Resources
Bibiliography and Abstracts of RIAS Studies through 2014

Following are abstracts of RIAS studies, listed in alphabetical order by first author. Just click on a letter below to view the abstracts by the author's last name. Monographs and doctoral theses have their own page.

A     B     C     D     E     F     G     H     I     J     K     L     M     N     O     P     Q     R     S

T     U     V     W     X     Y     Z     Monographs & Theses

E

Eide H, Frankel R, Haaversen AC, Vaupel KA, Graugaard PK, Finset A. Listening for feelings: identifying and coding empathic and potential empathic opportunities in medical dialogues. Patient Educ. Couns. 2004 Sep;54(3):291-7.
(Oncology, Norway)
The objective of the study was to validate the model of empathic opportunity (EO) and potential empathic opportunity (PEO) using the Roter Interaction Analysis System (RIAS) in a sample of cancer patients. Thirty-nine audio taped consultations at an outpatient oncology clinic performed by four oncologists were previously coded with the Roter Interaction Analysis System for another purpose. These consultations were also coded by two raters with the empathic and potential empathic opportunity method (E-PE-O method). The reliability of EO and PEO coding was satisfactory. Most of the Eos was found within the RIAS category “showing concern”. The PEOs were found in both the socio-emotional and the instrumental categories of the RIAS. We conclude that the E-PE-O method is a good starting point for studying the empathy process in oncology consultations.

Eide H, Graugaard P, Holgersen K, Finset A. Physician communication in different phases of a consultation at an oncology outpatient clinic related to patient satisfaction. Patient Educ Couns. 2003 Nov;51(3):259-66.
(Oncology, Patient Satisfaction, Norway)
The aim of this study was to identify the relationship between content during the different phases of the consultation and overall patient satisfaction with regular follow-up consultations at a cancer outpatient clinic. Thirty-six consultations were analysed with Roter Interaction Analysis System (RIAS). In the statistical analysis, timed events of the RIAS categories were used. The regular follow-up consultations were rather short aiming at discussing medical and therapeutic aspects of the illness. There was a positive correlation between physician informal talk (IT) and patient satisfaction in the history-taking phase. Patients were found to be dissatisfied if the physician had focused on a great deal of psychosocial exchange (PE) during physical examination. Our study suggests that the physician should not initiate discussion of psychosocial topics during physical exam. This result should be studied further in other samples and designs.

Eide H, Quera V, Finset A. Exploring rare patient behaviour with sequential analysis: an illustration. Epidemiol Psichiatr Soc. 2003 Apr-Jun;12(2):109-14.
(Interaction Analysis, Oncology, Norway)
AIMS: To illustrate the application of sequence analysis to the study of rare patient behaviour in physician-patient dialogue. The rare behaviour in question here is patients' expression of emotional cues and concerns. We investigate which physician behaviours precede and follow such expressions. METHODS: Thirty-five cancer-patient consultations performed by four oncologists (two male and two female) were analysed. The consultations were coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by means of Sequential Data Interchange Standard (SDIS) and the Generalized Sequential Querier (GSEQ) was applied to the coded data. Lag analysis (using RIAS categories) was applied to associate the given behaviour (patient 'concerns') with target behaviours (physician utterances). RESULTS: For female physicians the significantly associated behaviour before the patient's expression of concern was reassurance, while male physicians also applied facilitation behaviour. After patients' expression of concern both reassurance and facilitating behaviour were shown by physicians of both genders. CONCLUSIONS: Sequence analysis appears to be a clinically meaningful and statistically sound method for analysing are patient utterances and associated physician behaviour.

Eide H, Quera V, Graugaard P, Finset A. Physician-patient dialogue surrounding patients' expression of concern: applying sequence analysis to RIAS. Soc Sci Med. 2004 Jul; 59(1):145-55.
(Interaction Analysis, Oncology, Norway)
The aim of this study was to analyze with sequence analysis physician-patient dialogue surrounding patients' expression of emotional cues. Two samples, sample 1 consisting of 36 cancer patient consultations conducted by four oncologists, and sample 2 consisting 79 consultations of haematology patients conducted by nine specialists, were audiotaped and coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by means of a generalized sequential querier (GSEQ) was applied to the coded data. Lag sequential analysis (analyzed using RIAS categories) showed that certain behaviors of physicians corresponded with patients' expressions of concern. Physicians in both samples used silence and minimal encouragers before patient concern. The oncologists also used optimistic and affirming responses. The most common physician responses to patients' concern were minimal encouragers or affirming and optimistic responses. Sequence analysis based on RIAS coding appears to be a promising method for the study of doctor-patient dialogue and should be utilized more in studies of the communication process in medical consultations.

Ellington L, Baty BJ, McDonald J, Venne V, Musters A, Roter D, Dudley W, Croyle RT. Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches. J Genet Couns. 2006 Jun 15(3):179-89.
(Genetics Counseling, United States)
The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.

