title: Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations.
abstract: The aims of the study were to explore the importance of macro (patient, physician, consultation) and micro (doctor-patient speech sequences) variables in promoting patient cues (unsolicited new information or expressions of feelings), and to describe the methodological implications related to the study of speech sequences. Patient characteristics, a consultation index of partnership and doctor-patient speech sequences were recorded for 246 primary care consultations in six primary care surgeries in Verona, Italy. Homogeneity and stationarity conditions of speech sequences allowed the creation of a hierarchy of multilevel logit models including micro and macro level variables, with the presence/absence of cues as the dependent variable. We found that emotional distress of the patient increased cues and that cues appeared among other patient expressions and were preceded by physicians' facilitations and handling of emotion. Partnership, in terms of open-ended inquiry, active listening skills and handling of emotion by the physician and active participation by the patient throughout the consultation, reduced cue frequency.
authors.affiliation: Department of Medicine and Public Health, University of Verona, Italy. lidia.delpiccolo@univr.it
authors.forename: Lidia
authors.initials: L
authors.lastname: Del Piccolo
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Mazzi
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.forename: Marco
authors.initials: M
authors.lastname: Sandri
authors.forename: Christa
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003463:Cues; D004644:Emotions; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation; D012962:Sociology, Medical; D013315:Stress, Psychological