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MacGillivray F, Bard AM, Cobb KA, Corah L, Reyher KK, Green MJ, Wapenaar W. Communicating without words: Measuring nonverbal communication between veterinarians and farmers during routine herd health consultations. J Dairy Sci 2023:S0022-0302(23)00287-4. [PMID: 37268581 DOI: 10.3168/jds.2022-22479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 06/04/2023]
Abstract
Uptake of advice and the ability to facilitate change on-farm are key elements for successful veterinary practice. However, having the necessary clinical skills and knowledge is not enough to achieve this: effective communication skills are essential for veterinarians to realize their advisory role by exploring and understanding the farmer's worldview. Research of verbal aspects of veterinarian communication supports the use of a relationship-centered communication style; we next need to study how veterinarian-farmer nonverbal communication (NVC) can influence interactions and their outcomes, which has been examined in medical and companion animal practice. In this study, we considered which aspects of NVC should be measured, and how, to provide an essential first step toward understanding the significance of NVC for veterinarians working in dairy practice, which should be of interest to researchers, veterinary educators, and practitioners. Eleven video recordings of routine consultations in the UK were analyzed for farmer and veterinarian NVC. The NVC attributes with established links to positive patient and client outcomes from medical and social science studies were chosen, and a methodology developed for their measurement, by adapting measures typically used in NVC research. Each consultation was segmented into intervals defined by the main activity and location on farm: introduction, fertility examination, discussion, and closing. This approach allowed us to analyze the content more consistently, establish which aspects of NVC featured within each interval, and whether the activity and location influenced the observed NVC. We measured 12 NVC attributes, including body orientation, interpersonal distance, head position, and body lean, which have been shown to influence empathy, rapport, and trust: key components of relationship-centered communication. Future research should seek to establish the significance of NVC in effective communication between veterinarian and farmer, building on our findings that show it is possible to measure nonverbal attributes. Veterinarians may benefit from becoming skilled nonverbal communicators and have more effective conversations during routine consultations, motivating farmers to make changes and improve herd health.
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Affiliation(s)
- F MacGillivray
- MacVet Cattle Communications Limited, Knutsford, United Kingdom WA16 9EE.
| | - A M Bard
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom SY23 3DA
| | - K A Cobb
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, United Kingdom LE12 5RD
| | - L Corah
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, United Kingdom LE12 5RD
| | - K K Reyher
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom BS40 5DU
| | - M J Green
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, United Kingdom LE12 5RD
| | - W Wapenaar
- Elanco Animal Health, 40789 Monheim am Rhein, Germany
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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3
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Van den Bossche C, Wolf D, Rekittke LM, Mittelberg I, Mathiak K. Judgmental perception of co-speech gestures in MDD. J Affect Disord 2021; 291:46-56. [PMID: 34023747 DOI: 10.1016/j.jad.2021.04.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/06/2021] [Accepted: 04/25/2021] [Indexed: 01/10/2023]
Abstract
Cognitive bias in depression may increase sensitivity to judgmental appraisal of communicative cues. Nonverbal communication encompassing co-speech gestures is crucial for social functioning and is perceived differentially by men and women, however, little is known about the effect of depression on the perception of appraisal. We investigate if a cognitive bias influences the perception of appraisal and judgement of nonverbal communication in major depressive disorder (MDD). During watching videos of speakers retelling a story and gesticulating, 22 patients with MDD and 22 matched healthy controls pressed a button when they perceived the speaker as appraising in a positive or negative way. The speakers were presented in four different conditions (with and without speech and with natural speaker or as stick-figures) to evaluate context effects. Inter-subject covariance (ISC) of the button-press time series measured consistency across the groups of the response pattern depending on the factors diagnosis and gender. Significant effects emerged for the factors diagnosis (p = .002), gender (p = .007), and their interaction (p < .001). The female healthy controls perceived the gestures more consistently appraising than male controls, the female patients, and male patients whereas the latter three groups did not differ. Further, the ISC measure for consistency correlated negatively with depression severity. The natural speaker video without audio speech yielded the highest responses consistency. Indeed co-speech gestures may drive these ISC effects because number of gestures but not facial shrugs correlated with ISC amplitude. During co-speech gestures, a cognitive bias led to disturbed perception of appraisal in MDD for females. Social communication is critical for functional outcomes in mental disorders; thus perception of gestural communication is important in rehabilitation.
