Physician eye contact in telemedicine video consultations: A cross-cultural experiment

Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study

Nonverbal communication is essential in physician-patient interaction, especially in telemedicine where verbal cues may be limited. This study aimed to identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations through a Delphi method. A three-round Delphi study was conducted from June to November 2022, involving various experts, including academics, healthcare professionals, AI/telemedicine researchers, industry professionals, and patients. Experts evaluated the importance, validity, and reliability of potential nonverbal cues. Consensus was determined based on median responses and expert scoring percentages, with statistical agreement and stability assessed using Kendall's coefficient of concordance (Kendall's W) and Wilcoxon signed-rank test. Analyses were conducted using SPSS, version 23.0 with significance set at p < 0.05. Of the 72 experts invited, 37 (51%) agreed to participate, with 35 completing the first round (95% completion rate). Eight significant nonverbal cues were identified in the first round, though one did not reach consensus. The second round obtained an 89% response rate (31/35), with three new cues introduced; one did not reach consensus. Round 3 achieved a 94% response rate (29/31), finalizing nine key cues: facial expression, eye contact, tone of voice, smiling, head nodding, body posture, hand gesture, distance, and environmental cues. Among these, facial expression, eye contact, and tone of voice were identified as the most crucial. Inter-expert agreement was statistically significant across all items with strong agreement on the importance (W = 0.739, p < 0.001), good agreement on their validity (W = 0.689, p < 0.001), and moderate agreement on their reliability (W = 0.452, p < 0.001). This study highlights the importance of specific nonverbal cues in telemedicine, particularly facial expression, eye contact, and tone of voice. It provides a validated foundation for developing tools to enhance physician-patient interactions and potentially improve health outcomes in telemedicine.

Nonverbal behavior in telehealth visits: A narrative review

OBJECTIVES

To synthesize findings from research examining nonverbal behavior (NVB) in telehealth. Use of telehealth has increased substantially in recent years-thus, it is critical to identify nonverbal strategies that facilitate positive patient-provider communication in this context.

METHODS

Four peer-reviewed databases were searched: PubMed, PsycINFO, CINAHL, and EMBASE. Following a review of abstracts and full texts by the first author, 50 studies met inclusion criteria.

RESULTS

The role of six NVBs- gaze, facial expression, gesture, head movement, proxemics, and posture- has been examined in the context of telehealth. Most included studies assessed patients' and providers' perspectives of NVB in telehealth. There was a lack of research examining nonverbal behaviors, and their associations with patient-centered outcomes, in naturalistic clinical settings.

CONCLUSIONS

While this review identified some promising nonverbal strategies to facilitate patient-provider rapport in telehealth, there is a need for future research that objectively measures NVBs and examines relationships between these behaviors and patient-centered outcomes.

PRACTICE IMPLICATIONS

Potential strategies for providers to enhance quality of communication in telehealth include gazing at the camera (vs. the screen), mirroring patients' facial expressions and head movements, leaning forward, and exaggerating gestures and facial expressions.

Establishing trust in emergency telehealth consultations

Over recent years, emergency telehealth has developed rapidly in Australasia. From the patient's perspective, establishing trust with a healthcare provider is uniquely challenging when using the audio and video modalities commonly used in telehealth. It is crucial to consider how we may improve the delivery of care through this emerging pathway if high-quality care is to be delivered. Several simple techniques have been identified in the literature and can be employed to create trust and improve the patient-provider relationship. These include ensuring privacy and an appropriate setting for the consultation; considering how eye contact and expressions are best used; providing alternative options to telehealth; and clearly identifying names, roles and qualifications. We describe how these methods can best be employed in the virtual emergency care setting.

