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Objective: (1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression.Methods: 308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists' interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists' evaluations of the patient were collected after.Results: Breast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist's attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist's ability to pick up on patient's worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions.Conclusion: Both contextual and interactional aspects have an impact on patient emotional expressions.Practice Implications: Oncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account. [ABSTRACT FROM AUTHOR]

Objective: To assess European patients' preferences regarding seven aspects of doctor-patient communication.Methods: 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences.Results: Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest.Conclusions: Treating the patient as a person and providing continuity of care emerged as universal values.Practice Implications: The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe. [ABSTRACT FROM AUTHOR]

Objective: In a previous qualitative study (GULiVer-I), a series of lay-people derived recommendations ('tips') was listed for doctor and patient on 'How to make medical consultation more effective from the patient's perspective'. This work (GULiVer-II) aims to find evidence whether these tips can be generally applied, by using a quantitative approach, which is grounded in the previous qualitative study.Methods: The study design is based on a sequential mixed method approach. 798 patients, representing United Kingdom, Italy, Belgium and the Netherlands, were invited to assess on four point Likert scales the importance of the GULiVer-I tips listed in the 'Patient Consultation Values questionnaire'.Results: All tips for the doctor and the patient were considered as (very) important by the majority of the participants. Doctors' and patients' contributions to communicate honestly, treatment and time management were considered as equally important (65, 71 and 58% respectively); whereas the contribution of doctors to the course and content of the consultation was seen as more important than that of patients.Conclusions: The relevance of GULiVer-I tips is confirmed, but tips for doctors were assessed as more important than those for patients.Practice Implications: Doctors and patients should pay attention to these "tips" in order to have an effective medical consultation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people. Methods: A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations. In a two-step procedure participants gave their individual quality ratings of the whole consultations and then of a set of four fragments from each consultation. They contained a patient negative emotional expression and the subsequent physician response, according to the VR-CoDES. Results: Higher quality ratings were given to physician responses which provided space to the patient to talk and to the explicit expressions of empathy. The explicit responses were favored above non-explicit responses. Participants’ global evaluation of the whole consultation affected their quality assessments of the fragments (halo-effect). In a multivariate model, lay people''s background characteristics appeared to be relevant: to be female, of lower educational level and living in Belgium or Italy predicted higher ratings. Conclusions: Providing space to patients is appreciated by all participants, combined with the need for tailor made communication. Practice implications: To teach physicians listening skills and how to show empathy with distressed patients should be a core element in medical education. [Copyright &y& Elsevier]

Abstract: Objective: To illustrate how patients introduce cues and concerns during clinical consultations and how psychiatrists respond to them. Method: Sixteen psychiatrists recorded 104 first diagnostic consultations, coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Cues, concerns and responses were analyzed in relation to patient gender and ICD-10 diagnosis, and psychiatrists’ age, gender, clinical experience and consultation process. Results: Cues were more frequent among female patients and were equally distributed among diagnostic categories. Concerns were more frequent among patients with “Mood” or “Neurotic” disorders. Psychiatrists’ responses to cues tended to “provide space” without being explicit. Referral to the affective part was restricted to concerns which had been solicited by the psychiatrist. Empathic responses were infrequent. Cues and concerns received more attention by female psychiatrists. Conclusion: The study confirms gender differences in expressing and dealing with emotions both by patients and psychiatrists. Females tend to give more space to this topic. Psychiatrists ‘responses differed according to cues, concerns, gender, diagnosis and to who prompted the cue/concern, showing a preference for topics introduced by themselves. Practice implications: The VR-CoDES is a useful tool to define the strategies psychiatrists adopt when handling patients’ emotions in terms of cues and concern. [Copyright &y& Elsevier]

Objective: To describe the Emoty-Com training, its impact on medical students' attitudes towards doctors' emotions and to explore the association between students' empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores.Methods: The 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors' emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training.Results: 264 students participated in the study. The training reduced students' worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students' attitudes towards emotions but not with empathy, EI, and AS.Conclusion: The Emoty-Com training increased students' self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors' emotions in clinical encounters.Practice Implications: The Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors' emotions during the years of education are highlighted. [ABSTRACT FROM AUTHOR]

The Emoty-Com training is a 16 hours-course based on interactive teaching to increase communication and emotion-handling skills for medical students. The study aimed to describe the Emoty-Com training impact on medical students' attitudes towards patients' emotions and to explore the association between students' empathy, emotional intelligence (EI), attachment style (AS) and attitudes with post-training performance scores. The Emoty-Com training was delivered to all second-year students of Medicine and Surgery Schools in Verona and Milan (Italy) Universities. Empathy, AS and EI were assessed at pre-training; attitudes towards emotions in the doctor-patient encounter were assessed at pre-training and post-training; at post-training, a final test evaluating the knowledge acquired during the training was administered. The Emoty-Com training increased the relevance attributed to doctor emotional involvement, at least by male students, and students' perception of self-efficacy in handling their own emotions during a consultation. Students with higher final test scores were those with less perceived self-efficacy in dealing with patients' emotions before the training, while students with lower final scores were those who tended to give scarce importance to doctors' emotions in the clinical encounter after the training. In contrast with previous literature, the relationship between AS, EI, empathy, and communication skills measured by the final test was not confirmed. Students' acquired knowledge resulted related to their attitude towards emotions, which should be considered in adapting future training to the specific needs of medical students. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide psychometric characteristics of the Italian language version of the OPTION scale and descriptive statistics on patients’ involvement. The OPTION scale assesses the extent to which clinicians involve patients in therapeutic decisions. The English language version has a Cohen''s κ score for individual items ranging from 0.45 to 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77. Methods: Six male GPs provided 235 audiotaped consultations with consecutive patients who had attended for a new illness episode over a 2-month period. Thirty interviews were rated by two raters to assess inter- and intra rater as well as test–retest reliability of the Italian language version of the OPTION scale. Based on the whole sample, Cronbach''s α and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings. Results: Cohen''s κ values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach''s α 0.82. The ratings for each OPTION item showed a skewed distribution: the majority of scores (>70%) were between 0 (behaviour absent) and 2 (minimum skill level). Conclusion: The reliability indices were satisfactory and similar to those reported for the original OPTION. Practice implications: OPTION can be used for both teaching purposes and research, as well as for future cross-national comparisons. [Copyright &y& Elsevier]

