Studying medical communication with video vignettes: a randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients' engagement

Abstract

Background: Video vignettes are used to test the effects of physicians' communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants' engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants' engagement with a video vignette showing a bad news consultation.

Methods: Introduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient's situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants' electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction.

Results: The audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, [Formula: see text]= 0.05) and the consultation part of the vignette (p = 0.051, [Formula: see text]= 0.05), when compared to the written introduction. With respect to camera focus, results revealed that the variant focusing on the patient at emotional moments evoked a higher level of electrodermal activity (p = 0.003, [Formula: see text]= 0.06), when compared to the other two variants. Furthermore, an interaction effect was shown on self-reported emotional engagement (p = 0.045, [Formula: see text]= 0.04): the physician-only variant resulted in lower emotional engagement if the vignette was preceded by the audiovisual introduction. No effects were shown on the other dimensions of self-reported engagement.

Conclusions: Our findings imply that using an audiovisual introduction combined with alternating camera focus depicting patient's emotions results in the highest levels of emotional engagement in analogue patients. This evidence can inform methodological decisions during the development of video vignettes, and thereby enhance the ecological validity of future video-vignettes studies.

Keywords: Analogue patients; Camera viewpoint; Engagement; Introduction; Patient-provider communication; Psychophysiology; Video-vignettes design.

Fig. 1

Visual illustration of the development of the six video-vignette conditions

Fig. 2

Analogue patients’ self-reported emotional engagement with the video vignette: an interaction effect of introduction format and camera focus. Notes. For analogue patients who watched the physician-only variant (variant 1), an effect of introduction format was found: the audiovisual introduction (format A) resulted in lower emotional engagement than the written introduction (format B; p = 0.004)

Fig. 3

Impact of introduction format on the increase in cardiovascular activity from baseline to the video-vignette introduction (a) and consultation (b). Notes. This figure shows, from top to bottom, analogue patients’ mean systolic blood pressure, diastolic blood pressure and heart rate. Figure 3a, at the left, shows their cardiovascular activity at baseline and during the video-vignette introduction, stratified by introduction formats. Significant effect were shown on systolic blood pressure (p = 0.008) and diastolic blood pressure (p = 0.042), but not on heart rate (p = 0.896). Figure 3b, at the right, shows analogue patients’ mean cardiovascular activity at baseline and during the video-vignette consultation, stratified by introduction formats. Significant effect were shown on systolic blood pressure (p = 0.015) and diastolic blood pressure (p = 0.015), but not on heart rate (p = 0.314)

Fig. 4

Impact of camera focus on the increase in analogue patients’ electrodermal activity from baseline to the video-vignette consultation. Notes. The graph on the left shows analogue patients’ mean skin conductance level and the graph on the right mean skin conductance responses, at baseline and during the video-vignette consultation, stratified by camera focus variants. Analogue patients who watched the vignette with emotion-focused alternating camera focus (variant 3) showed a larger increase in electrodermal activity compared to those who watched one of the other two variants (SCL: p = 0.005; SCRs: p = 0.001)