The objective of the study was to validate the model of empathic opportunity (EO) and potential empathic opportunity (PEO) using the Roter Interaction Analysis System (RIAS) in a sample of cancer patients. Thirty-nine audio taped consultations at an outpatient oncology clinic performed by four oncologists were previously coded with the Roter Interaction Analysis System for another purpose. These consultations were also coded by two raters with the empathic and potential empathic opportunity method (E-PE-O method). The reliability of EO and PEO coding was satisfactory. Most of the EOs were found within the RIAS category "showing concern". The PEOs were found in both the socio-emotional and the instrumental categories of the RIAS. We conclude that the E-PE-O method is a good starting point for studying the empathy process in oncology consultations.
Adult patients present concerns as defined in the Verona Coding Definitions of Emotional Sequences (VR-CoDES), but we do not know how children express their concerns during medical consultations. This study aimed to evaluate the applicability of VR-CoDES to pediatric oncology consultations.
Twenty-eight pediatric consultations were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES), and the material was also qualitatively analyzed for descriptive purposes. Five consultations were randomly selected for reliability testing and descriptive statistics were computed.
Perfect inter-rater reliability for concerns and moderate reliability for cues were obtained. Cues and/or concerns were present in over half of the consultations. Cues were more frequent than concerns, with the majority of cues being verbal hints to hidden concerns or non-verbal cues. Intensity of expressions, limitations in vocabulary, commonality of statements, and complexity of the setting complicated the use of VR-CoDES. Child-specific cues; use of the imperative, cues about past experiences, and use of onomatopoeia were observed.
Children with cancer express concerns during medical consultations. VR-CoDES is a reliable tool for coding concerns in pediatric data sets.
For future applications in pediatric settings an appendix should be developed to incorporate the child-specific traits.
The aim of this study was to analyse with sequence analysis physician-patient dialogue surrounding patients' expression of emotional cues. Two samples, sample 1 consisting of 36 cancer patient consultations conducted by four oncologists, and sample 2 consisting 79 consultations of haematology patients conducted by nine specialists, were audiotaped and coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by means of a generalized sequential querier (GSEQ) was applied to the coded data. Lag sequential analysis (analysed using RIAS categories) showed that certain behaviours of physicians corresponded with patients' expressions of concern. Physicians in both samples used silence and minimal encouragers before patient concern. The oncologists also used optimistic and affirming responses. The most common physician responses to patients' concern were minimal encouragers or affirming and optimistic responses. Sequence analysis based on RIAS coding appears to be a promising method for the study of doctor-patient dialogue and should be utilized more in studies of the communication process in medical consultations.
Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments.
Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders.
Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician.
More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early.
Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.
The Canadian Occupational Performance Measure (COPM) is a client-centered measure, designed to detect changes in occupational performance over time. The main aim of our study was to examine the test-retest reliability of the Norwegian version of the COPM in patients with ankylosing spondylitis (AS) in 3 different retest modes of data collection.
A total of 119 patients with AS completed the baseline COPM interview before randomization into one of 3 modes of retest data collection performed 2 weeks later: by personal interview, telephone interview, or mailed questionnaire. Scores were computed for Performance and Satisfaction, and the 2 sets of scores were examined for reliability by intraclass correlations (ICC), and by the Bland-Altman procedure for calculation of smallest detectable difference (SDD).
The ICC coefficients for Performance and Satisfaction were as follows: 0.92 and 0.93 (rescoring by personal interview), 0.73 and 0.73 (rescoring by telephone interview), and 0.90 and 0.90 (rescoring by mail). SDD for the Performance and Satisfaction scores were 1.47 and 1.80, respectively, for rescoring by personal interview; 3.14 and 4.00 for rescoring by telephone interview; and 2.20 and 2.41 for rescoring by mailed survey.
The results confirm that the COPM is a reliable instrument for use in clinical practice in patients with AS, and may serve as an instrument to promote a patient-centered approach in the planning and evaluation of rehabilitation programs. Mailed questionnaires may replace personal interview in followup examinations, while rescoring by telephone interview is less reliable.
There is a need for valid and comprehensive measures of parental influence on children's energy balance-related behaviours (EBRB). Such measures should be based on a theoretical framework, acknowledging the dynamic and complex nature of interactions occurring within a family. The aim of the Family & Dietary habits (F&D) project was to develop a conceptual framework identifying important and changeable family processes influencing dietary behaviours of 13-15 year olds. A second aim was to develop valid and reliable questionnaires for adolescents and their parents (both mothers and fathers) measuring these processes.
A stepwise approach was used; (1) preparation of scope and structure, (2) development of the F&D questionnaires, (3) the conducting of pilot studies and (4) the conducting of validation studies (assessing internal reliability, test-retest reliability and confirmatory factor analysis) using data from a cross-sectional study.
The conceptual framework includes psychosocial concepts such as family functioning, cohesion, conflicts, communication, work-family stress, parental practices and parental style. The physical characteristics of the home environment include accessibility and availability of different food items, while family meals are the sociocultural setting included. Individual characteristics measured are dietary intake (vegetables and sugar-sweetened beverages) and adolescents' impulsivity. The F&D questionnaires developed were tested in a test-retest (54 adolescents and 44 of their parents) and in a cross-sectional survey including 440 adolescents (13-15 year olds), 242 mothers and 155 fathers. The samples appear to be relatively representative for Norwegian adolescents and parents. For adolescents, mothers and fathers, the test-retest reliability of the dietary intake, frequencies of (family) meals, work-family stress and communication variables was satisfactory (ICC: 0.53-0.99). Barratt Impulsiveness Scale-Brief (BIS-Brief) was included, assessing adolescent's impulsivity. The internal reliability (Cronbach's alphas: 0.77/0.82) and test-retest reliability values (ICC: 0.74/0.77) of BIS-Brief were good.
The conceptual framework developed may be a useful tool in guiding measurement and assessment of the home food environment and family processes related to adolescents' dietary habits, in particular and for EBRBs more generally. The results support the use of the F&D questionnaires as psychometrically sound tools to assess family characteristics and adolescent's impulsivity.
To describe the process for developing interrater reliability (IRR) for the Four Habits Coding Scheme (4HCS) for a heterogeneous material as part of a randomized controlled trial.
Videotapes from 497 hospital encounters involving 71 doctors from most clinical specialties were collected. Four experienced psychology students were trained as raters. We calculated Pearson's r and the intraclass correlation (ICC) on the total score across consecutive samples of twenty videos, and Pearson's r on single videos across items in the initial coding phase.
After 18h of training and one rating session, the total score Pearson's r and ICC exceeded .70 for all pairs of raters. Across items within single videos, the Pearson's r was never below 0.60 after the first 50 videos. At item and habit level Pearson's r remained unsatisfactory for some rater pairs mostly due to low variance on some items.
Based on the evaluation of the effect of communication skills training via a total score, IRR was satisfactory for the 4HCS as applied to heterogeneous material. However, good reliability at item level was difficult to achieve.
4HCS may be used as an outcome measure for clinical communication skills in randomized controlled trials.