Challenges and recommendations in the implementation of audiovisual telemedicine communication: a systematic review

This systematic review aims to identify the elements of doctor-patient communication in telemedicine, emerging challenges, and proposed recommendations. Four databases, including Science Direct, PubMed, Cochrane, and ProQuest, were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria consisted of original research papers, availability of free full text, and publications during the past 10 years. A total of 13 articles completed the selection process and satisfied the established criteria. The issues and recommendations of telemedicine communication were categorized into three distinct groups: pre-consultation, during-consultation, and post-consultation. Preparation encompasses the arranging of visual elements, safeguarding patient privacy and confidentiality, and addressing any technical challenges that may arise. The consultation encompasses nonverbal behavior, empathy, the doctor-patient connection, and a physical examination. Post-telemedicine consultations refer to medical appointments that occur after a telemedicine session, typically involving follow-up medical interactions. Telemedicine presents unique challenges in doctor-patient consultations that differ from face-to-face interactions. Therefore, clinicians must acquire communication skills specific to telemedicine to ensure effective consultations and achieve optimal health results.

Factors Associated with College Students' Attitudes Toward Telehealth for Primary Care

Introduction: Establishing routine primary care visits helps to prevent serious health issues. College students are less likely than the general population to have a regular primary care provider and engage in routine health visits. Recent research provides evidence that telehealth is a convenient alternative to in-person primary care and that college students are comfortable using this technology, suggesting that telehealth has the potential to mitigate this disparity. As attitudes toward telehealth are one critical precursor to behavioral intention and actual utilization of telehealth, the goal of this study was to investigate which factors predict positive or negative attitudes toward telehealth. Methods: Data for this study were collected from a sample of 621 college students at a large southeastern university between September 19, 2022 and December 19, 2022. Results: The study found that college students who reported more trust in physicians, less medical mistrust, and less discrimination in health care settings reported more positive attitudes toward telehealth. Conclusions: These findings suggest that health care providers' skills in delivering patient-centered culturally informed care and building trust and rapport with patients might promote more positive attitudes toward telehealth and, potentially, greater overall utilization of health care services (including both telehealth and in-person services) among college students. This study lays the foundation for future research to examine psychological mechanisms underlying individuals' utilization of telehealth.

Off-camera gaze decreases evaluation scores in a simulated online job interview

During the pandemic, digital communication became paramount. Due to the discrepancy between the placement of the camera and the screen in typical smartphones, tablets and laptops, mutual eye contact cannot be made in standard video communication. Although the positive effect of eye contact in traditional communication has been well-documented, its role in virtual contexts remains less explored. In this study, we conducted experiments to gauge the impact of gaze direction during a simulated online job interview. Twelve university students were recruited as interviewees. The interview consisted of two recording sessions where they delivered the same prepared speech: in the first session, they faced the camera, and in the second, they directed their gaze towards the screen. Based on the recorded videos, we created three stimuli: one where the interviewee's gaze was directed at the camera (CAM), one where the interviewee's gaze was skewed downward (SKW), and a voice-only stimulus without camera recordings (VO). Thirty-eight full-time workers participated in the study and evaluated the stimuli. The results revealed that the SKW condition garnered significantly less favorable evaluations than the CAM condition and the VO condition. Moreover, a secondary analysis indicated a potential gender bias in evaluations: the female evaluators evaluated the interviewees of SKW condition more harshly than the male evaluators did, and the difference in some evaluation criteria between the CAM and SKW conditions was larger for the female interviewees than for the male interviewees. Our findings emphasize the significance of gaze direction and potential gender biases in online interactions.

Patient and Clinician Satisfaction in Teledermatology: Key Factors for Successful Implementation

Purpose of review

Teledermatology has emerged as a promising solution for remote dermatologic care, especially during COVID-19 pandemic. It improves access to care through information and communication technologies. This paper explores patient and clinician satisfaction in teledermatology.

Recent findings

Patient satisfaction encompasses various aspects, including future willingness, the quality of care, technical quality, and access to care. Clinician satisfaction is influenced by quality of care, implementation, technical aspects, clinician-patient rapport, and financial considerations. It is important to evaluate patient and clinician satisfaction in different teledermatology models, including store-and-forward, live interactive, and hybrid interactive approaches.

