Clinician-patient Interaction During Addiction Consultation and Drug Overdose Risk

Background

Drug misusers present to addiction services a wide range of problems with the most serious consequence of drug overdose being the threat to life. Accurately predicting the risk of suffering a drug overdose therefore plays a crucial role in effective prevention of drug overdose. So far, most effect have been focused on investigating predictive variables that are related to drug misusers' subjective perceptions of coping abilities and measures of life experience or treatment history. However, very little attention has been directed to the factors that are associated with the aspects of the addiction consultation process, where clinicians have a greater degree of control over patient interaction.

Some initial empirical evidences suggest that clinicians' and patients' facial expressions were predictive of suicidal reattempt. It was found that doctors showed a higher frequency and intensity in frowning working with suicide repeaters than with non-repeaters. In addition, repeater patients were found to have a higher activity of the mouth and to look downwards significantly more often. This line of study has laid some foundation for a new way of prediction through observation of clinician-patient interactions. We are therefore interested in exploring some non-verbal behaviours of both clinicians and patients during the consultation process that are potentially predictive of a patient's risk of suffering a drug overdose.

Regarding how verbal communicative behaviours during the consultation process might influence patient care outcomes, findings from other healthcare communication areas have consistently demonstrated that patient-centred communication is positively correlated with improved patient health outcomes. One key feature of a patient-centred consulting style is clinicians' ability to verbally recognize and address individual patients' emotional distress. To our knowledge, it is the first time to investigate how clinicians manage patients' emotional distress affects patient care outcomes in a drug service setting.

No validated coding schemes so far have been developed to explore the relationship between aspects of interaction and drug service outcomes. In other areas of healthcare communication, the Verona Coding Definitions of Emotional Sequences (VR-CoDES) has been frequently used to code patient expressions of emotional distress and provider responses. Although it has been widely used in a variety of contexts from psychiatric contexts to dental settings, it has not yet been used in consultations involving drug users. We are therefore interested to test the applicability of the system in a drug service setting after a suitable modification. Drug addiction consultation is usually an emotion-provoking environment and accurate perception of patient emotions has become a precondition for empathic responses. The modification of a validated coding scheme to be suitable for the drug service context will be the first useful tool to help clinicians to recognize patients' emotional concerns and thereby improving the quality of patient care.