How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations: a multilevel study

Abstract

Abstract:Objectives: Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional wellbeing) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress.Methods: Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence (VR-CoDES). Multilevel logistic regression modelled the probability of the occurrence of consultant reduce space response as a function of patient distress cue expression, controlling for consultation and patient-related variables.Results: An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional wellbeing. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduce space response was more pronounced as the consultation continued. However, about six minutes into the consultation, this effect (i.e. tendency to block patients) started to weaken.Conclusions: Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.

Do multimorbidity and deprivation influence patients’ emotional expressions and doctors’ responses in primary care consultations? – An exploratory study using multilevel analysis

“…This finding suggested that GPs were adopting complex strategies in dealing with subtle emotional issues expressed by their patients in consultations, which is consistent with the findings reported in a recent study with head and neck cancer consultants [10]. GPs, similar to oncology consultants, are faced with a patient population with diverse backgrounds and complex disease conditions.…”

“…Compared with studies using the same VR-CoDES measure in the oncology setting (mean = 3 -4 per interview [8,10,23] the mean frequency of cue/concern expression per consultation was higher (mean = 13.68) in our sample from the primary care setting. This might be partly explained by the proportion (approximately 50%) of participants with multimorbidity, a complex condition often associated with depression and psychological discomfort [24,25], which increases emotionally loaded expressions.…”

“…For example, medical students provided room for the disclosure of emotional cues expressed in vague words, but discouraged expressions of cues emphasizing physiological/cognitive correlates [9]; whereas head and neck cancer consultants did not seem to respond differently to how cues were expressed [10]. Despite this inconsistent finding regarding the effect of cue type on responses, healthcare providers working at various settings seemed unanimously to provide room for the disclosure of emotional cues at the earlier stages of the consultation and tended to block emotional expressions closer to the end [8 -10].…”

Using fundamental frequency of cancer survivors’ speech to investigate emotional distress in out-patient visits

“…When and the way in which concerns are presented during the consultation can also impact whether they are met by empathy and given space, or shut down [2][3][4]. Furthermore, Kennifer et al [5] found that the intensity and type of emotional concern (e.g.…”

“…We were motivated to conduct our research with clinical interactions, in the oncology field, that are frequently interspersed with emotional content, as has been previously shown by our group [3] and others [2]. Patients, in cancer clinics especially, may hide their emotions through embarrassment, a wish not to burden others, accepting anxiety as part of treatment or because they were not asked about additional concerns [12].…”