Nonverbal behavior in prognostic communication: A pilot experiment in virtual reality

Context: Clinicians' nonverbal behaviors contribute to patients' responses to prognosis communication, yet little empirical evidence supports precise nonverbal behaviors and the mechanisms by which they contribute to perceptions of high-quality communication. Virtual reality (VR) is a promising tool for researching communication, allowing researchers to manipulate nonverbal behaviors in controlled simulation and examine outcomes. Objectives: The goal of this pilot study was to assess whether manipulated changes in avatar doctors' nonverbal behaviors could lead to measurable differences of participant feelings, reactions, or sense of immersion in a VR scenario of prognosis communication. Methods: In this pilot experiment, university student participants were randomized to a short prognosis communication simulation in immersive VR representing one of five nonverbal conditions: No nonverbals, Smile only, Nod only, Lean only, All nonverbals. Outcomes included cognitive (e.g., cognitive load, recall), socioemotional (e.g., emotional valence, satisfaction, anxiety), and immersion and presence. Results: Our sample comprised 229 participants. Pilot experimental findings suggest that some participant responses differed as a result of the manipulation of nonverbal behaviors. However, results did not point to the presence or absence of a particular nonverbal behavior as driving reactions to prognostic communication. Conclusions: VR can allow for experimental manipulation of nonverbal behavior. There is need for further development to optimally conduct sensitive and ecologically valid communication simulations for research, and for research into discrete nonverbal behaviors to improve serious illness communication training and practice. Innovation: VR experimental simulations are a promising tool for building the evidence base of nonverbal behavior in serious illness communication.