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Affiliation(s)
| | - Dhana Wolf
- Dept. Psychiatry, Psychosomatik and Psychosomatics, RWTH Aachen University
| | | | - Irene Mittelberg
- Dept. Linguistics and Cognitive Semiotics, RWTH Aachen University
| | - Klaus Mathiak
- Dept. Psychiatry, Psychosomatik and Psychosomatics, RWTH Aachen University; Translational Brain Research, Jülich Aachen Research Alliance.
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Impact of hearing loss on clinical interactions between older adults and health professionals: a systematic review. Eur Geriatr Med 2020; 11:919-928. [DOI: 10.1007/s41999-020-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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Gol JM, Rosmalen JGM, Gans ROB, Voshaar RCO. The importance of contextual aspects in the care for patients with functional somatic symptoms. Med Hypotheses 2020; 142:109731. [PMID: 32335457 DOI: 10.1016/j.mehy.2020.109731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/30/2022]
Abstract
Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit. We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioural environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organized office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician's competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behaviour and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms.
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Affiliation(s)
- J M Gol
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands.
| | - J G M Rosmalen
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R O B Gans
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R C Oude Voshaar
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
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Hagiwara N, Elston Lafata J, Mezuk B, Vrana SR, Fetters MD. Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: Challenges, solutions, and future directions for provider communication training. PATIENT EDUCATION AND COUNSELING 2019; 102:1738-1743. [PMID: 31036330 PMCID: PMC7269129 DOI: 10.1016/j.pec.2019.04.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/02/2019] [Accepted: 04/19/2019] [Indexed: 05/16/2023]
Abstract
Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic minority patients. This suggests provider implicit racial bias likely manifests through their communication behaviors, which in turn may offer a means of addressing racial disparities in healthcare and ultimately in health. However, identifying provider communication behaviors that mediate the links between provider implicit racial bias and patient outcomes is challenging. In this paper, we argue that identifying these provider communication behaviors requires (1) taking into account findings from social psychology research of implicit racial bias and (2) incorporating the perspectives of racial/ethnic minority patients into patient-provider communication research. We discuss the utility of mixed methods research designs as a framework for resolving this complex scientific question. Research that draws on social psychology research of implicit racial bias and incorporates the racial/ethnic minority patient perspectives can inform the development of communication skills training programs for students and residents in various healthcare fields. Such programs are one element of a broader effort to reduce racial/ethnic disparities in healthcare.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, USA.
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, Chapel Hill, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Scott R Vrana
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
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Osuna E, Pérez-Carrión A, Pérez-Cárceles MD, Machado F. Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process. J Public Health Res 2018; 7:1445. [PMID: 30687676 PMCID: PMC6321946 DOI: 10.4081/jphr.2018.1445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022] Open
Abstract
The information process is considered a core element in decision- making and an obligatory matter of concern for the health professional. Rather than information per se, we should perhaps mention the need for communication between the health professional and the patient, which should be appropriate to each specific case and situation. Interaction and communication during the relationship generates a degree of trust that contributes to improving care quality and health-related results. The aim of this study is to know the perception of professionals on the quality of communication and its impact on the decision-making process of the patient and the degree of involvement of health professionals in the process of communication with the patient. A sample of 2186 health professionals (1578 nurses, 586 physicians, and 22 pharmacists) was studied. A questionnaire composed of 20 items dealing with the process of communication with the patient and obtaining informed consent was administered. Our study revealed the high consideration that professionals hold of their communication skills with patients since almost 80% of those surveyed, think they are sufficiently skilled in this area. Professionals refers that nurses are most skilled at communicating with patients. Communication in the clinical relationship must not only serve as a way for the professional to obtain information from the patient on their pathology, but also as a means to inform patients so that they understand their illness. Patients also like to feel that they are being listened to and are co-participants in the care process. Communication should be a continuous object of study for all health professionals, both in primary and specialised attention.
