title: Using music[al] knowledge to represent expressions of emotions.
abstract: OBJECTIVE
  Being able to identify expressions of emotion is crucial to effective clinical communication research. However, traditional linguistic coding systems often cannot represent emotions that are expressed nonlexically or phonologically (i.e., not through words themselves but through vocal pitch, speed/rhythm/tempo, and volume).
  
  
  METHODS
  Using audio recording of a palliative care consultation in the natural hospital setting, two experienced music scholars employed Western musical notation, as well as the graphic realization of a digital audio program (Piano roll visualization), to visually represent the sonic features of conversation where a patient has an emotional "choke" moment.
  
  
  RESULTS
  Western musical notation showed the ways that changes in pitch and rate correspond to the patient's emotion: rising sharply in intensity before slowly fading away. Piano roll visualization is a helpful supplement.
  
  
  CONCLUSIONS
  Using musical notation to illustrate palliative care conversations in the hospital setting can render visible for analysis several aspects of emotional expression that researchers otherwise experience as intuitive or subjective. Various forms and formats of musical notation techniques and sonic visualization technologies should be considered as fruitful and complementary alternatives to traditional coding tools in clinical communications research.
  
  
  CONCLUSIONS
  Musical notation offers opportunity for both researchers and learners to "see" how communication evolves in clinical encounters, particularly where the lexical and phonological features of interpersonal communication are concordant and discordant with one another.
authors.affiliation: Department of Consumer Science, Purdue University, West Lafayette, IN, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA. Electronic address: alexa045@mc.duke.edu.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.affiliation: Department of Music, Duke University, Durham, NC, USA.
authors.forename: David Kirkland
authors.initials: DK
authors.lastname: Garner
authors.affiliation: Department of Music, Duke University, Durham, NC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Somoroff
authors.affiliation: Department of German Studies, University of Arizona, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gramling
authors.affiliation: School of Nursing, University of Rochester, USA; Department of Family Medicine, University of Rochester, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Norton
authors.affiliation: School of Nursing, University of Rochester, USA; Department of Family Medicine, University of Rochester, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
mesh_terms: D004644:Emotions; D006761:Hospitals; D006801:Humans; D009146:Music; D010166:Palliative Care / Q000523:psychology*; D012017:Referral and Consultation; D013060:Speech
keywords: Emotions; Empathic Opportunities; Music; Music notation; Patient-provider communication