Does physician–patient communication that aims at empowering patients improve clinical outcome?: A case study
Introduction
It is generally known from clinical routine, and supported by studies of various designs that better physician–patient communication will have a favourable effect on patient satisfaction and compliance [1], [2], [3], [4], [5], [6], [7]. Physician–patient communication also is generally acknowledged as an important quality factor in treatment processes [7], [8], [9], [10], [11], [12], [13], [14]. But little is known so far about effects of physician–patient communication on subjective and objective health status of patients. Clarification is needed whether these effects are unspecific “context effects” (like the Hawthorne effect in organization research—the effect of any kind of social attention as powerful stimulus for improved group performance), or whether specific aspects of communication, in literature often grouped in emotional aspects (a good interpersonal relationship; physician's demonstrated empathy), the exchange of information (leading to improved information and raised motivation of patients), or others are decisive [7].
In the last years, a concept of the relationship between providers of health care and patients stressing the importance of empowering patients to act more co-productive in treatment processes to improve clinical outcomes broadly has been accepted [15], [16], [17], [18], [19], [20], [21]. At the same time this concept also is questioned. Empowerment may only be a lip-service with a traditional paternalistic attitude and practice behind it [22]. Or empowerment may not be the actual wish of the patients [23]. Or empowerment is better conducted by direct focus on patient behaviour than by improving provider–patient interaction [24].
But patient's co-production in our view refers to the fact that a patient cannot just leave his/her body to the doctor to be repaired but always has to (co-)produce his/her health or recuperation, if he/she wants or not. Therefore, clinical outcome is always the effect of a co-production of clinical interventions by staff and living processes of the patient him/herself. So, for optimal clinical results patients have to actively participate and co-operate in all treatment processes, and they have to be enabled by providers to do that effectively.
Prerequisites for enablement or empowerment of patients seems to be a successful doctor–patient communication that provides adequate information, opportunities for (shared) decision making [25], [26] and motivates and supports the patient to co-operate.
Here, we report on a case study in a heart surgery department in an Austrian University Hospital that introduced a program for communication improvement. Focus of the program was to train staff members to communicate in a more patient centred style. Patient centred communication combines to inform the patient about all aspects of treatment that are relevant for him/her, especially concerning possibilities of his/her active participation in treatment processes (informational quality), and to establish a friendly and supportive relationship (emotional quality of communication).
The study examined two research questions: first, whether a training in skills of patient centred communication for professionals and improvements in patient information talk schemes have effects on objective and subjective clinical outcome parameters. Secondly, how can such effects be explained, as unspecific (a Hawthorne effect), or as specifically related either to the informational or to the emotional quality (relational aspect) of provider–patient communication.
The case study was performed as part of an intervention study with three Austrian Hospitals, funded by the Austrian Ministry of Health, that aimed at examining costs and benefits of improving communication with in-patients. Within the larger intervention study, a joint project group with members from all hospitals discussed and counselled the planning of intervention and evaluation designs, and compared results after the implementation of measures.
The heart surgery department was chosen for this case study, because it had the most consistent approach in reorganising patient information schemes and had a sufficient sample size in the patient survey for statistical analysis as well. Also, heart surgery patients are described as an important group for communication interventions [27], [28], [29], [30], [31], [32] due to their special needs for psychosocial support and for relevant information about treatment and rehabilitation processes.
Section snippets
Methods and sample
The case study included 199 patients who underwent cardiac surgery interventions of one of four standardized types (bypass; insertion of an artificial valve; stent; a combination of these; all patients uniformly received a general anaesthesia). Ninety-nine patients were included in the intervention group after a communication training for staff and a reorganization program aiming at improving physician–patient communication was implemented, 100 patients already had been selected for control
Group differences by age, sex, education, type of surgery
There were 98 patients studied without and 97 with the intervention. Proportion of males was 2/3 in both groups, mean age among male patients was 64.6 (S.D. 11.7) versus 62.1 (S.D. 11.8) years, for females 69.8 (S.D. 10.8) versus 66.6 (S.D. 10.6) for control and intervention group, respectively. General education was measured on a nine-item scale, from dropout of elementary school to university graduate: the variable displayed the same distribution for control and intervention group for both
Discussion and conclusion
With respect to potentially relevant confounders like sex, age, formal education and type of surgery, the intervention, and control group were quite homogeneous. These variables also did not predict the clinical outcome measures.
But the intervention group displayed, compared to the control group, substantial improvements in the two objective measures of clinical outcome—incidence of one major type of complications, namely post-surgery tachyarrhythmia, and care level adjusted duration of stay in
Practice implications
Improved communication with patients in major routine interactions in patient care (admission, round wards, trainings, and discharge) in many cases will lead to better clinical results and higher patient satisfaction, without raising net costs. Therefore, investing into staff training and reorganization of information and communication schemes can be an effective and cost effective intervention in hospital care.
More detailed results of the reported project, including a hands-on description of
Limitations to study
As in many studies that are conducted in the framework of an intervention program that aims at improving practical routines in hospitals, there was no randomisation of samples in this case study. All patients that were admitted at the centre during the two survey periods for elective surgery of defined types and fulfilled the inclusion criteria were included in the study.
The indicator used in this study for informational quality also is of limited validity as it measured only patients’
Acknowledgements
We would like to thank the members of the project team at the participating hospital: Dipl. Physiother. Waltraud Beitzke, Ass. Dr. Peter Bergmann, Stat. Sr. Theresia Donner, Mag. Christine Foussek, Dr. Rosina Hetterle, Univ. Prof. Dr. Heinrich Mächler, Univ. Prof. Dr. Peter Stix
References (35)
Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies
Patient Educ Couns
(1992)- et al.
Doctor–patient communication: a review of the literature
Soc Sci Med
(1995) - et al.
Communication between surgeons and patients in routine office visits
Surgery
(1999) - et al.
Information and its impact on satisfaction among surgical patients
Soc Sci Med
(2000) Patient–doctor communication
Med Clin N Am
(2003)- et al.
Empowerment: from philosophy to practice
Patient Educ Couns
(1995) The importance of patient empowerment in health system reform
Health Policy
(1998)- et al.
Patient empowerment and control: a psychological discourse in the service of medicine
Soc Sci Med
(2003) - et al.
Patient empowerment and control: a psychological discourse in the service of medicine
Soc Sci Med
(2003) - et al.
Provider–patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review
Patient Educ Couns
(2003)
Decision-making in the physican–patient encounter: revisiting the shared treatment decision-making model
Soc Sci Med
Effects of education and support for surgical patients: the role of perceived control
Patient Educ Couns
Reducing the risk after coronary artery bypass surgery: documentation of risk factors and communication between hospital and general practice
Public Health
Clinical and cost-saving effects of psychoeducational interventions with surgical patients: a meta-analysis
Res Nurs Health
Influence of context effects on health outcomes: a systematic review
Lancet
The Effects of Physician Empathy on Patient Satisfaction and Compliance
Eval Health Prof
Effective physician–patient communication and health outcomes: a review
Can Med Assoc J
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