Emotional Communication in HIV Care: An Observational Study of Patients’ Expressed Emotions and Clinician Response

Abstract

Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

“…ECRC toward minorities (i.e., immigrants, people with a language barrier, “enemy” patients during military conflicts) tended to be lower 38 , 40 , 112 , 159 , 174 , 180 . Blacks/African Americans were less likely recipients of ECRC as compared to Whites 112 , 121 , 181 . Gender 61 , 101 , 176 , 178 , 179 , 181 , age 101 , 121 , 176 , 178 , 181 (except for elderly 38 , 61 and children 38 , 138 ), and marital status 179 of the patients showed no associations with ECRC.…”

“…Blacks/African Americans were less likely recipients of ECRC as compared to Whites 112 , 121 , 181 . Gender 61 , 101 , 176 , 178 , 179 , 181 , age 101 , 121 , 176 , 178 , 181 (except for elderly 38 , 61 and children 38 , 138 ), and marital status 179 of the patients showed no associations with ECRC. Evidence regarding (perceived) doctor-patient similarity was conflicted, with some studies showing that greater patient (or patients’ illness) similarity to the physician or their relatives 38 , 117 , 126 , 178 might predict greater ECRC and others suggesting that similarity to self or relatives might have a negative effect on ECRC due to countertransference 93 , 154 ; there was little evidence for effects associated with patient-doctor age or ethnicity concordance 121 .…”

“…There were also few studies examining situational factors. Dealing with time-consuming emotional issues during the diagnosis conversation 176 , 181 – 183 has shown to affect ECRC negatively. Other factors such as presence of empathic opportunities 184 , 185 , the presence of a third person 61 , and time spent speaking to patients’ family 95 were of mostly of lower quality and inconsistent.…”

“I’m Not Feeling Like I’m Part of the Conversation” Patients’ Perspectives on Communicating in Clinical Video Telehealth Visits

“…Relationship building may be made more difficult in CVT than in-person visits because patients and providers use their senses differently, such as eye contact and body language. 15 Patients' concerns about impersonal CVT visits might be related to providers missing opportunities to communicate with empathy 16,17 and our results suggest that it is more difficult to recognize such opportunities with differences in sensing in CVT. One strategy to overcome this challenge is for provider training to develop "webside manner" and to engage patients with attention to facial expression, voice modulation, and body positioning (Table 1).…”

“…The study was approved by the VA Central Institutional Review Board (no. [14][15][16][17][18][19][20][21][22].…”