Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study
Nonverbal communication is essential in physician–patient interaction, especially in telemedicine where verbal cues may be limited. This study aimed to identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations through a Delphi method. A three-round Delphi...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2025-12-01
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| Series: | Medical Education Online |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/10872981.2025.2497328 |
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| author | Annisa Ristya Rahmanti Hsuan-Chia Yang Chih-Wei Huang Ching-Tzu Huang Lutfan Lazuardi Che-Wei Lin Yu-Chuan Jack Li |
| author_facet | Annisa Ristya Rahmanti Hsuan-Chia Yang Chih-Wei Huang Ching-Tzu Huang Lutfan Lazuardi Che-Wei Lin Yu-Chuan Jack Li |
| author_sort | Annisa Ristya Rahmanti |
| collection | DOAJ |
| description | Nonverbal communication is essential in physician–patient interaction, especially in telemedicine where verbal cues may be limited. This study aimed to identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations through a Delphi method. A three-round Delphi study was conducted from June to November 2022, involving various experts, including academics, healthcare professionals, AI/telemedicine researchers, industry professionals, and patients. Experts evaluated the importance, validity, and reliability of potential nonverbal cues. Consensus was determined based on median responses and expert scoring percentages, with statistical agreement and stability assessed using Kendall’s coefficient of concordance (Kendall’s W) and Wilcoxon signed-rank test. Analyses were conducted using SPSS, version 23.0 with significance set at p < 0.05. Of the 72 experts invited, 37 (51%) agreed to participate, with 35 completing the first round (95% completion rate). Eight significant nonverbal cues were identified in the first round, though one did not reach consensus. The second round obtained an 89% response rate (31/35), with three new cues introduced; one did not reach consensus. Round 3 achieved a 94% response rate (29/31), finalizing nine key cues: facial expression, eye contact, tone of voice, smiling, head nodding, body posture, hand gesture, distance, and environmental cues. Among these, facial expression, eye contact, and tone of voice were identified as the most crucial. Inter-expert agreement was statistically significant across all items with strong agreement on the importance (W = 0.739, p < 0.001), good agreement on their validity (W = 0.689, p < 0.001), and moderate agreement on their reliability (W = 0.452, p < 0.001). This study highlights the importance of specific nonverbal cues in telemedicine, particularly facial expression, eye contact, and tone of voice. It provides a validated foundation for developing tools to enhance physician–patient interactions and potentially improve health outcomes in telemedicine. |
| format | Article |
| id | doaj-art-7e3c2cfc9c854fafb8e0d2866a12e331 |
| institution | Kabale University |
| issn | 1087-2981 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Medical Education Online |
| spelling | doaj-art-7e3c2cfc9c854fafb8e0d2866a12e3312025-08-20T03:48:52ZengTaylor & Francis GroupMedical Education Online1087-29812025-12-0130110.1080/10872981.2025.2497328Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi studyAnnisa Ristya Rahmanti0Hsuan-Chia Yang1Chih-Wei Huang2Ching-Tzu Huang3Lutfan Lazuardi4Che-Wei Lin5Yu-Chuan Jack Li6Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaInternational Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanInternational Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanInternational Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanDepartment of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaCenter for Education in Medical Simulation, Taipei Medical University, Taipei, TaiwanInternational Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanNonverbal communication is essential in physician–patient interaction, especially in telemedicine where verbal cues may be limited. This study aimed to identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations through a Delphi method. A three-round Delphi study was conducted from June to November 2022, involving various experts, including academics, healthcare professionals, AI/telemedicine researchers, industry professionals, and patients. Experts evaluated the importance, validity, and reliability of potential nonverbal cues. Consensus was determined based on median responses and expert scoring percentages, with statistical agreement and stability assessed using Kendall’s coefficient of concordance (Kendall’s W) and Wilcoxon signed-rank test. Analyses were conducted using SPSS, version 23.0 with significance set at p < 0.05. Of the 72 experts invited, 37 (51%) agreed to participate, with 35 completing the first round (95% completion rate). Eight significant nonverbal cues were identified in the first round, though one did not reach consensus. The second round obtained an 89% response rate (31/35), with three new cues introduced; one did not reach consensus. Round 3 achieved a 94% response rate (29/31), finalizing nine key cues: facial expression, eye contact, tone of voice, smiling, head nodding, body posture, hand gesture, distance, and environmental cues. Among these, facial expression, eye contact, and tone of voice were identified as the most crucial. Inter-expert agreement was statistically significant across all items with strong agreement on the importance (W = 0.739, p < 0.001), good agreement on their validity (W = 0.689, p < 0.001), and moderate agreement on their reliability (W = 0.452, p < 0.001). This study highlights the importance of specific nonverbal cues in telemedicine, particularly facial expression, eye contact, and tone of voice. It provides a validated foundation for developing tools to enhance physician–patient interactions and potentially improve health outcomes in telemedicine.https://www.tandfonline.com/doi/10.1080/10872981.2025.2497328Nonverbal communicationtelemedicinedoctor–patient interactionDelphi studyempathy |
| spellingShingle | Annisa Ristya Rahmanti Hsuan-Chia Yang Chih-Wei Huang Ching-Tzu Huang Lutfan Lazuardi Che-Wei Lin Yu-Chuan Jack Li Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study Medical Education Online Nonverbal communication telemedicine doctor–patient interaction Delphi study empathy |
| title | Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study |
| title_full | Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study |
| title_fullStr | Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study |
| title_full_unstemmed | Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study |
| title_short | Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study |
| title_sort | validating nonverbal cues for assessing physician empathy in telemedicine a delphi study |
| topic | Nonverbal communication telemedicine doctor–patient interaction Delphi study empathy |
| url | https://www.tandfonline.com/doi/10.1080/10872981.2025.2497328 |
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