Applying the Verona coding definitions of emotional sequences (VR-CoDES) in the dental context involving patients with complex communication needs: An exploratory study

Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention

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.

'It's like being in a tunnel': Understanding the patient journey from tooth loss to life with removable dentures

INTRODUCTION

The aim of this study was to conceptualise the key stages of the patient journey in the provision of a new denture and examine the factors leading to successful patient-related outcomes.

METHODS

Two partially dentate patient samples were included: (i) Denture wearers - patients who had a denture fitted within the previous five years and (ii) New dentures - patients receiving treatment for a new or replacement denture. The methods involved direct targeted participant observations of the denture fitting process, debriefing interviews and a follow-up focus group exploring the patient journey. Data were analysed through the use of phenomenology and grounded theory.

RESULTS

Interviews were completed with twenty participants of the denture-wearing sample (11 males and nine females, age range 22 to 86 years). Thirteen participants were included in the treatment journey sample in two primary care settings (six males and seven females, age range 55 to 101 years). Tooth loss and recovery was described as being in an 'emotional tunnel' resulting from 'bodyphonic processes' associated with tooth loss. 'Bodyphonia' subsequently became the context for 'taking control' and 'managing disclosure' when living with a removable denture. Different courses through this process can be readily observed, moderated by different variables (i.e., previous experience, working knowledge, a good fit, the treatment alliance, negotiated compromises and bounded responsibility).

CONCLUSIONS

An'integrating framework' that seeks to describe the patient journey from the experience of tooth loss to recovery with a denture is proposed. This framework could be used to aid development of a clinical pathway to guide treatment options.

CLINICAL SIGNIFICANCE

This paper conceptualises the patient journey. It stresses the importance of understanding the stages patients go through and highlights that for the dental team, the try-in stage is perhaps the best stage to give information about the denture and plans for continued care.

Coding the negative emotions of family members and patients among the high-risk preoperative conversations with the Chinese version of VR-CoDES

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.

Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children

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.

Applying Chinese Verona Coding Definitions of Emotional Sequences (VR-CoDES) in ophthalmic consultations: An observational study

OBJECTIVE

Apply Chinese VR-CoDES in ophthalmic setting and describe patients' worries and the doctor's responses. Explore cultural differences in coding.

METHODS

102 audio-taped consultations of 84 patients were coded by Chinese version of VR-CoDES. The intra-class correlation coefficient (ICC) was used to test inter/intra-rater reliability, and inductive content analysis was conducted.

RESULTS

The ICCs of inter-rater reliability for cues/concerns and responses were 0.78 and 0.81, and intra-rater reliability were 0.87 and 0.99, respectively. Cues were more frequent than concerns and elicited often by patients. Explicit Reduce Space (ER) was the most frequent response. Interruptions and the doctor's repetitions were evident. Some expressions were not specified in the coding manual. Patients concerned about treatment effect (22 %), expenses (18 %), risk of operation (14 %), and pain (10 %).

CONCLUSION

The Chinese VR-CoDES can be applied to clinical consultations in China. Ophthalmic patients often expressed cues which were frequently elicited by themselves. The ophthalmologist preferred to give ER response. Interruptions and the ophthalmologist's repetitions were difficult to code. More Chinese expressions should be collected to reduce cultural difference when coding.

PRACTICE IMPLICATION

VR-CoDES will be helpful in doctor-patient communication and medical education. VR-CoDES should undergo cultural adaptions in China.

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

Background

People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD.

Methods

A scoping literature review was conducted focusing on ‘oral health’ and ‘intellectual disability’. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author.

Results

A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services.

Conclusions

A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system-based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.

Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions

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.

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

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.

Adult Dental Anxiety: Recent Assessment Approaches and Psychological Management in a Dental Practice Setting

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.

Practice nurses mental health provide space to patients to discuss unpleasant emotions

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.