cues is being translated by the informal interpreter to the GP. Furthermore, 20% of all cues in encounters with informal interpreters is being expressed by the interpreter, independent of patients' expression of emotions. CONCLUSION The presence of an informal interpreter decreases the amount of patients' expression of emotional concerns and cues. Furthermore, a substantial amount of cues is being expressed by the informal interpreter, corroborating the often-made observation that they are active participants in triadic medical encounters. PRACTICE IMPLICATIONS GPs should be trained in communication strategies that enable elicitation of migrant patients' emotions, in particular in encounters with informal interpreters.
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Affiliation(s)
- Barbara C Schouten
- Department of Communication Science, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sanne Schinkel
- Department of Communication Science, University of Amsterdam, Amsterdam, The Netherlands
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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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