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

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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Correspondence to Mary Catherine Beach.

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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.

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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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Keywords

  • Patient-provider communication
  • Patient-centeredness
  • HIV
  • Quality