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

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Abstract

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.

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Acknowledgements

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

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jenny Park

  2. Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA

    Somnath Saha & Todd Korthuis

  3. Portland VA Medical Center, Portland, OR, USA

    Somnath Saha

  4. Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dingfen Han, Richard Moore & Mary Catherine Beach

  5. Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium

    Stéphanie De Maesschalck

  6. Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Debra Roter & Amy Knowlton

  7. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Tanita Woodson

  8. Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA

    Mary Catherine Beach

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  1. Jenny Park
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Correspondence to Mary Catherine Beach.

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Park, J., Saha, S., Han, D. et al. Emotional Communication in HIV Care: An Observational Study of Patients’ Expressed Emotions and Clinician Response. AIDS Behav 23, 2816–2828 (2019). https://doi.org/10.1007/s10461-019-02466-z

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