Measuring nonverbal behavior in clinical interactions: A pragmatic guide

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.

P1 and beyond: functional separation of multiple emotion effects in word recognition

Event-related potentials (ERPs) revealed effects of emotional meaning on word recognition at distinguishable processing stages, in rare cases even in the P1 time range. However, the boundary conditions of these effects, such as the roles of different levels of linguistic processing or the relative contributions of the emotional valence and arousal dimensions, remain to be fully understood. The present study addresses this issue by employing two tasks of different processing demands on words that orthogonally varied in their emotional valence and arousal. Effects of emotional valence in ERPs were evident from 100 ms after word onset and showed a task-insensitive processing advantage for positive words. Early posterior negativity (EPN) effects to high-arousing words were limited to the lexical decision task, corroborating recent reports that suggested that perceptual processing as reflected in the EPN might not be as automatic as previously assumed.     

How interpreters influence patient participation in medical consultations: The confluence of verbal and nonverbal dimensions of interpreter-mediated clinical communication

Objective

To investigate i) how the patient’s participation in interaction occurs in interpreter-mediated consultations (IMCs) when the doctor provides information to the patient or tries to elicit information from them; ii) how the interpreter’s presence in the consultation influences the patient’s participation.

The Test of Accurate Perception of Patients’ Affect (TAPPA): An ecologically valid tool for assessing interpersonal perception accuracy in clinicians

Objective

A clinician's ability to infer patients’ thoughts and feelings is a critical component of high quality care. The goal of this article is to present a new test to measure this ability in clinicians, called the Test of Accurate Perception of Patients’ Affect (TAPPA).

Methods

Audiovisual clips were taken from patients’ actual medical visits. The patients reviewed the videotape after the visit to identify their thoughts and feelings during the visit. This information was used to extract short audiovisual clips for which the correct answer was the patient's report of the thought or feeling associated with that clip. The TAPPA contains 48 audiovisual clips, each responded to in a multiple choice format.

Results

The TAPPA showed good psychometric properties (optimal mean and good variance, adequate internal consistency, and strong re-test reliability) and convergent validity with other tests of emotion recognition. In addition, the test showed predicted better performance by female than male participants.

Conclusion

The TAPPA promises to be a valuable tool for research and education on provider–patient relationships and quality of care.

Practice implications

A tool for testing clinicians’ understanding of patients’ thoughts and feelings may contribute to better quality of care and to improved selection and training.     

Patient validation of cues and concerns identified according to Verona coding definitions of emotional sequences (VR-CoDES): A video- and interview-based approach

Objective

A challenging but main task for clinicians is to identify patients’ concerns related to their medical conditions. The study aim was to validate a new coding scheme for identifying patients’ cues and concerns.

Methods

12 videotaped consultations between nurses and pain patients were coded according to the Verona Coding Scheme for Emotional Sequences (VR-CoDES). During a metainterview each patient watched his/her own video interview with the researcher to confirm or disconfirm the identified cues and concerns. A directive or an open format was applied. Quantitative and qualitative data analyses were performed.

Results

Patients’ confirmation in relation to the coding gave a sensitivity of 0.95 and specificity of 0.99 in the directive format and a sensitivity of 0.99 and specificity of 0.70 applying the open format. Through a qualitative analysis 83% of researcher-identified cues and concerns were validated. 17% were not confirmed or uncertain.

Conclusion

The VR-CoDES seems to capture what are experienced as real concerns to patients, and proves to be a coding scheme with a high degree of ecological validity.

Practice implications

The VR-CoDES provides a valid framework for detecting patients’ cues and concerns, and should be explored as a training tool to develop clinicians’ empathic accuracy.     

Shedding light on the dark side of doctor-patient interactions: verbal and nonverbal messages physicians communicate during error disclosures

Objective

Existing investigations on medical error disclosures have neglected the fact that a disproportionately large amount of the meaning in messages is derived from nonverbal cues. This study provides an empirical assessment of the verbal and nonverbal messages physicians communicate when disclosing medical errors to standardized patients.

Methods

Sixty hypothetical error disclosures by a volunteer sample of attending physicians were videotaped, coded, and statistically analyzed.

Results

Physicians used friendly, smooth, approaching and invested nonverbal styles as they disclosed medical errors to standardized patients. Female physicians smiled more and were more attentive to patients than male physicians, and physicians tended to exhibit more positive affect in the form of facial pleasantness toward angry female patients than toward angry male patients. Furthermore, physicians touched and smiled at patients more frequently at the beginning and at the end of their error disclosures, and displayed decreased attentiveness and interactional fluency.

Conclusion

Future research needs to examine which disclosure styles patients perceive as competent, and to assess their causal impacts on objective and relational disclosure outcomes.

