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Broadbridge E, Roter DL, Persky S, Erby LH. Measuring the therapeutic bond in genetic counseling: Testing measurement error in the bond subscale of the Working Alliance Inventory. J Genet Couns 2024:10.1002/jgc4.1844. [PMID: 38308411 PMCID: PMC11294495 DOI: 10.1002/jgc4.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
The therapeutic relationship is a key component of successful genetic counseling. In psychotherapy, a strong therapeutic relationship can improve patient health outcomes and a poor relationship can worsen psychological functioning. Investigation of the therapeutic relationship in genetic counseling has shown evidence for a similar pattern. Reliable measurement of the therapeutic relationship is necessary for consistency across studies in the genetic counseling context. One measure that has been adapted for use in genetic counseling is the Working Alliance Inventory (WAI). However, there have been no studies of the factor structure or item-level method bias analyses for the genetic counseling-adapted version of the WAI. The goal of this study was to test the factor structure of the WAI observer version (WAI-O) bond subscale and assess method bias in a genetic counseling context. We hypothesized that differences in factor structures would exist for items that were positively (n = 9) versus negatively (n = 3) worded (reverse coded). Secondary data analysis was performed on two data sets that utilized the WAI-O in genetic counseling contexts. Data set 1 used simulated genetic counseling sessions that were judged by analog clients recruited through crowdsourcing platforms (N = 861). Data set 2 was conducted with genetic counseling clients, and sessions were evaluated by a research team (N = 120). Principal axis factor analysis with oblique oblimin rotation supported a two-factor solution for the WAI-O bond subscale across data sets. Items factored based on wording, with the positively worded items loading together and the negatively worded items loading on the second factor. Confirmatory factor analyses supported the removal of all negatively worded items from the instrument across data sets. Results suggest that the negatively worded items on the WAI-O may be capturing a construct inconsistent with the positively worded items and support rewording and/or excluding them from use for a more reliable measure of the therapeutic bond.
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Affiliation(s)
- Elizabeth Broadbridge
- Department of Communication, Rutgers University, New Brunswick, NJ
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, MD
| | - Debra L. Roter
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, MD
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD
| | - Lori H. Erby
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, MD
- Center for Precision Health Research, National Human Genome Research Institute, NIH, Bethesda, MD
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2
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Carmel MA, Mishali M. Patient-physician alliance and patient's sense of self-efficacy are negatively associated with resistance to treatment among patients with type 2 diabetes. Prim Care Diabetes 2023; 17:185-189. [PMID: 36775726 DOI: 10.1016/j.pcd.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 10/19/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
AIMS Resistance to treatment is prevalent among patients diagnosed with chronic conditions, including type 2 diabetes (T2DM). The current study aimed to examine the relationship between patient characteristics, patient-physician relationship, and resistance to treatment in T2DM. METHODS A sample of 120 T2DM patients were recruited by means of non-randomized sampling and through a public post on Facebook. Participants were asked to fill-in several questionnaires online: Rotter's Locus of Control questionnaire (short version); the General Self-efficacy (GSE) questionnaire; the Working Alliance Inventory - Short Revised (WAI-SR) - evaluating patient-physician relationship; and, finally, the Resistance to Treatment Questionnaire (RTQ) - which meant to capture the intensity of resistance to treatment and served as the dependent variable in this study. RESULTS Interestingly, better patient-physician relationship and higher sense of self-efficacy among patients were found to negatively associate with patient's resistance to treatment (r = -.53, p < .001, and, r = -.26, p < .01, respectively). Patient-physician relationship explained 22% of the variance of resistance to treatment, and self-efficacy explained 6% of the variance. CONCLUSIONS Stronger patient-doctor relationship and higher sense of self-efficacy are shown to robustly associate with lower resistance to treatment among patients with T2DM. Current findings may instructor educate physicians as to the importance of the alliance with these chronic patients.
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Affiliation(s)
- Moran Accos Carmel
- The School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838 Haifa, Israel.
| | - Moshe Mishali
- The School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838 Haifa, Israel.
