The Empathic Communication Analytical Framework (ECAF): A multimodal perspective on emotional communication in interpreter-mediated consultations

Abstract

Empathic communication (EC) in healthcare occurs when patients express empathic opportunities, such as emotions, to which doctors respond empathically. This interactional process during which participants try to achieve specific communicative goals (e.g., seeking and displaying empathy) serves as a context in which doctors and patients perform verbal and nonverbal actions and collaboratively co-construct meaning. This applies to interpreter-mediated consultations (IMCs) too, where interpreters perform additional actions of a similar kind. However, there is a dearth of research on the ways in which participants perform these actions in the context of EC, and how these actions in turn help (re)shape the context of EC in IMCs (Theys et al., 2020). To date, any tools for studying EC investigate participants’ actions in isolation, without studying them in the context of EC or in relation to the participants’ awareness of their own and others’ ongoing interactions. In this article, we present the Empathic Communication Analytical Framework (ECAF). The tool draws on valid, complementary analytical tools that allow for a fine-grained, three-level multimodal analysis of interactions. The first level of analysis allows for instances of EC in spoken language IMCs to be identified and for participants’ verbal actions in the context of EC to be studied. The second level allows analysts to investigate participants’ verbal and nonverbal actions in the previously identified context of EC. The third level of analysis links the participants’ concurrent verbal and nonverbal (inter)actions to their levels of attention and awareness and shows how participants’ actions are shaped and in turn help to reshape the context of EC in IMCs. In this article, we present the various levels of the ECAF framework, discuss its application to real-life data, and adopt a critical stance towards its affordances and limitations by looking into one excerpt of EC in IMCs. It is shown that the three distinct yet interconnected levels of analysis in the ECAF framework allow participants’ concurrent multimodal interactions in the context of EC to be studied.

Doctors, Patients, and Interpreters’ Views on the Co-Construction of Empathic Communication in Interpreter-Mediated Consultations: A Qualitative Content Analysis of Video Stimulated Recall Interviews

“…This practice led in some cases to the patient’s negative illness experience going undetected and not responded to by the doctor (e.g., the interaction between Meghan P , Phoebe I , and Clara MSIT , see Interpreters’ alterations of verbal expressions can create conditions that complicate others’ understanding of each other’s experiences ). This finding corroborates previous studies’ hypothesis that interpreters’ alterations can lead to misunderstanding between doctors and patients on the level of EC (Krystallidou et al, 2020; Theys et al, 2020, 2021).…”

“…This concern was also voiced by some doctors in our study (e.g., Mathew MSIT , see Interpreters’ alterations of verbal expressions can create conditions that complicate others’ understanding of each other’s experiences and Doctors and patients were generally satisfied with others’ communicative actions in the empathic interaction ). So, our results confirm the hypothesis suggested in previous studies, namely that interpreters’ aversion of gaze and/or body orientation can be problematic in the context of co-constructing EC (Theys et al, 2021). This finding call for critical reflection on the interpreters’ professional framework and training which prescribe such practices.…”

“…These results are in line with the notion that nonverbal components of communication carry more meaning during the co-construction of EC than verbal components (Haase & Tepper, 1972;Mehrabian, 2017). This finding stresses the importance of studying nonverbal aspects of EC in IMCs, a field of research that has received minimal attention up till now (Lan, 2019;Theys et al, 2020Theys et al, , 2021.…”

“…In addition, different cultures often employ different back channel cues or use back channel cues differently (White, 1989). The lack of interpretation of these cues could have led to cultural misunderstanding between doctors and patients, confirming once again that interpreters' omissions can lead to misunderstanding between doctors and patients on the level of EC (Krystallidou et al, 2020;Theys et al, 2020Theys et al, , 2021.…”

“…Doctors and interpreters would benefit from interprofessional education where they learn about each other’s communicative practices and professional frameworks. In doing so, they learn how to be more aware of their own and each other’s actions and their impact on EC in IMCs (Krystallidou et al, 2018; Theys et al, 2020, 2021).…”