Can patient–provider interaction increase the effectiveness of medical treatment or even substitute it?—An exploration on why and how to study the specific effect of the provider

doi:10.1016/j.pec.2010.07.020

Patient Education and Counseling

Volume 80, Issue 3, September 2010, Pages 307-314

https://doi.org/10.1016/j.pec.2010.07.020 Get rights and content

Abstract

Objective

Numerous studies demonstrate the impact of high-quality patient–provider interaction (PPI) on health outcomes. However, transformation of these findings into clinical practice is still a crucial problem. One reason might be that health communication research rarely investigated whether PPI can increase the effectiveness of medical treatment and/or even substitute it. Therefore, our objective was to provide empirical and methodological background of why and how to investigate the specific effect of the provider on patients’ health outcomes.

Methods

This is a debate paper based on a narrative (non-systematic) literature review in Medline and PsycINFO without any year limitation.

Results

Neurobiological evidence based on expectation and conditioning theory indicates that PPI is able to increase the effectiveness of medical treatment. Moreover, the use of creative RCT study designs described in this paper enables health communication researchers to investigate whether PPI is able to substitute medical treatment.

Conclusion

This paper exemplifies that there exist an evidence-based knowledge from neurobiology as well as creative RCT designs which enable researcher to investigate the specific effects of PPI.

Practice implications

Research on the specific effects of PPI requires intense reflection on which patient groups or types of illness are reasonable, suitable, and ethically justifiable for interventions.

Introduction

In 1984, Inui and Carter stated that “… health services research on provider–patient communication should ultimately sense to improve the quality and effectiveness of clinical practice.” [1, p. 534]. In 2010, there is strong research evidence that high-quality verbal and non-verbal interaction between patient and provider can improve a diverse range of patient health outcomes. However, the transformation of these primarily analytic findings into clinical practice remains still a crucial problem [2].

According to the model of “Interaction between the societal sector and research” [3] (see Fig. 1), the lack of transformation these research findings into clinical practice results in a missing perception of the practical problems of stakeholders (e.g. patients and clinicians), intermediary groups (e.g. health insurance, universities) and health policy such as follows:

•
Health policy: “We highly promote health care/medical interventions that are safe, effective, patient-centered, timely, efficient, and equitable.” [4].
•
Health insurance: “We do not pay for talking, when we know nothing about the effectiveness and efficiency of an enhanced patient–provider interaction.”
•
Clinicians: “I am not able to spend 15 or 20 min for intense communication with each patient without highly risking my financial security.” [5], [6].
•
Universities: “We do not develop patient–provider interaction as a main subject, if the effects for the patient do not have a strong evidence base as e.g. in pharmacology.”
•
Patients: “It is hard to find a doctor who listens, explains clearly, who has sufficient time for me and with whom I am able to get an appointment. I should rather go to a CAM-practitioner.” [7].

Recognizing and responding to these practical problems implies deriving appropriate research questions in health communication research as for example: (1) can high-quality patient–provider interaction increase the effectiveness and/or efficiency of medical treatment, particularly related to achieving improved health outcomes? and (2) can high-quality patient–provider interaction even substitute for medical treatment? In other words: does patient–provider interaction have a specific effect on patient health outcomes that is tangible and accountable?

The aim of this paper is to present empirical and methodological background of why and how to investigate these research questions. Therefore, we

(a)
provide a basic introduction to the placebo concept (Section 3.1);
(b)
give a brief summary of neurobiological findings on expectation and classical conditioning theories and provide study examples showing how these mechanisms can increase the effectiveness of medical treatment (Section 3.2);
(c)
present examples of research designs of how to investigate whether patient–provider interaction can substitute for medical treatment (Section 3.3);
(d)
discuss these results by deriving implications for health communication research (Section 4).

Section snippets

Methods

This is a debate paper based on a narrative (non-systematic) literature review in Medline and PsycINFO without any year limitation. A hand search was also conducted of reprint files and reference sections of the articles and other publications we found in Medline and PsycINFO.

The first author selected relevant publications among the generated hits by examining the title and abstract of every publication. Subsequently, they were considered by all authors in an in-depth process, according to the

Results

Firstly, we give a basic introduction to the placebo concept (compare also Bensing et al. in this issue) for a deeper understanding of Sections 3.2 Can patient–provider interaction increase the effectiveness of medical treatment?, 3.3 Can patient–provider interaction substitute medical treatment?.

Discussion

Summarizing our results, we can state that (1) neurobiological evidence indicates that patient–provider interaction is able to increase the effectiveness of medical treatment, and (2) the presented study design examples are able to investigate if patient–provider interaction could substitute for medical treatment.

Although we respond to an evidence-based and stakeholder-oriented research paradigm by proposing RCT design, we are aware of several limitations: in real clinical practice the

Role of the funding source

We are grateful to the Software AG Foundation, the Mahle Foundation and the Cultura Foundation for their financial support of Melanie Neumann, Christian Scheffer, Diethard Tauschel and Friedrich Edelhaeuser.

Conflict of interest

We confirm that all patient/personal identifiers have been removed or disguised to ensure anonymity of all patients/persons described. The authors indicated no potential conflict of interest.

Acknowledgements

The first author is grateful to her husband for his outstanding support of her work and his tireless encouragement to pursue new thoughts and ideas.

All authors would like to thank Gudrun Lamprecht for her wonderful support in the delivery of literature as well as Sarah Frances for her qualified support concerning our application of the English language.

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View full text

Can patient–provider interaction increase the effectiveness of medical treatment or even substitute it?—An exploration on why and how to study the specific effect of the provider

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Methods

Results

Discussion

Role of the funding source

Conflict of interest

Acknowledgements

Behav Res Ther

Neuron

Patient Educ Couns

Soc Sci Med

Explore

Lancet

Soc Sci Med

Problems and prospects for health services research on provider–patient communication

Med Care

Opportunities for health communication scholarship to shape public health policy and practice: examples from the National Cancer Institute

Doing the right thing and doing it right: toward a framework for assessing the policy relevance of health services research

Int J Technol Assess Health Care

Crossing the quality chasm: a new health system for 21st century

Consultation length in general practice: cross sectional study in six European countries

Brit Med J

The P value of empathy

Brit Med J

The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review

Health Technol Assess

How the doctor's words affect the brain

Eval Health Prof

Placebo effects. Understanding the mechanisms in health and disease

Attitudes toward the use of placebos in treatment

J Nerv Ment Dis

Factors contributing to the placebo effect

Am J Psychother

Patient–provider relationships and the placebo effect

Explication and implications of the placebo concept

The placebo response

J Fam Pract

Placebo interventions for all clinical conditions

Cochrane Database Syst Rev

The placebo effect. Illness and interpersonal healing

Perspect Biol Med

Expectations and associations that heal: immunomodulatory placebo effects and its neurobiology

Brain Behav Immun

Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes

CMAJ

Placebo-responsive Parkinson patients show decreased activity in single neurons of subthalamic nucleus

Nat Neurosci

Reviving the old sermon of medicine with the placebo effect

Rev Bras Psiquitr