Ellington L, Kelly KM, Reblin M, Latimer S, Roter D. Communication in Genetic Counseling: Cognitive and Emotional Processing. Health Commun. 2011 May 27:1-9.
(Genetics Counseling, United States)
The profession of genetic counseling has received limited guidance from theoretical models in how to communicate complex health information so that clients can actively use the information. In this study of a national sample of 145 genetic counselors conducting sessions with simulated clients, we apply two different approaches for analyzing and describing verbal health communication. The Roter interaction analysis system (RIAS) and linguistic inquiry word count (LIWC) were used to identify evidence of communication behaviors consistent with tenets of the social cognitive processing model (SCPM). These tools revealed descriptive evidence of counselor facilitation of client emotional processing and, to a lesser extent, facilitation of client cognitive processing and understanding. Conversely, descriptive analysis of client communication revealed evidence of cognitive processing, but less affective processing. Second, we assessed whether genetic counselor facilitative communication predicted simulated client responses consistent with the cognitive and emotional processing inherent in SCPM. These analyses revealed that counselor attempts to promote emotional expression and client insight were positively associated with client word usage indicative of expression of negative affect and cognitive processing. This study is the first to our knowledge to apply RIAS and LIWC in tandem and gives us a description of current practices within genetic counseling within a theoretical framework. Additionally, it provides suggestions for education and communication goals to improve providers' responses to patient emotions as well as skills to engender patient understanding and personal meaning-making of complex medical information.

Ellington L, Rebecca Poynton M, Reblin M, Latimer S, Bennett HK, Crouch B, Caravati EM. Communication patterns for the most serious poison center calls. Clin Toxicol (Phila). 2011 Apr;49(4):316-23.
(Poison Control, United States)
CONTEXT: The communication demands faced by specialists in poison information (SPI) are unique in the health-care context. OBJECTIVES: (1) To describe SPI communication patterns for the highest risk poison exposure calls using cluster analysis, and (2) to describe variation in communication patterns or clusters. METHODS: A sample of 1 year of poison exposure calls to a regional poison control center with SPIs' perceived severity rating of major or moderate perceived was collected. Digital voice recordings were linked with medical records and were coded using the Roter Interaction Analysis System. Descriptive analyses were applied, and cluster-analytic techniques were used to assess variation in call communication and factors associated with that variation. RESULTS: Cases were described, and four communication styles were identified. The informational cluster represents calls with relatively high levels of SPI clinical information and caller questions. The Facilitative cluster represents calls with a pattern of relatively high SPI questions and caller information provision. The Planning cluster represents calls with relatively high levels of SPI relationship talk. The Emotional cluster represents calls with relatively high caller and SPI emotion. Further analyses revealed relationships between call characteristics, SPI identity, and cluster membership. CONCLUSION: This study provides a beginning step to understanding SPI communication behaviors. Our results suggest that SPIs are able to use a range of communication strategies that often involve not only information but also emotional responsiveness and rapport building. Findings also point to the opportunity for future communication training for SPIs to meet the needs of the heterogeneous caller population.

Ellington L, Matwin S, Jasti S, Williamson J, Crouch B, Caravati M, Dudley W. Poison control center communication and impact on patient adherence. Clin Toxicol (Phila). 2008 Feb;46(2):105-9.
(Poison Control, Telephone, United States)
OBJECTIVE: This project explored the communication processes associated with poison control center calls. METHODS: In this preliminary study, we adapted the Roter Interaction Analysis System to capture staff-caller dialogue. This involved case selection, wherein adherence and non-adherence cases were selected; call linkage to medical records, where case records were linked with voice recordings; and application of Roter Interaction Analysis System to calls. RESULTS: Results indicate that communications are predominantly provider-driven. Patient age and percentage of staff partnership statements were significantly associated with adherence at the 0.05 level. Increases in age were associated with decreases in adherence to recommendations (p < 0.001). Increases in percentage of staff partnership statements (over all staff talk) were associated with increases in adherence (p = 0.013). CONCLUSION: This line of research could lead to evidence-based guidelines for effective staff-caller communication, increased adherence rates, and improved health outcomes.

Ellington L, Maxwel A, Baty BJ, Roter D, Dudley WN, Kinney AY. Genetic counseling communication with an African American BRCA1 kindred. Soc Sci Med. 2007 Feb;64(3):724-34.
(Genetics Counseling, United States)
We studied communication in genetic counseling sessions conducted with an African American, Breast Cancer 1, Early Onset (BRCA1) kindred in the USA. The Roter Interaction Analysis System (RIAS) was used to code and compare two sessions of 46 participants (26 females and 20 males) before and after they underwent genetic testing. Three certified genetic counselors and one medical geneticist conducted the sessions. When compared to pre-test communication, most of the providers' post-test communication was devoted to the provision of biomedical information (including screening recommendations) with fewer questions and psychosocial statements. Clients contributed a similar proportion to the total session dialogue in pre- and post-test sessions (40%). A larger proportion of their post-test session was devoted to indicating receptiveness to provider information than in the pre-test session. We found when providers were informing clients that they were BRCA1 mutation carriers, they provided more biomedical and psychosocial information and asked more psychosocial questions than when talking with non-carriers. This study provides the first description of genetic counseling communication for pre- and post-test BRCA1 sessions with African American individuals.