Factor analysis (FA) is a powerful method of testing the construct validity of coding systems of the medical interview. The study uses FA to test the underlying assumptions of the Verona Medical Interview Classification System (VR-MICS). The relationship between factor scores and patient characteristics was also examined. The VR-MICS coding categories consider the three domains of the biopsychosocial model and the main functions of the medical interview—data gathering, relationship building and patient education. FA was performed on the frequencies of the VR-MICS categories based on 238 medical interviews. Seven factors (62.5% of variance explained) distinguished different strategies patients and physicians use to exchange information, build a relationship and negotiate treatment within the domains of the biopsychosocial model. Three factors, Psychological, Social Inquiry and Management of Patient Agenda, were related to patient data: sociodemographic (female gender, age and employment), social (stressful events), clinical (GHQ-12 score), personality (chance external health locus of control) and clinical characteristics (psychiatric history, chronic illness, attributed presence of emotional distress). [Copyright &y& Elsevier]

Objective To describe how emotions are disclosed during psychiatric diagnostic consultations and the contribution of the psychiatrists in facilitating their expression. Methods Descriptive naturalistic study. Sixteen psychiatrists recorded their first consultations with 104 patients. Emotions and the immediate response given by the psychiatrist were coded with the Verona Coding Definitions of Emotional Sequences. For each disclosed emotion, the potential link to preceding expressions with affective content (cue or concern) was checked and the immediate response given by the psychiatrist was coded. Results Most emotions were expressions of anxiety in terms of psycho-physiological or cognitive correlates. Concerns were present in 94% of the consultations, 47.6% were not linked to previous cues/concerns. Cues which became concerns and concerns which were further elaborated by the patient were those that had been acknowledged and handled by the psychiatrist by actively providing space to their expression. Compared to all other diagnostic groups, patients with mood disorders talked more explicitly and more often about their feelings. Conclusion The type and frequency of expressed emotions varies with patient diagnosis, suggesting different cognitive processes underlining psychopathology. Practice Implications Psychiatrist's competence in providing space by using active listening skills is essential to uncover patients emotions. [ABSTRACT FROM AUTHOR]

Objective: To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) and Zimmermann et al. (submitted for publication) ). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion. Methods: The Verona-CoDES-P system has been developed based on consensus views within the “Verona Network of Sequence Analysis”. The different phases of the creation process are described in detail. A reliability study has been conducted on 20 interviews from a convenience sample of 104 psychiatric consultations. Results: The VR-CoDES-P has two main classes of provider responses, corresponding to the degree of explicitness (yes/no) and space (yes/no) that is given by the health provider to each cue/concern expressed by the patient. The system can be further subdivided into 17 individual categories. Statistical analyses showed that the VR-CoDES-P is reliable (agreement 92.86%, Cohen's kappa 0.90 (±0.04) p <0.0001). Conclusion: Once validity and reliability are tested in different settings, the system should be applied to investigate the relationship between provider responses to patients’ expression of emotions and outcome variables. Practice implications: Research employing the VR-CoDES-P should be applied to develop research-based approaches to maximize appropriate responses to patients’ indirect and overt expressions of emotional needs. [Copyright &y& Elsevier]

Objective: This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). Method: Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. Results: Agreement indices for the division of speech units varied between 88-96 and 87-93% for GP and patient speech, respectively; those for coding categories between 88-91 and 82-86%, with Cohen's Kappa values between 0.86-0.91 and 0.80-0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more 'doctor-centred', while the UK GPs tended to use a more 'sharing' consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. Conclusion: The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients' verbal behaviours in relation to their emotional state in the two settings. Practice Implications: The VR-MICS may be an useful coding instrument to support collaborative research on doctor-patient communication between the two countries. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). Method:: Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. Results:: Agreement indices for the division of speech units varied between 88–96 and 87–93% for GP and patient speech, respectively; those for coding categories between 88–91 and 82–86%, with Cohen''s Kappa values between 0.86–0.91 and 0.80–0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more ‘doctor-centred’, while the UK GPs tended to use a more ‘sharing’ consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. Conclusion:: The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients’ verbal behaviours in relation to their emotional state in the two settings. Practice implications:: The VR-MICS may be an useful coding instrument to support collaborative research on doctor–patient communication between the two countries. [Copyright &y& Elsevier]