Practice implications

This study provides an important baseline understanding of medical error disclosures that is essential for the successful implementation of empirically based training programs.     

Infertility patient-provider communication and (dis)continuity of care: An exploration of illness identity transitions

Objective

To identify how and why infertility patients’ communication with health care providers relates to their continuity of care within infertility treatment.

Biodanza for kindergarten children (TANZPRO-Biodanza): reporting on changes of cortisol levels and emotion recognition

The evidence-based programme “TANZPRO-Biodanza for children” was developed in 2009 by Marcus Stueck and Alejandra Villegas based on the Biodanza concept of Rolando Toro and Cecilia Luzzi (Children-Biodanza). The 10-session programme includes elements of dance, movement, encounter and non-verbal communication. There are two versions of the programme, for younger children aged 4–6, and older children, aged 7–12. TANZPRO-Biodanza is the nonverbal part of the School of Empathy concept, based on an integrative empathy model by Stueck (2013b, verbal part: “Respectful, nonviolent communication”). In the current study (10 children, age 4–6), a significant reduction in cortisol and improvements in emotion recognition and concentration (in children with high or medium pre-cortisol values) were found. This indicates the potential of TANZPRO-Biodanza to promote stress reduction and the enhancement of social skills. Despite the methodical limitations, the current study is a valid pilot and gives a first insight into the effects of dance on the responses and modulation of neurohormones in 4–6-year-old children.     

Daily Record of Severity of Problems (DRSP): reliability and validity

Summary The Daily Record of Severity of Problems (DRSP) form was developed to aid in the diagnosis and evaluation of DSM-IV Premenstrual Dysphoric Disorder (PMDD). The reliability and validity of the procedure was tested in two studies. Study A included 27 subjects who ranged from having few or no premenstrual problems to those who met criteria for PMDD. Study B included 243 subjects, all of whom met criteria for PMDD. Individual items and Summary Scores had high test–retest reliability in both studies. Internal consistency of Summary Scores was also high in both studies. Summary Scores had moderate to high correlations with other measures of severity of illness. In addition, items and Summary Scores have been shown to be sensitive to change and to treatment differences in Study B. The DRSP provides sensitive, reliable, and valid measures of the symptoms and impairment criteria for PMDD.     

Patient perceived participation in decision making on their antipsychotic treatment: Evidence of validity and reliability of the COMRADE scale in a sample of schizophrenia spectrum disorders

Objective

The aim of this paper is to provide evidence of the validity and reliability of the COMRADE scale (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness) in patients suffering from schizophrenia spectrum disorders.

Individual recognition of female hamsters by males: role of chemical cues and of the olfactory and vomeronasal systems

Sexually satiated male hamsters preferred to investigate and to mount an anesthetized, estrous, novel female over a similarly presented female with which the male had become satiated (the Coolidge effect); likewise, such males preferred a novel female recently mated with another male over the familiar female but showed no preference between fresh and mated novel females. Thus the Coolidge effect is at least partly dependent on discrimination of a new female by chemical cues. Another experiment indicated that transfer of a male's own scent during mating is not involved in discrimination between familiar and novel females. Flank gland secretion of females were sufficient for individual discrimination by males, whereas head region scents and vaginal secretions were not sufficient. The presence of female's flank glands was not, however, necessary for such discrimination. Lesions of or removal of the vomeronasal organ did not disrupt the preferences of sexually satiated males for a novel female, but elimination of main olfactory system function by ZnSO4 treatment of the olfactory mucosa did abolish such preferences. Thus olfactory cues are sufficient for individual discrimination of novel females by sexually satiated male hamsters, and such recognition leads to increased sexual arousal. These processes are mediated by the main olfactory system but not the vomeronasal accessory-olfactory system.     

Thermometer of warmth in the patient-provider relationship (WARMOMETER)--theory-based development of a patient self-report measure and initial validation using cognitive interview methodology

Objective

The aims of this study are twofold: (1) the theory-based development of a patient self-report measure of physician warmth and (2) the application of cognitive interview methodology to understand patients’ perception and interpretation of this new measure.

Methods

A draft measure was developed based on an in-depth literature review of the concept of human warmth by a multidisciplinary expert group. Sixteen cognitive probing interviews were conducted to examine how patients perceive and interpret this new measure and to identify potential problems. A content analysis of the interviews was used to evaluate findings.

Results

Findings indicate that the WARMOMETER is a short patient self-report assessment of physician warmth, which seems easy and intuitive to understand. In addition, most respondents were found to share a common concept of physician warmth.

Conclusions

Verification of our study hypotheses and confirmation of the theoretical assumptions of human warmth give basic indications that the WARMOMETER seems to be a valid and sensitive patient self-report instrument for assessing the socio-emotional quality of physicians.

