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Yasmina K, Valérie SDDA. The content of patients' emotional expressions during follow-up consultations for chronic diseases. Chronic Illn 2024:17423953241241758. [PMID: 38528745 DOI: 10.1177/17423953241241758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES In this article, we seek to extract the themes that patients share when they express negative emotions in the context of follow-up consultation of chronic illness. We are mainly interested in patients with chronic illnesses, as these pathologies have a significant emotional overload leading to a significant deterioration of the patient's quality of life. METHODS Our corpus included audio recordings of 12 chronic disease follow-up consultations conducted by physicians practicing in neurology, nutrition, internal medicine and infectiology. The 12 patients participating suffer from various chronic diseases: Parkinson's, HIV, diabetes, etc. We performed thematic content analyses on the emotional sequences in order to extract the themes underlying these emotional expressions. RESULTS The 10 themes we have extracted are related to physical aspects, psychological aspects, the healthcare system and/or the healthcare provider, prognostic elements, social life, family life, aspects of professional life, issues of daily life, treatments and finally, aspects related to objectives and disease progress. DISCUSSION/CONCLUSION Our results show that follow-up consultations for chronic illnesses are consultations during which patients express emotions for different purposes. These emotional expressions concern particular themes that are not found in other forms of medical consultations. We will compare these results in the discussion part of this article.
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Affiliation(s)
- Kebir Yasmina
- 2LPN (Psychology and Neuroscience Lab, UR7489), Université de Lorraine, Nancy, France
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Smets EMA, Hillen MA, Douma KFL, Stalpers LJA, Koning CCE, de Haes HCJM. Does being informed and feeling informed affect patients' trust in their radiation oncologist? PATIENT EDUCATION AND COUNSELING 2013; 90:330-7. [PMID: 22694893 DOI: 10.1016/j.pec.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE We investigated whether the content of information provided by radiation oncologists and their information giving performance increase patients' trust in them. METHODS Questionnaires were used to assess radiotherapy patients (n=111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance. RESULTS Patients mean trust score was 4.5 (sd=0.77). The more anxious patients were, the less they tended to fully trust their radiation oncologist (p=0.03). Patients' age, gender, educational attainment and anxious disposition together explained 7%; radiation oncologists' information giving (content and performance) explained 3%, and patients' perception of radiation oncologists' information-giving explained an additional 4% of the variance in trust scores. CONCLUSION It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients. PRACTICE IMPLICATIONS It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation oncologists' information giving performance, our data suggest that they can particularly improve their assessments of patients' understanding.
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Affiliation(s)
- Ellen M A Smets
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands.
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Ellington L, Reblin M, Clayton MF, Berry P, Mooney K. Hospice nurse communication with patients with cancer and their family caregivers. J Palliat Med 2012; 15:262-8. [PMID: 22339285 DOI: 10.1089/jpm.2011.0287] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. METHODS The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. RESULTS We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah 84112, USA.
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Guirguis LM. Mixed methods evaluation: pharmacists' experiences and beliefs toward an interactive communication approach to patient interactions. PATIENT EDUCATION AND COUNSELING 2011; 83:432-442. [PMID: 21632196 DOI: 10.1016/j.pec.2011.04.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 04/27/2011] [Accepted: 04/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To characterize pharmacists' experience and explore their beliefs toward an interactive communication technique, the three prime questions (3PQs),where pharmacists ask about patients' understanding of medication's purpose, directions, and monitoring. METHODS Mixed method design. Pharmacists were briefly trained and then integrated the 3PQs into their practice for two weeks. Pharmacists recorded their perceptions of patient interactions, completed a survey addressing self-efficacy and role beliefs toward the 3PQs, and participated in a focus group. RESULTS Eleven pharmacists participated and the 3PQs were used with 176 patients. Most interactions were under 5min. Pharmacists reported that questions about directions and monitoring were most effective in gathering new information with refills whereas medication purpose question was preferred for new fills. The majority of pharmacists were certain they could use the 3PQs and agreed it was their role. Five themes arose from the qualitative analysis: established communication routines, enhanced patient-pharmacist relationships, good medication history, tailoring of the 3PQs, and impact of pharmacy organization. CONCLUSION The 3PQs enabled pharmacists to briefly assess patient medication experiences and tailor education while fostering patient-centered relationships in pharmacy practice. PRACTICE IMPLICATIONS While the 3PQs may enhance pharmacists' patient assessment; integration may challenge pharmacists' work routine.
