Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Stortenbeker, Inge; Houwen, Juul; Lucassen, Peter; Stappers, Hugo W; Assendelft, W. J. J.; Dulmen, Sandra van; Hartman, Tim olde; Das, Enny

doi:10.1016/j.pec.2018.05.002

Cited by 23 publications

(17 citation statements)

References 44 publications

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“…Although it was previously shown that linguistic elements (directness of positive and negative messages) may affect patients' state anxiety [13], our findings show no relationship between implicit uncertainty and patient anxiety. This contributes to previous findings about uncertainty and patient anxiety [8], which has reported both positive and negative effects of uncertainty expressions on patient satisfaction [3,7,9].…”

Section: Discussioncontrasting

confidence: 99%

“…This study was part of a larger research on GP-patient communication about MUS in which 393 everyday consultations of 20 GPs were video-recorded on 1-2 days per GP. Forty-one consultations were labelled as MUS consultation by 18 GPs [12,13]. To compare uncertainty of GPs, each MUS consultation was compared to a MES consultation (same GP, same day for all except three consultations) resulting in a dataset of 82 consultations.…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…Two coders identified and categorized GPs' expressions about patients' medical situation. We describe the coding procedure in more detail elsewhere [13]. Frequent expressions of implicit Stortbeker, I. , Houwen, J., Dulmen, S. van, olde Hartman, T, Das, E. Quantifying implicit uncertainty in primary care consultations: Asystematic comparison of communication about medically explained versus unexplained symptoms.…”

Section: Coding Procedures and Reliabilitymentioning

confidence: 99%

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Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Stortenbeker

Houwen²,

Dulmen

et al. 2019

Patient Education and Counseling

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A B S T R A C TObjective: General practitioners (GPs) disclose more uncertainty (e.g. "I don't know") in consultations with patients presenting medically unexplained symptoms (MUS) versus medically explained symptoms (MES), which could negatively affect patient outcomes. This study assessed if this pattern also holds for more subtle, implicit uncertainty expressions (e.g. "maybe", "might") during different consultation phases, and assessed their relation to patient pre-post consultation anxiety. Methods: We quantified implicit markers of uncertainty of 18 GPs in 82 consultations about MUS or MES during different consultation phases. Relative frequencies of implicit uncertainty per consultation were regressed on differences in momentary anxiety pre and post consultation. Results: We coded 2590 GP utterances. Uncertainty expressions were more frequent in MUS versus MES consultations (OR = 1.54, p = .004), especially during diagnosis and treatment recommendations compared to physical examinations (OR =0 .45, p = .001). Implicit uncertainty was not related to patients' changes in anxiety (b = 0.11, p = .817). Conclusions: GPs express more uncertainty during MUS (versus MES) consultations, especially during the diagnostic phase and treatment recommendations. This does not necessarily affect patient anxiety.Stortbeker, I. , Houwen, J., Dulmen, S. van, olde Hartman, T, Das, E. Quantifying implicit uncertainty in primary care consultations: Asystematic comparison of communication about medically explained versus unexplained symptoms.

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Section: Discussioncontrasting

confidence: 99%

Section: Participants and Proceduresmentioning

confidence: 99%

Section: Coding Procedures and Reliabilitymentioning

confidence: 99%

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Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Stortenbeker

Houwen²,

Dulmen

et al. 2019

Patient Education and Counseling

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“…Important reasons for exclusion were that the studies did not describe natural patient-provider interactions (n = 58) or any linguistic or interactional aspect (n = 17). We identified only one quantitative study [35], which was excluded from further analysis since its methodology differed too much from the qualitative studies. Our additional search yielded six additional publications.…”

Section: Resultsmentioning

confidence: 99%

Linguistic and interactional aspects that characterize consultations about medically unexplained symptoms: A systematic review

Stortenbeker

Stommel

Dulmen

et al. 2019

Journal of Psychosomatic Research

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Objective: The apparent absence of any specific underlying diseases challenges patient-provider communication about medically unexplained symptoms (MUS). Previous research focused on general communication patterns in these interactions; however, an overview of more detailed interactional and linguistic aspects is lacking. This review aims to gain a detailed understanding of communicative challenges in MUS consultations by synthesizing evidence from conversation and discourse analytic research. Methods: A systematic review of publications using eight databases (PubMed, Embase, CINAHL, PsychINFO, Web of Science, MLA International Bibliography, LLBA and Communication Abstracts). Search terms included 'MUS', 'linguistics' and 'communication'. Additional studies were identified by contacting experts and searching bibliographies. We included linguistic and/or interactional analyses of natural patient-provider interactions about MUS. Two authors independently extracted the data, and quality appraisal was based on internal and external validity. Results: We identified 18 publications that met the inclusion criteria. The linguistic and interactional features of MUS consultations pertained to three dimensions: 1) symptom recognition, 2) double trouble potential (i.e. patients and providers may have differing views on symptoms and differing knowledge domains), and 3) negotiation and persuasion (in terms of acceptable explanations and subsequent psychological treatment). We describe the recurrent linguistic and interactional features of these interactions. Conclusions: Despite the presence of a double trouble potential in MUS consultations, validation of symptoms and subtle persuasive conduct may facilitate agreement on illness models and subsequent (psychological) treatment.

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“…Conversely, poor communication can have a negative impact on outcomes . Whilst strides have been made in the move towards more person‐centred care, communication skills still need to be addressed in order to facilitate this . This is especially true for people with diabetes for whom messages about self‐management are numerous and ongoing throughout that person's lifetime.…”

Section: Introductionmentioning

confidence: 99%

Language matters: a UK perspective

et al. 2018

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Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Abstract: GPs could manage patient's state anxiety by expressing negative messages in an indirect rather than direct manner.

Cited by 23 publications

References 44 publications

Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Linguistic and interactional aspects that characterize consultations about medically unexplained symptoms: A systematic review

Language matters: a UK perspective

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