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Affiliation(s)
- Eduardo Osuna
- Department of Forensic Medicine, School of Medicine, University of Murcia
| | | | | | - Francisco Machado
- University Hospital Reina Sofía, School of Medicine, University of Murcia, Spain
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Blanch-Hartigan D, Ruben MA, Hall JA, Schmid Mast M. Measuring nonverbal behavior in clinical interactions: A pragmatic guide. PATIENT EDUCATION AND COUNSELING 2018; 101:2209-2218. [PMID: 30146408 DOI: 10.1016/j.pec.2018.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Understanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors. METHODS Based on our experience conducting nonverbal behavior research in clinical interactions, we developed practical advice and strategies for coding nonverbal behavior in clinical communication, including a checklist of questions to consider for any nonverbal coding project. RESULTS We provide suggestions for beginning the nonverbal coding process, operationalizing the coding approach, and conducting the coding. CONCLUSION A key to decision-making around nonverbal behavior coding is establishing clear research questions and using these to guide the process. PRACTICE IMPLICATIONS The field needs more coding of nonverbal behavior to better describe what happens in clinical interactions, to understand why nonverbal behaviors occur, and to determine the predictors and consequences of nonverbal behaviors in clinical interactions. A larger evidence base can inform better teaching practices and communication interventions.
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Affiliation(s)
| | - Mollie A Ruben
- Department of Psychology, University of Maine, Orono, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, USA
| | - Judith A Hall
- Department of Psychology, Northeastern University, Boston, USA
| | - Marianne Schmid Mast
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland
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Gorawara-Bhat R, Hafskjold L, Gulbrandsen P, Eide H. Exploring physicians' verbal and nonverbal responses to cues/concerns: Learning from incongruent communication. PATIENT EDUCATION AND COUNSELING 2017; 100:1979-1989. [PMID: 28698034 DOI: 10.1016/j.pec.2017.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/22/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Explore physicians' verbal and nonverbal responses to cues/concerns in consultations with older-patients. METHODS Two teams independently coded a sample of Norwegian consultations (n=24) on verbal and nonverbal dimensions of communication using VR-CoDES and NDEPT instruments. Consultations exploring older-patients' verbal emotional expressions were labeled 'Acknowledging of patients' emotional expressions', and 'Distancing from patients' emotional expressions.' Based on type and extent of nonverbal expressiveness, consultations were labeled 'Affective' and 'Prescriptive.' Congruency of verbal and nonverbal communication was assessed and categorized into four types. Incongruent consultations were qualitatively analyzed. RESULTS Types 1 and 2 consultations were described as 'Congruent,' i.e. both verbal and nonverbal behaviors facilitate or inhibit emotional expressions. Types 3 and 4 were considered 'Incongruent,' i.e. verbal inhibits, but nonverbal facilitates emotional expressions or vice versa. Type 3 incongruent encounters occurred most often when it was challenging to meet patients' needs. CONCLUSIONS Frequently physicians' display incongruent behavior in challenging situations. Older patients' may perceive this as either alleviating or increasing distress, depending on their needs. PRACTICE IMPLICATIONS Type 3 consultations may shed light on reasons for physicians' incongruent behavior; therefore, independent measurement and analyses of verbal and nonverbal communication are recommended. Older-patients' perceptions of incongruent communication should be further explored.
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Affiliation(s)
| | - L Hafskjold
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University College of Southeast-Norway, Drammen, Norway
| | - P Gulbrandsen
- University of Oslo, Oslo, Norway; Akershus University Hospital, Norway
| | - H Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University College of Southeast-Norway, Drammen, Norway
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Elliott AM, Alexander SC, Mescher CA, Mohan D, Barnato AE. Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life. J Pain Symptom Manage 2016; 51:1-8. [PMID: 26297851 PMCID: PMC4698224 DOI: 10.1016/j.jpainsymman.2015.07.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 11/17/2022]
Abstract
CONTEXT Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon. OBJECTIVES To test whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates. METHODS We conducted a randomized factorial trial of the relationship between patient race and physician communication using high-fidelity simulation. Using a combination of probabilistic and convenience sampling, we recruited 33 hospital-based physicians in western Pennsylvania who completed two encounters with prognostically similar, critically and terminally ill black and white elders with identical treatment preferences. We then conducted detailed content analysis of audio and video recordings of the encounters, coding verbal emotion-handling and shared decision-making behaviors, and nonverbal behaviors (time interacting with the patient and/or surrogate, with open vs. closed posture, and touching the patient and physical proximity). We used a paired t-test to compare each subjects' summed verbal and nonverbal communication scores with the black patient compared to the white patient. RESULTS Subject physicians' verbal communication scores did not differ by patient race (black vs. white: 8.4 vs. 8.4, P-value = 0.958). However, their nonverbal communication scores were significantly lower with the black patient than with the white patient (black vs. white: 2.7 vs. 2.9, P-value 0.014). CONCLUSION In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients.
