AIDS and Behavior

, Volume 23, Issue 10, pp 2816–2828 | Cite as

Emotional Communication in HIV Care: An Observational Study of Patients’ Expressed Emotions and Clinician Response

  • Jenny Park
  • Somnath Saha
  • Dingfen Han
  • Stéphanie De Maesschalck
  • Richard Moore
  • Todd Korthuis
  • Debra Roter
  • Amy Knowlton
  • Tanita Woodson
  • Mary Catherine BeachEmail author
Original Paper


Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle ‘cues’ vs. more explicit ‘concerns’), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.


Patient-provider communication Patient-centeredness HIV Quality 



This work was supported by Grants from the NIH (R01 DA037601, U01 DA036935, K24 DA037804 and P30 AI094189).

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at Johns Hopkins University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jenny Park
    • 1
  • Somnath Saha
    • 2
    • 3
  • Dingfen Han
    • 4
  • Stéphanie De Maesschalck
    • 5
  • Richard Moore
    • 4
  • Todd Korthuis
    • 2
  • Debra Roter
    • 6
  • Amy Knowlton
    • 6
  • Tanita Woodson
    • 7
  • Mary Catherine Beach
    • 4
    • 8
    Email author
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of General Internal Medicine and GeriatricsOregon Health and Science UniversityPortlandUSA
  3. 3.Portland VA Medical CenterPortlandUSA
  4. 4.Department of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Department of Family Medicine and Primary Health CareGhent UniversityGhentBelgium
  6. 6.Department of Health Behavior and SocietyJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  8. 8.Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreUSA

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