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3
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Oudshoorn CEM, Frielink N, Riper H, Embregts PJCM. Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:49-63. [PMID: 36320102 PMCID: PMC10092498 DOI: 10.1111/jir.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address. METHOD Both the validated Working Alliance Inventory - Short Form - MID (WAI-SF-MID) and Technical Alliance Inventory - Short Form - MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales. RESULTS An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions. CONCLUSION Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.
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Affiliation(s)
- C. E. M. Oudshoorn
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - N. Frielink
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - H. Riper
- Department of Clinical, Neuro‐ & Developmental PsychologyVrije Universiteit Amsterdam, Amsterdam Public Health, Mental Health ProgramAmsterdamThe Netherlands
- Department of PsychiatryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - P. J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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Dugas MJ, Sexton KA, Hebert EA, Bouchard S, Gouin JP, Shafran R. Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder. Behav Ther 2022; 53:1147-1160. [PMID: 36229113 DOI: 10.1016/j.beth.2022.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.
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Affiliation(s)
| | | | | | | | | | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London
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Sturgiss E, Advocat J, Ball L, Williams LT, Prathivadi P, Clark AM. Behaviour change for type 2 diabetes: perspectives of general practitioners, primary care academics, and behaviour change experts on the use of the 5As framework. Fam Pract 2022; 39:891-896. [PMID: 35079780 DOI: 10.1093/fampra/cmab182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The 5As framework is a recognized underpinning of behaviour change guidelines, teaching, and research in primary care. Supporting patients to improve their lifestyle behaviours, including diet and physical activity, is a common aspect of type 2 diabetes mellitus (T2DM) management. The 5As framework often informs behaviour change for patients with T2DM. OBJECTIVE To explore the experience and perspectives of general practitioners (GPs) and primary care academics and behaviour change experts regarding using the 5As framework when caring for patients with T2DM to better understand how and why the 5As are effective in practice. METHODS We recruited 20 practising GPs, primary care academics, and behaviour change experts for an individual semistructured interview and analysed the data using a realist evaluation approach. RESULTS There were diverse accounts of how GPs use the 5As in practice and few of the participants could name each "A." The 5As were commonly regarded as a framework best suited to beginners and although GPs expressed they followed the broad direction of the 5As, they did not consciously follow the framework in an instructive manner. Elements that could enhance the 5As included more emphasis on motivational interviewing, changing how "Ask" is included in the consultation, and increased person-centredness. CONCLUSION Although it is a ubiquitous framework in primary care, the 5As are understood in diverse ways and applied variably in practice. There is room to enhance how the 5As support behaviour change consultations to optimize outcomes in primary care.
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Affiliation(s)
- Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jenny Advocat
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Pallavi Prathivadi
- Department of General Practice, School of Primary and Allied Health Care, Monash University, MelbourneAustralia
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Meier ST. Investigation of causes of ceiling effects on working alliance measures. Front Psychol 2022; 13:949326. [PMID: 35936314 PMCID: PMC9353022 DOI: 10.3389/fpsyg.2022.949326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of ceiling effects on measures of working alliance is important because they (a) may moderate the observed size of the alliance-outcome correlation and (b) have implications for how quickly the alliance is formed and when. Despite this, little is known about ceiling effects on alliance measures, particularly about potential causes. This study attempted to replicate findings of ceiling effects using a 7-item version of the Working Alliance Inventory (WAI) (Horvath and Greenberg, 1989) accessed in an archival database of 616 parolees enrolled in a drug abuse treatment study. Item response patterns on alliance and related measures were examined to explore potential methodological and theoretical factors that could produce ceiling effects. Analyses revealed ceiling effects on alliance measures assessing relationships with counselors and parole officers as well as floor effects (indicating highly positive appraisals) in measures of outcome expectations with counselors and parole officers. No ceiling effects were found with measures of drug use problems or negative affect. Item responses on the alliance and outcome expectations measures evidenced high consistency where many respondents endorsed the same choice on the 5-point response format across all items on the scale. Ceiling effects offer a potential marker of the working alliance at the scale level, while consistent response choice may provide a specific behavioral marker at the item level. Discussion focuses on theoretical implications and directions for future research in psychotherapy.
