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Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations


  • Del Piccolo, Lidia
  • Mazzi, Maria Angela
  • Dunn, Graham
  • Sandri, Marco
  • Zimmermann, Christa


The aims of the study were to explore the importance of macro (patient, physician, consultation) and micro (doctor-patient speech sequences) variables in promoting patient cues (unsolicited new information or expressions of feelings), and to describe the methodological implications related to the study of speech sequences. Patient characteristics, a consultation index of partnership and doctor-patient speech sequences were recorded for 246 primary care consultations in six primary care surgeries in Verona, Italy. Homogeneity and stationarity conditions of speech sequences allowed the creation of a hierarchy of multilevel logit models including micro and macro level variables, with the presence/absence of cues as the dependent variable. We found that emotional distress of the patient increased cues and that cues appeared among other patient expressions and were preceded by physicians' facilitations and handling of emotion. Partnership, in terms of open-ended inquiry, active listening skills and handling of emotion by the physician and active participation by the patient throughout the consultation, reduced cue frequency.

Suggested Citation

  • Del Piccolo, Lidia & Mazzi, Maria Angela & Dunn, Graham & Sandri, Marco & Zimmermann, Christa, 2007. "Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations," Social Science & Medicine, Elsevier, vol. 65(11), pages 2357-2370, December.
  • Handle: RePEc:eee:socmed:v:65:y:2007:i:11:p:2357-2370

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    References listed on IDEAS

    1. Piccolo, Lidia Del & Mazzi, Mariangela & Saltini, Anna & Zimmermann, Christa, 2002. "Inter and intra individual variations in physicians' verbal behaviour during primary care consultations," Social Science & Medicine, Elsevier, vol. 55(10), pages 1871-1885, November.
    2. Street, Richard L., 1992. "Communicative styles and adaptations in physician-parent consultations," Social Science & Medicine, Elsevier, vol. 34(10), pages 1155-1163, May.
    3. Epstein, Ronald M. & Franks, Peter & Fiscella, Kevin & Shields, Cleveland G. & Meldrum, Sean C. & Kravitz, Richard L. & Duberstein, Paul R., 2005. "Measuring patient-centered communication in Patient-Physician consultations: Theoretical and practical issues," Social Science & Medicine, Elsevier, vol. 61(7), pages 1516-1528, October.
    4. Eide, Hilde & Quera, Vicenç & Graugaard, Peter & Finset, Arnstein, 2004. "Physician-patient dialogue surrounding patients' expression of concern: applying sequence analysis to RIAS," Social Science & Medicine, Elsevier, vol. 59(1), pages 145-155, July.
    5. Zandbelt, Linda C. & Smets, Ellen M.A. & Oort, Frans J. & de Haes, Hanneke C.J.M., 2005. "Coding patient-centred behaviour in the medical encounter," Social Science & Medicine, Elsevier, vol. 61(3), pages 661-671, August.
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