Summary

By evaluating satisfaction within different teledermatology models and addressing the factors that impact satisfaction, teledermatology can ensure high-quality care and promote positive outcomes. With proper implementation and ongoing evaluation, teledermatology has the potential to become a widely accepted and valuable component of dermatologic care, offering enhanced access to specialized services.

Patients preferences for communication during video consultations

Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.

Experiences with the quality of telemedical care in an offshore setting - a qualitative study

BACKGROUND

The evaluation and the improvement of the quality of telemedical care become increasingly important in times where this type of care is offered to a broad number of patients more and more. As telemedical care in an offshore setting has already been in use for decades, analyzing the extensive experience of offshore paramedics using telemedical care can help identify determinants of quality. Therefore, the aim of this study was to explore determinants of the quality of telemedical care using the experiences of experienced offshore paramedics.

METHODS

We conducted a qualitative analysis of 22 semi-structured interviews with experienced offshore paramedics. The results were categorized in a hierarchical category system using content analysis as described by Mayring.

RESULTS

All 22 participants were males, having a mean of 3.9 years of experience working with telemedicine support offshore. Generally, participants stated that for them telemedical interaction did not differ much from personal interaction. However, the offshore paramedics personality and way to communicate were mentioned to impact the quality of telemedical care as it influenced the way cases were presented. Furthermore, interviewees described it to be impossible to use telemedicine in cases of an emergency as it was too time-consuming, technically too complex, and lead to cognitive overload as other tasks with higher priority needed their attention. Three determinants of a successful consultation were mentioned: low levels of complexity in the reason for consultation, telemedical guidance training for the teleconsultant physician and for the delegatee.

CONCLUSION

Appropriate indications for telemedical consultation, communication training of consultation partners, and the impact of personality need to be addressed to enhance the quality of future telemedical care.

Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction

Objective

Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations.

Methods

A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed.

Results

Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication.

Conclusions

Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.

The influence of active listening on parents' perceptions of clinical empathy in a stuttering assessment: A preliminary study

PURPOSE

The primary purpose of this preliminary study was to explore whether a clinician's use of active listening skills (i.e., client-directed eye gaze and paraphrasing) influenced parents' perceptions of clinical empathy in a stuttering assessment. A secondary purpose was to determine whether parent age, education, or parent concern predicted perceived clinical empathy.

METHOD

Participants (n = 51 parents/guardians of children who stutter) watched two counter-balanced videos of a clinician demonstrating either high or low frequency use of active listening skills during the clinician's initial assessment with a standardized patient actor portraying a parent of a child who stutters. After each video, parents rated the clinician's empathy and active listening skills via the Jefferson Scale of Physician Empathy for Observers (JSPEO; Hojat et al., 2017) and the Counselor Activity Self-Efficacy Scales - Modified (Victorino & Hinkle, 2018). Participants then completed a demographic questionnaire and rated their concern about their child's stuttering.

RESULTS

Paired t-tests demonstrated significantly higher ratings of perceived clinical empathy in the high frequency active listening condition compared to the low frequency condition (d = 0.548). Simple linear regression analyses indicated parent age or level of education did not predict perceived clinical empathy. An independent samples t-test indicated that parent concern about stuttering did not predict perceived clinical empathy.

CONCLUSIONS

Preliminary findings suggest that the clinician was viewed as significantly more understanding, concerned, and caring (i.e., perceived as empathic) when active listening skills were used. Parents' ratings of empathy on the JSPEO, based on high levels of active listening by the clinician, were not associated with parents' ages, education levels, or concern about their children's stuttering. This may reflect the value of active listening in clinical relationships regardless of variables specific to the recipient (e.g., parent of a child who stutters). Given that parents are more apt to share thoughts and emotions about their child's communication with clinicians who demonstrate empathic qualities, this preliminary study suggests that the use of active listening skills warrant emphasis in clinical training.