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Paap D, Karel YHJM, Verhagen AP, Dijkstra PU, Geertzen JHB, Pool G. The Working Alliance Inventory's Measurement Properties: A Systematic Review. Front Psychol 2022; 13:945294. [PMID: 35910993 PMCID: PMC9337219 DOI: 10.3389/fpsyg.2022.945294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989–2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies.
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Affiliation(s)
- Davy Paap
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Physical Therapy, Saxion University of Applied Science, Enschede, Netherlands
- *Correspondence: Davy Paap
| | - Yasmaine H. J. M. Karel
- Center of Expertise Caring Society 3.0, Avans University of Applied Science, Breda, Netherlands
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
| | - Arianne P. Verhagen
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Grieteke Pool
- Section Health Psychology, Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Carvalho IP, Dores AR. Clinical Communication in Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127268. [PMID: 35742516 PMCID: PMC9223282 DOI: 10.3390/ijerph19127268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Irene P. Carvalho
- Medical Psychology Unit, Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence:
| | - Artemisa R. Dores
- Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal;
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, 4099-002 Porto, Portugal
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Galvão DA, Taaffe DR, Hayne D, Lopez P, Lyons-Wall P, Tang CI, Chambers SK, Devine A, Spry N, Jeffery E, Kudiarasu C, Joseph D, Newton RU. Weight loss for overweight and obese patients with prostate cancer: a study protocol of a randomised trial comparing clinic-based versus Telehealth delivered EXercise and nutrition intervention (the TelEX trial). BMJ Open 2022; 12:e058899. [PMID: 35667725 PMCID: PMC9171278 DOI: 10.1136/bmjopen-2021-058899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Obese men with prostate cancer have an increased risk of biochemical recurrence, metastatic disease and mortality. For those undergoing androgen deprivation therapy (ADT), substantial increases in fat mass are observed in the first year of treatment. Recently, we showed that a targeted supervised clinic-based exercise and nutrition intervention can result in a substantial reduction in fat mass with muscle mass preserved in ADT-treated patients. However, the intervention needs to be accessible to all patients and not just those who can access a supervised clinic-based programme. The purpose of this study was to evaluate the efficacy of telehealth delivered compared with supervised clinic-based delivered exercise and nutrition intervention in overweight/obese patients with prostate cancer. METHODS AND ANALYSIS A single-blinded, two-arm parallel group, non-inferiority randomised trial will be undertaken with 104 overweight/obese men with prostate cancer (body fat percentage ≥25%) randomly allocated in a ratio of 1:1 to a telehealth-delivered, virtually supervised exercise and nutrition programme or a clinic-based, face-to-face supervised exercise and nutrition programme. Exercise will consist of supervised resistance and aerobic exercise performed three times a week plus additional self-directed aerobic exercise performed 4 days/week for the first 6 months. Thereafter, for months 7-12, the programmes will be self-managed. The primary endpoint will be fat mass. Secondary endpoints include lean mass and abdominal aortic calcification, anthropometric measures and blood pressure assessment, objective measures of physical function and physical activity levels, patient-reported outcomes and blood markers. Measurements will be undertaken at baseline, 6 months (post intervention), and at 12 months of follow-up. Data will be analysed using intention-to-treat and per protocol approaches. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Edith Cowan University Human Research Ethics Committee (ID: 2021-02157-GALVAO). Outcomes from the study will be published in academic journals and presented in scientific and consumer meetings. TRIAL REGISTRATION NUMBER ACTRN12621001312831.
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Affiliation(s)
- Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dickon Hayne
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
- Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Pedro Lopez
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - P Lyons-Wall
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Colin I Tang
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Emily Jeffery
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christine Kudiarasu
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Knox M, Esteban EE, Hernandez EA, Fleming MD, Safaeinilli N, Brewster AL. Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program. BMJ Open Qual 2022; 11:e001807. [PMID: 35667706 PMCID: PMC9171266 DOI: 10.1136/bmjoq-2021-001807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers. SETTING Case management program for high-risk, complex patients run by an integrated, county-based public health system. PARTICIPANTS 30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March-November 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The analysis intended to identify characteristics of success working with patients. RESULTS Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients' mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics. CONCLUSIONS Themes emphasise the importance of compassion for complexity in patients' lives, and success as a step-by-step process that is built over longitudinal relationships.