Practice implications

These first promising results of our cognitive interviews suggest that the WARMOMETER may also be used and further validated in future health communication studies, also with other healthcare professionals.     

Measuring shared decision-making in the pediatric outpatient setting: Psychometric performance of the SDM-Q-9 and CollaboRATE among English and Spanish speaking parents in the US Midwest

Objective

Shared decision-making (SDM) measures have never been assessed for validity and feasibility in pediatric outpatient settings. We compared psychometric performance of parent adaptations of a well-established measure (SDM-Q-9) to a newer measure focusing on provider effort in facilitating SDM (CollaboRATE) in two clinics.

Early recognition of newborn goat kids by their mother: II. Auditory recognition and evidence of an individual acoustic signature in the neonate

The vocal recognition of newborn kids by their mother at 2 days postpartum and the possible existence of interindividual differences in the voice structure of newborn kids were investigated in two separate studies. The ability of goats to discriminate between the bleats of their own versus an alien kid was tested at 2 days postpartum in mothers being prevented access to visual and olfactory cues from the young. Goats spent significantly more time on the side of the enclosure from which their own kid was bleating, looked in its direction for longer, and responded more frequently to the bleats of their own than to those of the alien kid (p < 0.05). In the second study, the sonograms of 13 kids, studied from Days 1 to 5, showed significant interindividual differences for the five variables taken into account and on each of the 5 days (duration of bleat, fundamental frequency, peak frequency, and numbers of segments and of harmonics). The potential for individual coding ranged between 1.1 and 4.1, indicating that for some variables variations between individuals were greater than intraindividual variations. Furthermore, when considering the five parameters together, the discriminating scores showed an average of 95% in the 78 combinations of any 2 kids for any given day. Finally, some significant intraindividual differences also were found between days, suggesting ontogenic changes in the characteristics of the kid's voice in early life. Therefore, mother goats are likely to recognize the vocalizations of their 48-hr-old kids, as they show sufficient interindividual variability to allow the existence of individual vocal signatures, even though some of the characteristics of the bleats change rapidly over time.     

The Clinician-reported Genetic testing Utility InDEx (C-GUIDE): Preliminary evidence of validity and reliability

PurposeDemonstrating the clinical utility of genetic testing is fundamental to clinical adoption and reimbursement, but standardized definitions and measurement strategies for this construct do not exist. The Clinician-reported Genetic testing Utility InDEx (C-GUIDE) offers a novel measure to fill this gap. This study assessed its validity and inter-rater reliability.MethodsGenetics professionals completed C-GUIDE after disclosure of test results to patients. Construct validity was assessed using regression analysis to measure associations between C-GUIDE and global item scores as well as potentially explanatory variables. Inter-rater reliability was assessed by administering a vignette-based survey to genetics professionals and calculating Krippendorff’s α.ResultsOn average, a 1-point increase in the global item score was associated with an increase of 3.0 in the C-GUIDE score (P < .001). Compared with diagnostic results, partially/potentially diagnostic and nondiagnostic results were associated with a reduction in C-GUIDE score of 9.5 (P < .001) and 10.2 (P < .001), respectively. Across 19 vignettes, Krippendorff’s α was 0.68 (95% CI: 0.63-0.72).ConclusionC-GUIDE showed acceptable validity and inter-rater reliability. Although further evaluation is required, C-GUIDE version 1.2 can be useful as a standardized approach to assess the clinical utility of genetic testing.     

Measuring patient-provider communication skills in Rwanda: Selection,adaptation and assessment of psychometric properties of the Communication Assessment Tool

Objective

To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda.

Test of chiral recognition in the salmonella typhimurium (TA100) mutagenicity of mucochloric acid-cysteine adducts

A difference in biological response to enantiomers is not an uncommon observation and is, therefore, to be expected in various manifestations of genotoxicity. The bacterial mutagen mucochloric acid (2,3-dichloro-5-hydroxy-2(5H)-furanone) has one chiral center, at C-5, but this mutagen exists in racemic form because of the facile stereoisomerization occurring by the mechanism of ring-chain tautomerism. Two readily synthesized enantiomeric analogs of mucochloric acid, as well as the racemic form of the two, were prepared from mucochloric acid and (R)-(+)-, (S)-(-)-, and (R,S)-(+/-)-cysteine. Using Salmonella typhimurium (TA100), the enantiomeric compounds were assayed together in four dose/response assays along with mucochloric acid, the reference mutagen. In three of the same four assays, the racemic form was also assayed. Neither statistically significant differences in mutagenicity, as determined in slope responses, nor distinctions from the plotted curves were observed among the two enantiomers and their racemic form. Therefore, no enantiospecific interaction between enantiomers and chiral DNA or enzymes involved in repair or replication could be concluded. © 1993 Wiley-Liss, Inc.