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Affiliation(s)
- Andrea M Elliott
- Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stewart C Alexander
- Department of Consumer Sciences, College of Health and Human Science, Purdue University, West Lafayette, Indiana, USA
| | - Craig A Mescher
- Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deepika Mohan
- Department of Critical Care Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber E Barnato
- Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Center for Research on Health Care, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Gorawara-Bhat R. Importance of nonverbal communication in medical error disclosures. PATIENT EDUCATION AND COUNSELING 2014; 94:289-290. [PMID: 24534619 DOI: 10.1016/j.pec.2014.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Rita Gorawara-Bhat
- The University of Chicago, Department of Medicine, Section of Geriatrics and Palliative Medicine, Chicago, USA.
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Montague E, Asan O. Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention. Int J Med Inform 2013; 83:225-34. [PMID: 24380671 DOI: 10.1016/j.ijmedinf.2013.11.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 09/27/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. BACKGROUND Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. METHODS A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. RESULTS Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. CONCLUSION This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology.
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Affiliation(s)
- Enid Montague
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Onur Asan
- Industrial and System Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Abstract
This exploratory study examined patterns of nonverbal accommodation within health care interactions and investigated the impact of communication skills training and gender concordance on nonverbal accommodation behavior. The Nonverbal Accommodation Analysis System (NAAS) was used to code the nonverbal behavior of physicians and patients within 45 oncology consultations. Cases were then placed in one of seven categories based on patterns of accommodation observed across the interaction. Results indicated that across all NAAS behavior categories, physician-patient interactions were most frequently categorized as joint convergence, followed closely by asymmetrical-patient convergence. Among paraverbal behaviors, talk time, interruption, and pausing were most frequently characterized by joint convergence. Among nonverbal behaviors, eye contact, laughing, and gesturing were most frequently categorized as asymmetrical-physician convergence. Differences were predominantly nonsignificant in terms of accommodation behavior between pre- and post-communication skills training interactions. Only gesturing proved significant, with post-communication skills training interactions more likely to be categorized as joint convergence or asymmetrical-physician convergence. No differences in accommodation were noted between gender-concordant and nonconcordant interactions. The importance of accommodation behavior in health care communication is considered from a patient-centered care perspective.
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Affiliation(s)
- Thomas A D'Agostino
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan-Kettering Cancer Center
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Gorawara-Bhat R, Dethmers DL, Cook MA. Physician eye contact and elder patient perceptions of understanding and adherence. PATIENT EDUCATION AND COUNSELING 2013; 92:375-380. [PMID: 23537851 DOI: 10.1016/j.pec.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/23/2013] [Accepted: 03/02/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To Examine physician eye contact (EC), patient understanding and adherence. METHODS Secondary analysis of National Institute of Aging videotapes (N=52) of physician-elder patients in two visit types: (1) routine (n=20); (2) anxiety-provoking (n=32) was conducted. Self-reports of understanding and adherence were used. History-taking segments were qualitatively and quantitatively analyzed for relationships between EC, understanding and adherence. RESULTS Qualitative analysis showed: (1) two salient EC elements--frequency, type (brief or sustained)--and verbal synchronicity were commonly invoked; (2) conjoint unfolding of three communication elements--"looking, listening and talking"--may be salient for patient outcomes; (3) despite differing EC patterns in routine and anxiety provoking visits, statistical analyses showed patient understanding and adherence ratings were similar in the sample population comprising two visit types; no significant correlations between EC elements and understanding and adherence were found. CONCLUSIONS Salience of EC for patient-centered communication is shown in prior research. Present findings broaden the significance of EC by including verbal synchronicity. Methodological limitations may account for no significant correlations between EC and patient outcomes. PRACTICE IMPLICATIONS Using suggested framework for operationalizing EC elements, including verbally synchronous communication, may facilitate patient-centeredness and have positive implications for patient understanding and adherence.
