Medical & Biological Engineering & Computing

, Volume 57, Issue 1, pp 123–134 | Cite as

Cardiovascular assessment of supportive doctor-patient communication using multi-scale and multi-lag analysis of heartbeat dynamics

  • M. NardelliEmail author
  • A. Greco
  • O. P. Danzi
  • C. Perlini
  • F. Tedeschi
  • E. P. Scilingo
  • L. Del Piccolo
  • G. Valenza
Original Article


Emphatic doctor-patient communication has been associated with improved psycho-physiological well-being involving cardiovascular and neuroendocrine responses. Nevertheless, a comprehensive assessment of heartbeat linear and nonlinear dynamics throughout the communication of a life-threatening disease has not been performed yet. To this extent, we studied linear heartbeat dynamics through the extraction of time-frequency domain measurements, as well as heartbeat nonlinear and complex dynamics through novel approaches to compute multi-scale and multi-lag series analyses: namely, the multi-scale distribution entropy and lagged Poincaré plot symbolic analysis. Heart rate variability series were recorded from 54 healthy female subjects who were blind to the aim of the experiment. Participants were randomly assigned into two groups: 27 subjects watched a video where an oncologist discloses the diagnosis of a cancer metastasis to a patient, whereas the remaining 27 watched the same video including four additional supportive comments by the clinician. Considering differences between the beginning and the end of each communication video, results from non-parametric Wilcoxon tests demonstrated that, at a group level, significant differences occurred in heartbeat linear and nonlinear dynamics, with lower complexity during nonsupportive communication. Furthermore, a support vector machine algorithm, validated using a leave-one-subject-out procedure, was able to discern the supportive experience at a single-subject level with an accuracy of 83.33% when nonlinear features were considered, dropping to 51.85% when using standard HRV features only. In conclusion, heartbeat nonlinear and complex dynamics can be a viable tool for the psycho-physiological evaluation of supportive doctor-patient communication.

Graphical Abstract

Scheme of the three main stages of the study: signal acquisition during doctor-patient communication, ECG signal processing and pattern recognition results.


Supportive communication Multi-scale entropy Distribution entropy Lagged Poincaré plot Pattern recognition Support vector machine 


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Copyright information

© International Federation for Medical and Biological Engineering 2018

Authors and Affiliations

  1. 1.Bioengineering and Robotics Research Centre E. Piaggio, Department of Information Engineering, School of EngineeringUniversity of PisaPisaItaly
  2. 2.Department of Neurological, Biomedical and Movement SciencesUniversity of VeronaVeronaItaly

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