title: Fibromyalgia patients' communication of cues and concerns: interaction analysis of pain clinic consultations.
abstract: OBJECTIVE
  Clinicians' recognition of patients' concerns is an important component of effective treatment and care. During a consultation, patients often do not express their concerns directly, but rather present them indirectly as hints or cues. The aim of this study was to explore the types of concerns and cues patients expressed in an initial consultation with a nurse at a pain clinic, how and who initiated these cues and concerns, and predictors of these expressions.
  
  
  METHODS
  Initial consultations between patients with fibromyalgia [n=58, 85% female, duration 30 minutes, mean age 47.8 y (SD 10.7)] and clinical nurse specialists (n=5) were videotaped. Patients' cues and concerns were coded using the Verona Coding Definitions of Emotional Sequences. Nurses' responses to patients' cues and concerns were evaluated using the Hierarchical Coding Scheme of Comforting Strategies. In addition, pain intensity and duration, overall evaluation of health, affect at the start of the consultation, and psychological distress were evaluated.
  
  
  RESULTS
  Patients expressed more cues than concerns, mostly about pain, interpersonal relationships, and/or emotional reactions. Both the lack of empathic responding and unspecific empathic responding were associated with the expression of an increased number of cues in the consultation, whereas higher evaluation of health was associated with less cues. More concerns were expressed by patients when nurses exhibited a high level of empathic responding and when the patient entered the consultation with a higher level of negative effect.
  
  
  CONCLUSIONS
  Findings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns.
authors: Department of Health Sciences, Buskerud University College, Drammen, Norway. Hilde.Eide@ hibu.no
authors: Hilde
authors: H
authors: Eide
authors: Tonje
authors: T
authors: Sibbern
authors: Thore
authors: T
authors: Egeland
authors: Arnstein
authors: A
authors: Finset
authors: Tone
authors: T
authors: Johannessen
authors: Christine
authors: C
authors: Miaskowski
authors: Tone
authors: T
authors: Rustøen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003463:Cues; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010147:Pain Measurement; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000209:etiology; D014743:Videotape Recording