Coding patient emotional cues and concerns in medical consultations: The Verona coding definitions of emotional sequences (VR-CoDES)

Christa Zimmermann, Lidia Del Piccolo, Jozien Bensing, Svein Bergvik, Hanneke De Haes, Hilde Eide, Ian Fletcher, Claudia Goss, Cathy Heaven, Gerry Humphris, Young Mi Kim, Wolf Langewitz, Ludwien Meeuwesen, Matthias Nuebling, Michela Rimondini, Peter Salmon, Sandra van Dulmen, Larry Wissow, Linda Zandbelt, Arnstein Finset

Research output: Contribution to journalArticlepeer-review

150 Scopus citations


Objective: To present the Ve. rona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns. Methods: The system was developed by an international group of communication researchers. First, consensus was reached in different steps. Second, a reliability study was conducted on 20 psychiatric consultations. Results: A Cue is defined as a verbal or non-verbal hint which suggests an underlying unpleasant emotion that lacks clarity. A Concern is defined as a clear and unambiguous expression of an unpleasant current or recent emotion that is explicitly verbalized with or without a stated issue of importance. The conceptual framework sets precise criteria for cues and concerns and for whom (health provider or patient) elicits the cue/concern. Inter-rater reliability proved satisfactory (agreement 81.5%, Cohen's Kappa 0.70). Conclusion: The VR-CoDES CC will facilitate comparative research on provider-patient communication sequences in which patients express emotional distress. Practice implications: The VR-CoDES CC may be used to help clinicians in recognizing or facilitating cues and concerns, thereby improving the recognition of patients' emotional distress, the therapeutic alliance and quality of care for these patients.

Original languageEnglish (US)
Pages (from-to)141-148
Number of pages8
JournalPatient Education and Counseling
Issue number2
StatePublished - Feb 2011
Externally publishedYes


  • Coding definitions
  • Concern
  • Cue
  • VR-CoDES

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Coding patient emotional cues and concerns in medical consultations: The Verona coding definitions of emotional sequences (VR-CoDES)'. Together they form a unique fingerprint.

Cite this