Abstract
Objectives Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers’ responses to these utterances. Methods Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients’ expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study. Results 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion PLOS ONE PLOS ONE | February 10, 2022 1 / 12 OPEN ACCESS Citation: Otte R, Roodbeen R, Boland G, Noordman J, van Dulmen S (2022) Affective communication with patients with limited health literacy in the palliative phase of COPD or lung cancer: Analysis of video-recorded consultations in outpatient care. PLoS ONE 17(2): e0263433. Editor: Barbara Schouten, Universiteit van Amsterdam, NETHERLANDS Received: January 12, 2021 Accepted: January 19, 2022 Published: February 10, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: Copyright: © 2022 Otte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data from this study are available upon request due to the fact that the data contain potentially identifying or sensitive disclosed in the cue/concern.