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

Lidia Del Piccolo,Andrea Giordano,Alessandra Solari,Carla Tortorella,Paolo Confalonieri,Alessandra Lugaresi,Christoph Heesen,Erika Pietrolongo,Maura Pugliatti,Davide Radice,Markus Reindl

doi:10.1371/journal.pone.0127734

Abstract

BackgroundAnxiety 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).MethodsWe 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.ResultsPatients 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).ConclusionsPatient 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.

Highlights

Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system that affects women 2–3 times more often than men, and is the leading cause of non-traumatic neurologic disability in young adults [1]
Variables independently associated with number of cues/concerns were: anxiety (HADS-Anxiety score >8); patient age (IRR 0.98, 95% confidence intervals (CIs) 0.98-0.99; p
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

Summary

Introduction

Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system that affects women 2–3 times more often than men, and is the leading cause of non-traumatic neurologic disability in young adults [1]. Anxiety has been less extensively assessed in MS than depression; its prevalence varies from 20 to 40% [7,8,9,10]. Neurologists are usually less concerned with the emotional aspects of the disease than its ‘physical’ manifestations [12]. 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)

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