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Patient expression of emotions and neurologist responses in first multiple sclerosis consultations

Del Piccolo, Lidia and Pietrolongo, Erika and Radice, Davide and Tortorella, Carla and Confalonieri, Paolo and Pugliatti, Maura and Lugaresi, Alessandra and Giordano, Andrea and Heesen, Christoph and Solari, Alessandra (2015) Patient expression of emotions and neurologist responses in first multiple sclerosis consultations. PLoS One, Vol. 10 (6), e0127734. ISSN 1932-6203. Article.

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DOI: 10.1371/journal.pone.0127734


Background: Anxiety and depression are common in people with multiple sclerosis (MS), but data on emotional communication during MS consultations are lacking. We assessed patient expressions of emotion and neurologist responses during first-ever MS consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).
Methods: We applied VR-CoDES to recordings/transcripts of 88 outpatient consultations (10 neurologists, four MS Italian centers). Before consultation, patients completed the Hospital Anxiety and Depression Scale (HADS). Multilevel sequential analysis was performed on the number of cues/concerns expressed by patients, and the proportion of reduce space responses by neurologists.
Results: Patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The commonest cues were verbal hints of hidden worries (cue type b, 41%) and references to stressful life events (type d, 26%). Variables independently associated with number of cues/concerns were: anxiety (HADS-Anxiety score >8) (incidence risk ratio, IRR 1.08, 95% CI 1.06-1.09; p <0.001); patient age (IRR 0.98, 95% CI 0.98-0.99; p <0.001); neurologist age (IRR 0.94, 95% CI 0.92-0.96; p=0.03); and second opinion consultation (IRR 0.72, 95% CI 0.60-0.86; p=0.007). Neurologists reacted to patient emotions by reducing space (changing subject, taking no notice, giving medical advice) for 58% of cues and 76% of concerns. Anxiety was the only variable significantly associated with ‘reduce space’ responses (odds ratio 2.17, 95% CI 1.32-3.57; p=0.003).
Conclusions: Patient emotional expressions varied widely, but VR-CoDES cues b and d were expressed most often. Patient anxiety was directly associated with emotional expressions; older age of patients and neurologists, and second opinion consultations were inversely associated with patient emotional expression. In over 50% of instances, neurologists responded to these expressions by reducing space, more so in anxious patients. These findings suggest that neurologists need to improve their skills in dealing with patient emotions.

Item Type:Article
ID Code:11779
Uncontrolled Keywords:Multiple sclerosis, emotions, anxiety, depression, coding mechanisms, decision making, mental health and psychiatry, patients
Subjects:Area 06 - Scienze mediche > MED/26 Neurologia
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Medicina Clinica e Sperimentale
Publisher:Public Library of Science
Copyright Holders:© 2015 Del Piccolo et al.
Deposited On:20 Jun 2017 11:28

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