• Hilde Eide, Tonje Sibbern, Thore Egeland, Arnstein Finset, Tone Johannessen, Christine Miaskowski, and Tone Rustøen.
• Department of Health Sciences, Buskerud University College, Drammen, Norway. Hilde.Eide@ hibu.no
• Clin J Pain. 2011 Sep 1; 27 (7): 602-10.

ObjectivesClinicians' 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.MethodsInitial 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.ResultsPatients 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.DiscussionFindings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns.

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