Three types of ambiguity in coding empathic interactions in primary care visits: Implications for research and practice

Abstract

Objective To describe three methodological challenges experienced in studying patients’ expressions of emotion in a sample of routine ambulatory medical visits, and the research and practice implications of these challenges. Methods Qualitative analysis of empathic cues in audio-taped and transcribed periodic health examinations of adult patients (n=322) in an integrated delivery system. The empathic and potential empathic opportunities methodology was used. Results Identifying emotional cues that constitute “empathic opportunities” is a complex task. Three types of ambiguities made this task particularly challenging: 1) presentations of emotional cues can be “fuzzy” and varied; 2) expressions of illness can be emotionally laden in the absence of explicit “emotion words”; and 3) empathic opportunities vary in length and intensity. Conclusion Interactional ambiguities pose a challenge to researchers attempting to document emotional cues with a binary coding scheme that indicates only whether an empathic opportunity is present or absent. Additional efforts to refine the methodological approach for studying empathy in medical interactions are needed. Practice Implications The challenges discussed likely represent the same types of situations physicians find themselves in when talking with patients. Highlighting these ambiguities may aid physicians in better recognizing and meeting the emotional needs of their patients.

“Like No One Is Listening to Me”: A Qualitative Study of Patient–Provider Discordance Between Global Assessments of Disease Activity in Rheumatoid Arthritis

“…As previously suggested (31), these findings imply that a deeper understanding of the psychosocial burden of RA will enable health care providers to better manage or prevent patient-provider discordance. However, addressing this issue may present challenges because providers may not recognize psychosocial cues that patients present (32,33). When patients voice distress or other negative affective tones during rheumatology visits, their adherence to recommended treatments is predictably lower over time (34).…”

Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions

“…As pointed out by Stone et al, the application of strict coding rules, according to which expressions either are or are not coded as emotional expression, may imply that subtle expressions of emotion are not coded as cues and are lost to analysis [96]. Interestingly, when Kale et al compared a qualitative discourse analysis with VR-CoDES, they found some expressions which they considered expressions of emotions that were not coded as cues in VR-CoDES [24].…”

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

“…Mercer, Maxwell, Heaney, & Watt, 2004;Mercer, McConnachie, Maxwell, Heaney, & Watt, 2005). Issues arising from the use of these instruments have been reviewed by Stone, Tai-Seale, Stults, Luiz, and Frankel (2012), who point out that patients may present emotion cues in different ways, and that emotion episodes can vary a great deal in terms of length and intensity. These factors introduce complexity and ambiguity to the task of rating emotion events in real-life healthcare environments.…”