Expressions of Emotional Distress by Seriously Ill Hospitalized Patients in Admission Encounters with Hospital-Based Physicians (701)

Abstract

1.Discuss the frequency with which seriously ill hospitalized patients directly and indirectly verbally express negative emotion to physicians.2.Identify the most common topics about which seriously ill hospitalized patients express emotion.3.Describe the most common types of emotion that hospitalized patients express to physicians. Background. Research on how seriously ill patients express emotional distress to providers has focused on outpatients. Hospital admission may cause different and additional emotional distress. Research objectives. To describe how seriously ill patients express emotion to providers in the hospital. Methods. Cross-sectional observational study conducted on medical services at two hospitals within a university system between August 2008–March 2009. We recruited patients who were able to communicate verbally about their medical care and whose death or ICU transfer within the next year would not surprise their physician. Each patient's admission encounter with the attending hospital-based physician was audio-recorded. A codebook was iteratively developed, based on previous work, to identify instances where patients expressed negative emotion verbally, either directly, eg “I'm scared” or indirectly, eg “That's the hardest part.” Two coders independently coded 20% of encounters; kappa statistic for identification of expressions of emotion was 0.76, indicating substantial agreement. We categorized each expression by topic, and categorized direct expressions by type of emotion. Results. We audio-recorded 34 admission encounters (patient consent rate 66%). The median number of expressions of negative emotion per encounter was 2.5, range 0-15; 82% of encounters included at least one expression. Of 112 total expressions, 62% were indirect. Patients expressed emotion about the following topics: medical diagnoses and treatments (38%), symptoms and functional concerns (37%), the health care system (22%), social issues (15%), and death and dying (4%). In the direct expressions of emotion, anxiety was expressed most frequently (30%), followed by fear (21%), surprise (14%), depression (12%), and anger (5%). Conclusion. Expressions of emotion were of similar topic and type to those described in the outpatient setting. Compared to outpatient studies, we found a higher frequency of emotional expression, primarily in indirect expressions. Implications for research, policy, or practice. Expressions of emotion represent opportunities for hospital-based providers to provide emotional support.