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Affiliation(s)
- Margae Knox
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | | | - Mark D Fleming
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Nadia Safaeinilli
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Amanda L Brewster
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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11
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Tao S, Liu C, Wu Q, Zhao J, Xue Y, Song W, Sun M, Wang C, Zou D, Liu W, Hao Y, Jiao M, Sun H, Li Y, Shan L, Liang L. Developing a scale measuring the doctor-patient relationship in China from the perspective of doctors. Fam Pract 2022; 39:527-536. [PMID: 34791197 DOI: 10.1093/fampra/cmab142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The doctor-patient relationship is usually measured in line with patient needs and demands. This study aimed to develop a scale measuring such a relationship from the perspective of doctors. METHODS A draft scale was developed and adapted to the hospital context of China based on several existing scales, with an intention to measure how medical doctors view and manage their relationship with patients beyond episodic clinical encounters. Two rounds of Delphi consultations involving 14 experts were conducted to seek their consensus on the inclusion and descriptions of items. This resulted in a 19-item scale measuring four domains of the relationship. The scale was validated through a survey of 1,712 medical doctors selected from 27 public hospitals in Heilongjiang province of China. The internal consistency of the scale was assessed using Cronbach's α coefficients of the four domains. Confirmatory factor analyses were performed to test the construct validity of the scale. Linear regression analyses were performed to assess the known-group validity of the scale. RESULTS The scale measures four domains. The Cronbach's α of the scale reached an acceptable level, ranging from 0.61 to 0.78 for its four domains. Good fitness of data into the four-domain structure of the scale was confirmed by the confirmatory factor analysis. Known-group differences were demonstrated in the regression analyses. CONCLUSION The doctor-patient relationship scale developed in this study is a psychometrically valid tool assessing how medical doctors view and manage their relationship with patients in the hospital setting in China.
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Affiliation(s)
- Siyi Tao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China.,Academic Affair Office, Dean's Office of Clinical Medical College of Anhui Medical University, Xinzhan District, Hefei, Anhui, China
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Juan Zhao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Yuxin Xue
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China.,Office of discipline supervision & investigation, Chengyang People's Hospital, Chengyang District, Qingdao, Shandong, China
| | - Weijian Song
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China.,Department of Humanity and Social Sciences, Harbin Medical University, High-tech Zone, Daqing, Heilongjiang, China
| | - Minglei Sun
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Chen Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Dandan Zou
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Wei Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Hong Sun
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Ye Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Nangang District, Harbin, Heilongjiang, China
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Li W, Hong T, Liu W, Dong S, Wang H, Tang ZR, Li W, Wang B, Hu Z, Liu Q, Qin Y, Yin C. Development of a Machine Learning-Based Predictive Model for Lung Metastasis in Patients With Ewing Sarcoma. Front Med (Lausanne) 2022; 9:807382. [PMID: 35433754 PMCID: PMC9011057 DOI: 10.3389/fmed.2022.807382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to develop and validate machine learning (ML)-based prediction models for lung metastasis (LM) in patients with Ewing sarcoma (ES), and to deploy the best model as an open access web tool. Methods We retrospectively analyzed data from the Surveillance Epidemiology and End Results (SEER) Database from 2010 to 2016 and from four medical institutions to develop and validate predictive models for LM in patients with ES. Patient data from the SEER database was used as the training group (n = 929). Using demographic and clinicopathologic variables six ML-based models for predicting LM were developed, and internally validated using 10-fold cross validation. All ML-based models were subsequently externally validated using multiple data from four medical institutions (the validation group, n = 51). The predictive power of the models was evaluated by the area under receiver operating characteristic curve (AUC). The best-performing model was used to produce an online tool for use by clinicians to identify ES patients at risk from lung metastasis, to improve decision making and optimize individual treatment. Results The study cohort consisted of 929 patients from the SEER database and 51 patients from multiple medical centers, a total of 980 ES patients. Of these, 175 (18.8%) had lung metastasis. Multivariate logistic regression analysis was performed with survival time, T-stage, N-stage, surgery, and bone metastasis providing the independent predictive factors of LM. The AUC value of six predictive models ranged from 0.585 to 0.705. The Random Forest (RF) model (AUC = 0.705) using 4 variables was identified as the best predictive model of LM in ES patients and was employed to construct an online tool to assist clinicians in optimizing patient treatment. (https://share.streamlit.io/liuwencai123/es_lm/main/es_lm.py). Conclusions Machine learning were found to have utility for predicting LM in patients with Ewing sarcoma, and the RF model gave the best performance. The accessibility of the predictive model as a web-based tool offers clear opportunities for improving the personalized treatment of patients with ES.