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Connor M, Fletcher I, Salmon P. The analysis of verbal interaction sequences in dyadic clinical communication: a review of methods. PATIENT EDUCATION AND COUNSELING 2009; 75:169-177. [PMID: 19097842 DOI: 10.1016/j.pec.2008.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 09/30/2008] [Accepted: 10/07/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To identify methods available for sequential analysis of dyadic verbal clinical communication and to review their methodological and conceptual differences. METHODS Critical review, based on literature describing sequential analyses of clinical and other relevant social interaction. RESULTS Dominant approaches are based on analysis of communication according to its precise position in the series of utterances that constitute event-coded dialogue. For practical reasons, methods focus on very short-term processes, typically the influence of one party's speech on what the other says next. Studies of longer-term influences are rare. Some analyses have statistical limitations, particularly in disregarding heterogeneity between consultations, patients or practitioners. Additional techniques, including ones that can use information about timing and duration of speech from interval-coding are becoming available. CONCLUSION There is a danger that constraints of commonly used methods shape research questions and divert researchers from potentially important communication processes including ones that operate over a longer-term than one or two speech turns. Given that no one method can model the complexity of clinical communication, multiple methods, both quantitative and qualitative, are necessary. PRACTICE IMPLICATIONS Broadening the range of methods will allow the current emphasis on exploratory studies to be balanced by tests of hypotheses about clinically important communication processes.
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Affiliation(s)
- Martin Connor
- Division of Clinical Psychology, University of Liverpool, Liverpool L69 3GB, United Kingdom
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Themessl-Huber M, Humphris G, Dowell J, Macgillivray S, Rushmer R, Williams B. Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies. PATIENT EDUCATION AND COUNSELING 2008; 71:157-168. [PMID: 18356003 DOI: 10.1016/j.pec.2008.01.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 01/16/2008] [Accepted: 01/17/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants. METHODS A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search. RESULTS Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour. CONCLUSIONS Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed. PRACTICE IMPLICATIONS Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.
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Affiliation(s)
- Markus Themessl-Huber
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Del Piccolo L, Mazzi MA, Dunn G, Sandri M, Zimmermann C. Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations. Soc Sci Med 2007; 65:2357-70. [PMID: 17868965 DOI: 10.1016/j.socscimed.2007.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Indexed: 11/25/2022]
Abstract
The aims of the study were to explore the importance of macro (patient, physician, consultation) and micro (doctor-patient speech sequences) variables in promoting patient cues (unsolicited new information or expressions of feelings), and to describe the methodological implications related to the study of speech sequences. Patient characteristics, a consultation index of partnership and doctor-patient speech sequences were recorded for 246 primary care consultations in six primary care surgeries in Verona, Italy. Homogeneity and stationarity conditions of speech sequences allowed the creation of a hierarchy of multilevel logit models including micro and macro level variables, with the presence/absence of cues as the dependent variable. We found that emotional distress of the patient increased cues and that cues appeared among other patient expressions and were preceded by physicians' facilitations and handling of emotion. Partnership, in terms of open-ended inquiry, active listening skills and handling of emotion by the physician and active participation by the patient throughout the consultation, reduced cue frequency.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Medicine and Public Health, University of Verona, Italy.
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Abstract
In recent years there has been a growing recognition in Western healthcare systems of the importance of considering preferences of patients and the public in tailoring health services and treatment plans. The active collaboration between doctor and patient has recently been encouraged through the shared decision-making model. Aim of the present contribution is to describe the current state of patient and public participation in healthcare in Italy. First, we will briefly outline the organization of the Italian National Health Service; second, we will describe the governmental and institutional initiatives regarding participation; third, some examples of associations and initiatives promoting patient participation will be provided; forth, we will report on research projects on patient participation published in peer-reviewed journals; and finally, we will provide some examples on training activities promoting patient participation. The Italian National Health Plan and many regional and local health authorities in Italy explicitly recognize the importance of patient/citizen participation in healthcare decisions at the macro, meso and micro level of decision-making. However, application of a shared model is still at an early stage in Italy. The reported experiences have yielded positive results and have shown that particular attention should be dedicated to more disadvantaged subgroups of the population, involving patient organisations, enhancing patient/citizen knowledge and adopting approaches that take the specific context into account.
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Affiliation(s)
- Claudia Goss
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
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Goss C, Fontanesi S, Mazzi MA, Del Piccolo L, Rimondini M, Elwyn G, Zimmermann C. Shared decision making: the reliability of the OPTION scale in Italy. PATIENT EDUCATION AND COUNSELING 2007; 66:296-302. [PMID: 17433603 DOI: 10.1016/j.pec.2007.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 12/22/2006] [Accepted: 01/03/2007] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To provide psychometric characteristics of the Italian language version of the OPTION scale and descriptive statistics on patients' involvement. The OPTION scale assesses the extent to which clinicians involve patients in therapeutic decisions. The English language version has a Cohen's kappa score for individual items ranging from 0.45 to 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77. METHODS Six male GPs provided 235 audiotaped consultations with consecutive patients who had attended for a new illness episode over a 2-month period. Thirty interviews were rated by two raters to assess inter- and intra rater as well as test-retest reliability of the Italian language version of the OPTION scale. Based on the whole sample, Cronbach's alpha and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings. RESULTS Cohen's kappa values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach's alpha 0.82. The ratings for each OPTION item showed a skewed distribution: the majority of scores (>70%) were between 0 (behaviour absent) and 2 (minimum skill level). CONCLUSION The reliability indices were satisfactory and similar to those reported for the original OPTION. PRACTICE IMPLICATIONS OPTION can be used for both teaching purposes and research, as well as for future cross-national comparisons.