Ellington L, Reblin M, Clayton MF, Berry P, Mooney K. Hospice nurse communication with patients with cancer and their family caregivers. J Palliat Med. 2012 Mar;15(3):262-8. Epub 2012 Feb 17.
(Oncology, Nursing, United States)
BACKGROUND: Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. METHODS: The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. RESULTS: We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed.

Ellington L, Roter D, Dudley WN, Baty BJ, Upchurch R, Larson S, Wylie JE, Smith KR, Botkin JR. Communication analysis of BRCA1 genetic counseling. J Genet Couns. 2005 Oct;14(5):377-86.
(Genetics Counseling, United States)
In this study, we apply an existing medical communication coding system to BRCA1 genetic counseling sessions, describe the session dynamics, and explore variation in session communication. The sample was comprised of 167 members of an identified BRCA1 kindred whose pretest counseling session was audiotaped and coded using Roter's Interaction Analysis System (RIAS). Three certified genetic counselors followed a research protocol that dictated areas to be covered in the counseling session. We found that it was feasible to code long, protocol driven BRCA1 sessions in a quantitative manner without the use of transcripts and capture the dialogue of all session participants. These findings support the use of RIAS in genetic counseling research. Our results indicate that these BRCA1 sessions were predominantly educational in nature with minimal dialogue devoted to psychosocial issues. We found that participant gender, presence of a client companion, and counselor identity influence session communication.

Ellington L, Wiebe DJ. Neuroticism, symptom presentation, and medical decision making. Health Psychol 1999 Nov;18(6):634-43.
(Primary Care, United States)
In 2 studies, the authors explored whether neuroticism influences illness descriptions in a manner that affects medical decisions. In Study 1, 80 participants presented an imagined illness that was high or low in severity to a confederate medical student. Neuroticism was associated with more elaborate symptom presentations and, among high-severity participants, with more disclosures of psychosocial information. In Study 2, representative videotapes from Study 1 were selected as stimuli to be evaluated by 14 family practice residents. Residents were able to discriminate between severity conditions for low- but not for high-neuroticism participants. Residents also viewed high-neuroticism participants as less credible, less in need of medical treatment, and more in need of mental health treatment than low-neuroticism participants. Correlations suggest the report of psychosocial concerns by high-neuroticism participants contributed to these effects.

Erby LA, Roter DL, Biesecker BB. Examination of standardized patient performance: accuracy and consistency of six standardized patients over time. Patient Educ Couns. 2011 Nov;85(2):194-200. Epub 2010 Nov 20.
(Standardized Patients, United States)
OBJECTIVE: To explore the accuracy and consistency of standardized patient (SP) performance in the context of routine genetic counseling, focusing on elements beyond scripted case items including general communication style and affective demeanor. METHODS: One hundred seventy-seven genetic counselors were randomly assigned to counsel one of six SPs. Videotapes and transcripts of the sessions were analyzed to assess consistency of performance across four dimensions. RESULTS: Accuracy of script item presentation was high; 91% and 89% in the prenatal and cancer cases. However, there were statistically significant differences among SPs in the accuracy of presentation, general communication style, and some aspects of affective presentation. All SPs were rated as presenting with similarly high levels of realism. SP performance over time was generally consistent, with some small but statistically significant differences. CONCLUSION AND PRACTICE IMPLICATIONS: These findings demonstrate that well-trained SPs can not only perform the factual elements of a case with high degrees of accuracy and realism; but they can also maintain sufficient levels of uniformity in general communication style and affective demeanor over time to support their use in even the demanding context of genetic counseling. Results indicate a need for an additional focus in training on consistency between different SPs.

Ernesäter A, Engström M, Winblad U, Holmström IK. A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish healthcare direct: a case-control study. BMJ Open. 2014 Oct 3;4(10):e005961.
(Telephone/Telemedicine, Nursing, Physician Error/Malpractice, Sweden)
OBJECTIVES: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. SETTING: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. PARTICIPANTS: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. RESULTS: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. CONCLUSIONS: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

Ernesäter A, Winblad U, Engström M, Holmström IK. Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why? J Telemed Telecare. 2012;18(7):379-83.
(Malpractice, Nursing, Telephone/Telemedicine, Sweden)
We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

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