Culturally Acceptable Emotional Expressions Perceived by Non-U.S. Physicians Undergoing U.S.-Based Serious Illness Communication Skills Training: A Cross-Sectional Study

Context: Responding to emotions is a key feature of U.S.-based serious illness communication skills training, VitalTalk^®, of which trained actors portraying seriously ill patients is a component. The cultural appropriateness and perceived utility of the actors’ emotional expressions remain to be empirically evaluated outside of the U.S. Objectives: To determine the cultural appropriateness and educational utility of VitalTalk^® actors’ emotional expressions, as perceived by clinicians. Methods: From January 2021-April 2022, we conducted a cross-sectional study of physicians in Japan attending virtual VitalTalk^® training in Japanese, each session focusing on: responding to emotions (#1) and discussing goals of care (#2), respectively. We examined their perceived authenticity and utility of the actively and passively intense emotional expressions portrayed by actors in VitalTalk^® role-plays. Results: Physicians (N = 100, 94% response rate) from across Japan voluntarily attended two-session workshops and completed post-session surveys. Eighty-eight participants (88%) responded that both actively and passively intense emotions portrayed by the actors provided useful learning experiences. For session #1, the participants found actively intense emotional expressions to be more clinically authentic, compared to passively intense ones (4.21 vs 4.06 out of a 5-point Likert scale, PP=.02). For session #2, no such difference was observed (4.16 vs 4.08 of a 5-point Likert scale, P =.24). Conclusions: Even in a culture where patients may express emotions passively, any intense and authentic emotional expressions by actors can be perceived as facilitating learning. Most participants perceived both the Name, Understand, Respect, Support, and Explore ‘(NURSE)' statements and Reframe, Expect emotion, Map out patient goals Align with goals and Propose a plan ‘(REMAP)' frameworks as useful in routine clinical practice in Japan.