A general model of conversational dynamics and an example application in serious illness communication

PLoS One. 2021 Jul 1;16(7):e0253124. doi: 10.1371/journal.pone.0253124. eCollection 2021.

Abstract

Conversation has been a primary means for the exchange of information since ancient times. Understanding patterns of information flow in conversations is a critical step in assessing and improving communication quality. In this paper, we describe COnversational DYnamics Model (CODYM) analysis, a novel approach for studying patterns of information flow in conversations. CODYMs are Markov Models that capture sequential dependencies in the lengths of speaker turns. The proposed method is automated and scalable, and preserves the privacy of the conversational participants. The primary function of CODYM analysis is to quantify and visualize patterns of information flow, concisely summarized over sequential turns from one or more conversations. Our approach is general and complements existing methods, providing a new tool for use in the analysis of any type of conversation. As an important first application, we demonstrate the model on transcribed conversations between palliative care clinicians and seriously ill patients. These conversations are dynamic and complex, taking place amidst heavy emotions, and include difficult topics such as end-of-life preferences and patient values. We use CODYMs to identify normative patterns of information flow in serious illness conversations, show how these normative patterns change over the course of the conversations, and show how they differ in conversations where the patient does or doesn't audibly express anger or fear. Potential applications of CODYMs range from assessment and training of effective healthcare communication to comparing conversational dynamics across languages, cultures, and contexts with the prospect of identifying universal similarities and unique "fingerprints" of information flow.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anger
  • Communication
  • Critical Illness / psychology*
  • Emotions / physiology
  • Fear / psychology
  • Humans
  • Models, Theoretical
  • Palliative Care
  • Psychological Distress*
  • Speech / physiology*

Grants and funding

Grant Award #: RSG PCSM124655 Funded Authors: RG Funder Name: American Cancer Society Funder Website: https://www.cancer.org/research/we-fund-cancer-research/apply-research-grant/grant-types/research-scholar-grants.html Did funder play a role in the design, data collection, etc.: No Grant Award #: n/a Funded Authors: RG, LAC Funder Name: Holly & Bob Miller Endowment Funder Website: https://www.uvm.edu/uvmnews/news/holly-and-bob-miller-donate-3-million-establish-chair-palliative-medicine-uvm-college Did funder play a role in the design, data collection, etc.: No Grant Award #: NSF OIA 1556770 Funded Authors: DMR Funder Name: National Science Foundation Funder Website: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1556770 Did funder play a role in the design, data collection, etc.: No Grant Award #: NSF CRISP 1735513 Funded Authors: LAC, MJE Funder Name: National Science Foundation Funder Website: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1735513 Did funder play a role in the design, data collection, etc.: No.