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Affiliation(s)
- Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Tao Hong
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haosheng Wang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, China
| | - Wanying Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Bing Wang
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Zhaohui Hu
- Department of Spinal Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Qiang Liu
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China
- Qiang Liu
| | - Yong Qin
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Yong Qin
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
- *Correspondence: Chengliang Yin
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13
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Nagy A, McMahon A, Tapsell L, Deane F. The therapeutic relationship between a client and dietitian: A systematic integrative review of empirical literature. Nutr Diet 2022; 79:303-348. [PMID: 35324041 PMCID: PMC9543415 DOI: 10.1111/1747-0080.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/03/2023]
Abstract
Aim Scientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to provide a comprehensive overview of the topic of the therapeutic relationship between clients and dietitians in the individual counselling context by summarising empirical literature into qualitative themes. Methods An electronic literature search of the Cumulative Index of Nursing and Allied Health Literature, PsychInfo, Scopus and Web of Science databases was conducted in October 2018 and repeated in February 2021. Studies were included if they explicitly referred to the therapeutic relationship (or associated terms), were based on study data and available in full text. Extracted data were checked by a second researcher and the methodological quality was evaluated independently by two researchers using the Mixed Methods Appraisal Tool. An iterative process of qualitatively coding, categorising and comparing data to examine recurring themes was applied. Results Seventy‐six studies met the inclusion criteria. Five themes were identified which showed the extent and nature of research in this area. Studies revealed the therapeutic relationship: (i) is valued within clinical dietetic practice, (ii) involves complex and multifactorial interactions, (iii) is perceived as having a positive influence, (iv) requires skills training and (v) is embedded in practice models and tools. Conclusion Studies show the therapeutic relationship is a valued and multifactorial component of clinical dietetic practice and is perceived to positively influence the client and dietitian. Observational data are needed to assess the extent to which the strength of the therapeutic relationship might contribute to clients' health outcomes.
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Affiliation(s)
- Annaliese Nagy
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anne McMahon
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Tapsell
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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A Substance Use Treatment Programme for Mentally Ill Forensic Patients in an Australian Setting: A Pilot Study of Feasibility, Acceptability and Preliminary Efficacy. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Myers C, Thompson G, Hughey L, Young JL, Rhon DI, Rentmeester C. An exploration of clinical variables that enhance therapeutic alliance in patients seeking care for musculoskeletal pain: A mixed methods approach. Musculoskeletal Care 2022; 20:577-592. [PMID: 34984781 DOI: 10.1002/msc.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/OBJECTIVES Therapeutic alliance (TA) is an integral part of building a patient and clinician relationship. TA begins at the initial encounter; however, the specific TA behavioural practices that are most impactful and linked to pain reduction and improved function remain unclear. The primary objective of this study was to explore physical therapist behaviours and interactions during the initial physical therapy evaluation and how they related to the patient's perception of TA. A secondary objective was to explore the relationship between TA, pain intensity, and function. METHODS A mixed methods study was conducted. Pain intensity, TA and self-reported function were assessed at three time points. Spearman's Rho (ρ) was used to quantify if there was an association between increased TA and function and reduced pain intensity, while a checklist of TA themes and behavioural practices was used for the qualitative analysis. RESULTS There was a statistically significant negative correlation between patient-perceived TA and pain intensity immediately after the initial evaluation (ρ = -0.39 [p = 0.048]). Behavioural practices associated with higher TA included information gathering, pausing to listen, using humour and transitions, and use of clarifying questions. Behavioural practices associated with patient-perceived lower TA interactions were lack of touch, the absence of pain neuroscience education, and not restating what the patient said during the interview. CONCLUSION This study highlights a relationship between TA and reduction of pain intensity after the initial evaluation and identifies key behavioural practices that could positively and negatively impact TA during the clinical encounter.