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Affiliation(s)
- Rita Gorawara-Bhat
- The University of Chicago, Department of Medicine, Section of Geriatrics and Palliative Medicine, Chicago, IL 60637-1470, USA.
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Non-verbal communication between primary care physicians and older patients: how does race matter? J Gen Intern Med 2012; 27:576-81. [PMID: 22143454 PMCID: PMC3326104 DOI: 10.1007/s11606-011-1934-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/27/2011] [Accepted: 11/01/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Non-verbal communication is an important aspect of the diagnostic and therapeutic process, especially with older patients. It is unknown how non-verbal communication varies with physician and patient race. OBJECTIVE To examine the joint influence of physician race and patient race on non-verbal communication displayed by primary care physicians during medical interviews with patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS Video-recordings of visits of 209 patients 65 years old or older to 30 primary care physicians at three clinics located in the Midwest and Southwest. MAIN MEASURES Duration of physicians' open body position, eye contact, smile, and non-task touch, coded using an adaption of the Nonverbal Communication in Doctor-Elderly Patient Transactions form. KEY RESULTS African American physicians with African American patients used more open body position, smile, and touch, compared to the average across other dyads (adjusted mean difference for open body position = 16.55, p < 0.001; smile = 2.35, p = 0.048; touch = 1.33, p < 0.001). African American physicians with white patients spent less time in open body position compared to the average across other dyads, but they also used more smile and eye gaze (adjusted mean difference for open body position = 27.25, p < 0.001; smile = 3.16, p = 0.005; eye gaze = 17.05, p < 0.001). There were no differences between white physicians' behavior toward African American vs. white patients. CONCLUSION Race plays a role in physicians' non-verbal communication with older patients. Its influence is best understood when physician race and patient race are considered jointly.
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Pawlikowska T, Zhang W, Griffiths F, van Dalen J, van der Vleuten C. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement. PATIENT EDUCATION AND COUNSELING 2012; 86:70-76. [PMID: 21621365 DOI: 10.1016/j.pec.2011.04.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 03/29/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). METHODS We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations. RESULTS Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior. CONCLUSION For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations. PRACTICE IMPLICATIONS To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas.
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D'Agostino TA, Bylund CL. The Nonverbal Accommodation Analysis System (NAAS): initial application and evaluation. PATIENT EDUCATION AND COUNSELING 2011; 85:33-39. [PMID: 20851559 PMCID: PMC4801112 DOI: 10.1016/j.pec.2010.07.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 07/21/2010] [Accepted: 07/29/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe the development, initial application, and evaluation of the Nonverbal Accommodation Analysis System (NAAS). Grounded in Communication Accommodation Theory, this coding system provides a method for analyzing physician and patient nonverbal accommodation behaviors within medical consultations. METHODS Video recordings of 45 new visit consultations at a comprehensive cancer center were coded using the NAAS. Inter-rater and intra-rater reliability were assessed. For validation purposes, two independent coders rated all consultations for theoretically related constructs. RESULTS The NAAS demonstrated high levels of reliability. Statistically significant correlations were observed across all 10 behavior categories for both inter-rater and intra-rater reliability. Evidence of content and construct validity was also observed. CONCLUSION The current study presents the initial application and evaluation of a coding system meant for analysis of the nonverbal behavior of physicians and patients within medical consultations. The results of this initial trial and psychometric evaluation provide evidence of the NAAS as a valid and reliable nonverbal accommodation coding system. PRACTICE IMPLICATIONS The NAAS enables researchers to investigate the way in which physicians and patients manage social distance through nonverbal behavior within medical interactions from a theoretically-informed perspective. Such efforts can aid in the development of communication skill interventions.
