Previous reviews have attempted to estimate the magnitude of the effect of relational factors on health outcomes and to discern the relative impact of discrete interventions and contextual factors, ,. Indeed, any intervention designed to improve communication – if effectively employed – is also likely to improve the quality of the interpersonal relationship. While these techniques are intended to improve the quality of information exchange, they are also likely to produce richer interpersonal interactions. For example, communications interventions often train clinicians to ask more open-ended questions, to resist interrupting patients, to identify and respond to patient expectations and fears, and to check patients' understanding of the diagnosis and recommended treatment. We also note that the boundary between cognitive care such as communications training and emotional care that enhances the patient-clinician relationship is unclear.
We note, however, that studies that do not separately measure emotional care while investigating communication interventions leave unclear which factor – emotional care or cognitive care – is responsible for any beneficial effects. However, most studies of the patient-clinician relationship include both cognitive and emotional care, and consequently, we expanded our focus to include these studies also. Initially, our primary aim was to investigate the emotional component of the patient-clinician relationship. Cognitive care includes information gathering, sharing medical information, patient education, and expectation management. Emotional care includes mutual trust, empathy, respect, genuineness, acceptance and warmth. The patient-clinician relationship has both emotional and informational components – what Di Blasi and colleagues have termed emotional care and cognitive care. Nevertheless, these observational studies do suggest that relationship factors may hold important potential to affect health outcomes. In fact, most empirical studies examining the effect of the patient-clinician relationship on medical outcomes have been observational in nature, ,, ,, ,, and therefore cannot assess causality. However, despite this widespread and longstanding belief, the effect of the patient-clinician relationship on healthcare outcomes has rarely been tested in randomized controlled trials.
Excellent clinicians strive to master not only the theory of disease and treatment, but also to cultivate a therapeutic presence that is commonly believed to improve the experience of patients and to have a beneficial effect on medical outcomes. One of the great challenges of modern medicine is to preserve the finest elements of caregiving in an environment that is increasingly dominated by market forces and routinized practices. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
Riess is a stockholder, Chief Technology Officer, and Chairman of Empathetics, LLP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: Dr.
Joe Kossowsky's contributions to this study were supported by the Swiss National Science Foundation, grant project (P2BSP1_148628). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This study was made possible with a grant from the Arnold P. Received: AugAccepted: MaPublished: April 9, 2014Ĭopyright: © 2014 Kelley et al. PLoS ONE 9(4):Įditor: Antje Timmer, Carl von Ossietzky University of Oldenburg, Germany Citation: Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H (2014) The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.