Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study

Area of Science:

• Medical Informatics
• Communication Studies
• Human-Computer Interaction

Background:

• Nonverbal communication is vital in physician-patient interactions, yet challenging in telemedicine due to limited verbal cues.
• Assessing physician empathy in virtual settings requires understanding specific nonverbal signals.
• Existing frameworks for nonverbal cues in telemedicine are limited.

Purpose of the Study:

• To identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations.
• To establish a consensus among experts on the importance, validity, and reliability of these cues.
• To provide a foundation for developing tools to enhance virtual physician-patient communication.

Main Methods:

• A three-round Delphi study involving 37 experts (academics, healthcare professionals, researchers, patients) from June to November 2022.
• Experts evaluated potential nonverbal cues for importance, validity, and reliability.
• Statistical analysis included Kendall's W and Wilcoxon signed-rank test to assess agreement and stability.

Main Results:

• Nine key nonverbal cues were finalized: facial expression, eye contact, tone of voice, smiling, head nodding, body posture, hand gesture, distance, and environmental cues.
• Facial expression, eye contact, and tone of voice were identified as the most crucial cues.
• Strong inter-expert agreement was found for importance (W=0.739), good for validity (W=0.689), and moderate for reliability (W=0.452).

Conclusions:

• Specific nonverbal cues significantly impact physician empathy assessment in telemedicine.
• Facial expression, eye contact, and tone of voice are paramount for effective virtual interactions.
• The validated list of cues can inform the development of technologies to improve telemedicine communication and patient outcomes.