Fibromyalgia Patients' Communication of Cues and Concerns

Eide, Hilde; Sibbern, Tonje; Egeland, Thore; Finset, Arnstein; Johannessen, Tone; Miaskowski, Christine; Rustøen, Tone

doi:10.1097/ajp.0b013e3182102872

Cited by 23 publications

(22 citation statements)

References 44 publications

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“…We found that patients expressed a median of four cues and one concern during the consultation. This is consistent with the three-to-four cues/concerns expressed by cancer patients [ 31 – 33 ]; however patients with fibromyalgia [ 34 ] or psychiatric conditions [ 35 ] expressed more cues/concerns.…”

Section: Discussionsupporting

confidence: 81%

“…The most frequent cues identified ( Table 1 ) were b cues (41%) followed by d cues (26%), all others were 10% or below. B cues are common in all studies that use VR-CoDES [ 31 , 34 , 35 ] perhaps because using colorful or figurative language ( Table 1 ) is the easiest and most immediate way of expressing an affective state without mentioning emotions (Cit. 1 “ There was a period… perhaps for about a month when I felt pain… back pain… .…”

Section: Discussionmentioning

confidence: 99%

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Patient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations

et al. 2015

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BackgroundAnxiety and depression are common in people with multiple sclerosis (MS), but data on emotional communication during MS consultations are lacking. We assessed patient expressions of emotion and neurologist responses during first-ever MS consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).MethodsWe applied VR-CoDES to recordings/transcripts of 88 outpatient consultations (10 neurologists, four MS Italian centers). Before consultation, patients completed the Hospital Anxiety and Depression Scale (HADS). Multilevel sequential analysis was performed on the number of cues/concerns expressed by patients, and the proportion of reduce space responses by neurologists.ResultsPatients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The commonest cues were verbal hints of hidden worries (cue type b, 41%) and references to stressful life events (type d, 26%). Variables independently associated with number of cues/concerns were: anxiety (HADS-Anxiety score >8) (incidence risk ratio, IRR 1.08, 95% CI 1.06-1.09; p<0.001); patient age (IRR 0.98, 95% CI 0.98-0.99; p<0.001); neurologist age (IRR 0.94, 95% CI 0.92-0.96; p=0.03); and second opinion consultation (IRR 0.72, 95% CI 0.60-0.86; p=0.007). Neurologists reacted to patient emotions by reducing space (changing subject, taking no notice, giving medical advice) for 58% of cues and 76% of concerns. Anxiety was the only variable significantly associated with ‘reduce space’ responses (odds ratio 2.17, 95% CI 1.32-3.57; p=0.003).ConclusionsPatient emotional expressions varied widely, but VR-CoDES cues b and d were expressed most often. Patient anxiety was directly associated with emotional expressions; older age of patients and neurologists, and second opinion consultations were inversely associated with patient emotional expression. In over 50% of instances, neurologists responded to these expressions by reducing space, more so in anxious patients. These findings suggest that neurologists need to improve their skills in dealing with patient emotions.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Patient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations

et al. 2015

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“…Mellblom et al [20] used a thematic analysis to categorize emotional concerns expressed by adolescent cancer survivors, and disclosed new areas that were troublesome for this patient group. Eide et al [21] identified content areas from literature, and categorized the cues and concerns accordingly. Kale et al [22] compared VR-CoDES and discourse analysis (DA), and found a high degree of agreement between the two approaches on identified emotional talk, but that DA identified more of the understated emotional expressions.…”

Section: Introductionmentioning

confidence: 99%

Older persons’ worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences

Hafskjold

Eide

Holmström

et al. 2016

Patient Education and Counseling

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PostprintThis is the accepted version of a paper published in Patient Education and Counseling. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination. Citation for the original published paper (version of record):Hafskjold, L., Eide, T., Holmström, I K., Sundling, V., van Dulmen, S. et al. (2016) Older persons' worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods: An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Patient Education andResults: Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. Conclusion:The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions.Practice implications: The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health careproviders.

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“…There, 63% of the concerns/cues were elicited by staff. Similarly, a study exploring cancer consultations found that 63% of concerns/cues were elicited by the health-care providers (both physicians and nurses) [37], and for adult patients in a pain clinic, 80% of concerns/cues were elicited by the nurse [36]. The lower rate of health-care provider-elicited concerns/cues in our study may be linked to features of the communication taking place in the home care context.…”

Section: Discussionmentioning

confidence: 48%

The use of supportive communication when responding to older people’s emotional distress in home care – An observational study

et al. 2017

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BackgroundResponding to older people’s distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff’s responses to older people’s emotional distress, and identify factors that encourage further emotional disclosure.MethodsAudio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen’s kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher’s exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses.ResultsOlder people’s expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff’s elicitation of the emotional expression (vs patients initiating it) and patients’ expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses.ConclusionsEmotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.

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Fibromyalgia Patients' Communication of Cues and Concerns

Cited by 23 publications

References 44 publications

Patient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations

Patient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations

Older persons’ worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences

The use of supportive communication when responding to older people’s emotional distress in home care – An observational study

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