Coding patient emotional cues and concerns in medical consultations: the Verona coding definitions of emotional sequences (VR-CoDES).
OBJECTIVE
To present the Verona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns.


METHODS
The system was developed by an international group of communication researchers. First, consensus was reached in different steps. Second, a reliability study was conducted on 20 psychiatric consultations.


RESULTS
A Cue is defined as a verbal or non-verbal hint which suggests an underlying unpleasant emotion that lacks clarity. A Concern is defined as a clear and unambiguous expression of an unpleasant current or recent emotion that is explicitly verbalized with or without a stated issue of importance. The conceptual framework sets precise criteria for cues and concerns and for whom (health provider or patient) elicits the cue/concern. Inter-rater reliability proved satisfactory (agreement 81.5%, Cohen's Kappa 0.70).


CONCLUSIONS
The VR-CoDES CC will facilitate comparative research on provider-patient communication sequences in which patients express emotional distress.


CONCLUSIONS
The VR-CoDES CC may be used to help clinicians in recognizing or facilitating cues and concerns, thereby improving the recognition of patients' emotional distress, the therapeutic alliance and quality of care for these patients.
Zimmermann
Christa
C
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy. christa.zimmermann@univr.it
Del Piccolo
Lidia
L
Bensing
Jozien
J
Bergvik
Svein
S
De Haes
Hanneke
H
Eide
Hilde
H
Fletcher
Ian
I
Goss
Claudia
C
Heaven
Cathy
C
Humphris
Gerry
G
Kim
Young-Mi
YM
Langewitz
Wolf
W
Meeuwesen
Ludwien
L
Nuebling
Matthias
M
Rimondini
Michela
M
Salmon
Peter
P
van Dulmen
Sandra
S
Wissow
Larry
L
Zandbelt
Linda
L
Finset
Arnstein
A
D001007:Anxiety / Q000523:psychology; D003142:Communication; D003210:Concept Formation; D032921:Consensus; D003463:Cues; D004644:Emotions; D004645:Empathy; D006801:Humans; D010817:Physician-Patient Relations; D010865:Pilot Projects; D012017:Referral and Consultation; D015203:Reproducibility of Results; D014743:Videotape Recording