What are the differences between telephone and face-to-face consultations when discussing emotional symptoms/concerns? Findings from a mixed methods qualitative study.

Problem

The COVID-19 pandemic had a major impact on mental health and disrupted clinical routines for both patients and clinicians due to the rapid shift to an increased use of remote telephone consultations. While the move to more remote consultations offers several benefits to primary care, there are also several risks associated with this modality, such as missing cues associated with various medical issues, including emotional symptoms/concerns related to possible mental health problems. The REMOTION Study aims to explore how adult patients present new emotional symptoms and concerns, and compare whether and how they are discussed and managed by clinicians (both GPs and NPs), in telephone compared to face-to-face primary care consultations.

Approach

Semi-structured interviews were first conducted with 20 participating clinicians (10 General Practitioners and 10 Advanced Nurse Practitioners) across the South of England between January to October 2022. All interviews were transcribed verbatim and analysed thematically. We also conducted a communication study at the same time, which involved collecting audio and video-recordings of 12 telephone and 15 face-to-face consultations. 27 patients and 3 GPs have taken part (so far). All recordings are being coded and analysed using conversation analytic methods.

Findings

NB: Interim findings (all will be completed by the time of the conference).Within the interviews, clinicians described a range of visual cues associated with being able to pick up emotional symptoms/concerns that made it easier to carry out a mental health assessment. Telephone consulting, with the absence of these cues, was described as riskier for this reason, as it placed a greater emphasis on a patient being a ‘good historian’ of their condition, and a greater reliance on a clinician knowing to ask the ‘right’ questions. Clinicians reported that a large proportion of their daily consultations involve a mental health component, which is reflected in the consultation data so far (17/27 recordings have been coded as involving the expression or management of possible emotional concerns). In terms of communication, emotional symptoms/concerns were presented or elicited in more face-to-face consultations (11/15), compared to telephone (6/12). Patients often volunteered these concerns after the presentation of a physical problem, and clinicians usually asked questions related to the physical problem first.

Consequences

Clinicians reported being able to pick-up emotional symptoms/concerns more easily in face-to-face consultations compared to on the telephone. As general practices are still offering a high proportion of telephone consultations, it is important that communication about these concerns is considered, to ensure patients are afforded with opportunities to discuss these concerns across both modalities.