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Collins LG, Schrimmer A, Diamond J, Burke J. Evaluating verbal and non-verbal communication skills, in an ethnogeriatric OSCE. PATIENT EDUCATION AND COUNSELING 2011; 83:158-162. [PMID: 20561763 DOI: 10.1016/j.pec.2010.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 04/30/2010] [Accepted: 05/15/2010] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Communication during medical interviews plays a large role in patient adherence, satisfaction with care, and health outcomes. Both verbal and non-verbal communication (NVC) skills are central to the development of rapport between patients and healthcare professionals. The purpose of this study was to assess the role of non-verbal and verbal communication skills on evaluations by standardized patients during an ethnogeriatric Objective Structured Clinical Examination (OSCE). METHODS Interviews from 19 medical students, residents, and fellows in an ethnogeriatric OSCE were analyzed. Each interview was videotaped and evaluated on a 14 item verbal and an 8 item non-verbal communication checklist. The relationship between verbal and non-verbal communication skills on interview evaluations by standardized patients were examined using correlational analyses. RESULTS Maintaining adequate facial expression (FE), using affirmative gestures (AG), and limiting both unpurposive movements (UM) and hand gestures (HG) had a significant positive effect on perception of interview quality during this OSCE. Non-verbal communication skills played a role in perception of overall interview quality as well as perception of culturally competent communication. CONCLUSION Incorporating formative and summative evaluation of both verbal and non-verbal communication skills may be a critical component of curricular innovations in ethnogeriatrics, such as the OSCE.
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Affiliation(s)
- Lauren G Collins
- Division of Geriatric Medicine, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Gorawara-Bhat R, Cook MA. Eye contact in patient-centered communication. PATIENT EDUCATION AND COUNSELING 2011; 82:442-447. [PMID: 21211926 DOI: 10.1016/j.pec.2010.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To understand the relationship between eye contact and patient-centered communication (PC) in physician-elder patient interactions. METHODS Two instruments-Patient-centered Behavior Coding Instrument (PBCI) and Eurocommunication Global Ratings Scale-were used to measure PC in 22 National Institute of Aging videotapes. Eye contact was measured using a refined eye contact scale in NDEPT. Qualitative observational techniques were used to understand how eye contact can implicate communication. RESULTS 'High' eye contact tapes were found to be 'high' in PC using both instruments. However, the majority of 'low' tapes were also found to be 'high' in PC. Physicians' behavior distinctly differed in two ways: (1) high tapes were characterized by more 'sustained' eye contact episodes; low tapes consisted of a greater number of 'brief' episodes; (2) brief episode tapes showed a greater focus on 'charts', i.e. 'listening' was bereft of 'looking'; sustained episodes showed a focus on 'patients', i.e. 'listening' was accompanied by 'looking' indicating patient-centered communication. CONCLUSIONS A comprehensive understanding of elder patient-physician interaction needs to include both-'listening' and 'looking'-components of patient-centered communication. PRACTICE IMPLICATIONS Eye contact serves as a salient factor in the expression of PC, making it imperative to incorporate as a nonverbal dimension in PC instruments.
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Affiliation(s)
- Rita Gorawara-Bhat
- The University of Chicago, Department of Medicine, Chicago, IL 60637, USA.
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Abstract
BACKGROUND During doctor-patient interactions, many messages are transmitted without words, through non-verbal communication. AIM To elucidate the types of non-verbal behaviours perceived by patients interacting with family GPs and to determine which cues are perceived most frequently. DESIGN OF STUDY In-depth interviews with patients of family GPs. SETTING Nine family practices in different regions of Poland. METHOD At each practice site, interviews were performed with four patients who were scheduled consecutively to see their family doctor. RESULTS Twenty-four of 36 studied patients spontaneously perceived non-verbal behaviours of the family GP during patient-doctor encounters. They reported a total of 48 non-verbal cues. The most frequent features were tone of voice, eye contact, and facial expressions. Less frequent were examination room characteristics, touch, interpersonal distance, GP clothing, gestures, and posture. CONCLUSION Non-verbal communication is an important factor by which patients spontaneously describe and evaluate their interactions with a GP. Family GPs should be trained to better understand and monitor their own non-verbal behaviours towards patients.
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Physician Gender Affects How Physician Nonverbal Behavior Is Related to Patient Satisfaction. Med Care 2008; 46:1212-8. [DOI: 10.1097/mlr.0b013e31817e1877] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Finset A. Nonverbal communication--An important key to in-depth understanding of provider-patient interaction. PATIENT EDUCATION AND COUNSELING 2007; 66:127-8. [PMID: 17445744 DOI: 10.1016/j.pec.2007.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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