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Affiliation(s)
- Claudia Goss
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
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Rimondini M, Del Piccolo L, Goss C, Mazzi M, Paccaloni M, Zimmermann C. Communication skills in psychiatry residents-- how do they handle patient concerns? An application of sequence analysis to interviews with simulated patients. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:161-9. [PMID: 16636631 DOI: 10.1159/000091773] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The main focus of the training of psychiatrists is on diagnosis and treatment based on the traditional doctor-centered approach to the psychiatric interview. Less attention is given to the correct handling of patients' emotional concerns, which is crucial for the patient-physician relationship, but also for improving diagnostic and treatment decisions. The aim of this study is to assess psychiatrists' responses to patients' concerns and worries. METHOD 118 consultations, conducted by 10 residents in psychiatry with 20 simulated patients, have been coded using the Verona Psychiatric Interview Classification System. Lag1 sequential analysis and a multinomial logit regression analysis were performed to investigate the relationship between patients' expressions of concern and psychiatrists' subsequent interventions in terms of patient-centered skills. RESULTS Compared to doctor-centered interventions, all patients' expressions of concern increased the probability of passive listening (odds ratios between 2.4 and 4.2). They also increased the occurrence of emotion focusing interventions (odds ratios between 3.3 and 1.7), which however remained rare (4% of residents' total responses). A small although significant increase in the likelihood of active listening expressions was observed as a response to two types of patient expressions of concern: statements of feelings (odds ratio 1.4) and expression of opinions regarding problematic psychosocial issues (odds ratio of 1.7). CONCLUSIONS Young psychiatrists are good passive listeners but need to improve active listening skills which, together with emotion focusing skills, should be a major learning target in psychiatry. These patient-centered interviewing skills should integrate those traditionally used for attributing ICD-10 and/or DSM-IV categories.
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Affiliation(s)
- Michela Rimondini
- Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
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van Dulmen S, Finset A, Langewitz W, Zimmermann C, Peltenburg M, Visser A, Bensing J. Five years of EACH (European Association for Communication in Healthcare). PATIENT EDUCATION AND COUNSELING 2006; 62:379-84. [PMID: 16859868 DOI: 10.1016/j.pec.2006.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 06/01/2006] [Indexed: 05/11/2023]
Abstract
Five years after launching EACH (European Association for Communication in Healthcare) we look back at what EACH achieved so far and announce new ideas and activities EACH plans to carry out in the near future. During the past five years several scientific, educational as well as societal changes have taken place in the area of communication in healthcare that all underline the need for continued international collaboration in line with the activities employed by EACH so far. Within communication research the focus has shifted from counting communication utterances to unraveling sequences of patient cues and provider responses. In the field of teaching it is becoming more and more common to attend to the training of trainers as well. Within these developments, new areas of interest arise and need attention. To comply with these increasing demands, EACH invites new persons to become a member of one of the recently launched committees in the area of research, teaching and publishing.
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Affiliation(s)
- Sandra van Dulmen
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
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Del Piccolo L, Mead N, Gask L, Mazzi MA, Goss C, Rimondini M, Zimmermann C. The English version of the Verona medical interview classification system (VR-MICS). An assessment of its reliability and a comparative cross-cultural test of its validity. PATIENT EDUCATION AND COUNSELING 2005; 58:252-64. [PMID: 16122640 DOI: 10.1016/j.pec.2005.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Revised: 12/31/2004] [Accepted: 01/04/2005] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). METHOD Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. RESULTS Agreement indices for the division of speech units varied between 88-96 and 87-93% for GP and patient speech, respectively; those for coding categories between 88-91 and 82-86%, with Cohen's Kappa values between 0.86-0.91 and 0.80-0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more 'doctor-centred', while the UK GPs tended to use a more 'sharing' consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. CONCLUSION The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients' verbal behaviours in relation to their emotional state in the two settings. PRACTICE IMPLICATIONS The VR-MICS may be an useful coding instrument to support collaborative research on doctor-patient communication between the two countries.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Italy.
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