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Affiliation(s)
- Christina Myers
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Glenn Thompson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Lindsey Hughey
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Casey Rentmeester
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
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Sturgiss EA, O'Brien K, Elmitt N, Agostino J, Ardouin S, Douglas K, Clark AM. Obesity management in primary care: systematic review exploring the influence of therapeutic alliance. Fam Pract 2021; 38:644-653. [PMID: 33882128 DOI: 10.1093/fampra/cmab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care. METHOD Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms 'obesity', 'primary care' and 'intervention' of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present. RESULTS From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care. CONCLUSIONS We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42018091338 in PROSPERO (International prospective register of systematic reviews).
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Affiliation(s)
| | - Kathleen O'Brien
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Jason Agostino
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Stephen Ardouin
- Department of General Practice, Monash University, Melbourne, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Alexander M Clark
- Vice President Research and Innovation office, University of Alberta, Edmonton, Canada
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Meredith LS, Komaromy MS, Cefalu M, Murray-Krezan C, Page K, Osilla KC, Dopp AR, Leamon I, Tarhuni L, Hindmarch G, Jacobsohn V, Watkins KE. Design of CLARO (Collaboration Leading to Addiction Treatment and Recovery from other Stresses): A randomized trial of collaborative care for opioid use disorder and co-occurring depression and/or posttraumatic stress disorder. Contemp Clin Trials 2021; 104:106354. [PMID: 33713840 DOI: 10.1016/j.cct.2021.106354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) co-occurring with depression and/or posttraumatic stress disorder (PTSD) is common and, if untreated, may lead to devastating consequences. Despite the availability of evidence-based treatments for these disorders, receipt of treatment is low. Even when treatment is provided, quality is variable. Primary care is an important and underutilized setting for treating co-occurring disorders (COD) because OUD, depression and PTSD are frequently co-morbid with medical conditions and most people visit a primary care provider at least once a year. With rising rates of OUD and opioid-related fatalities, this is a critical treatment and quality gap in a vulnerable and stigmatized population. METHODS CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) is a multi-site, randomized pragmatic trial of collaborative care (CC) for co-occurring disorders in 13 rural and urban primary care clinics in New Mexico to improve care for patients with OUD and co-occurring depression and/or PTSD. CC, a service delivery approach that uses multi-faceted interventions, has not been tested with COD. We will enroll and randomize 900 patients to either CC adapted for COD (CC-COD) or enhanced usual care (EUC) and will collect patient data at baseline, 3-, and 6-month follow-up. Our primary outcomes are medications for OUD (MOUD) access, MOUD continuity of care, depression symptoms, and PTSD symptoms. DISCUSSION Although CC is effective for improving outcomes in primary care among patients with mental health conditions, it has not been tested for COD. This article describes the CLARO CC-COD intervention and clinical trial.
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, USA.
| | - Miriam S Komaromy
- Grayken Center for Addiction, Boston Medical Center, Boston, MA 02118, USA
| | - Matthew Cefalu
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | | | - Kimberly Page
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Karen Chan Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Lina Tarhuni
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Vanessa Jacobsohn
- First Choice Community Healthcare, 2001 North Centro Familiar, Albuquerque, NM 87105, USA
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Exploring the psychometric properties of the Working Alliance Inventory in general practice: a cross-sectional study. BJGP Open 2020; 5:bjgpopen20X101131. [PMID: 33172852 PMCID: PMC7960525 DOI: 10.3399/bjgpopen20x101131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background The therapeutic alliance is a framework from psychology that describes three components: goals, tasks, and bond. The Working Alliance Inventory adapted for general practice (WAI-GP) measures the strength of the therapeutic alliance between the patient and the clinician, and it could be useful in both research and clinical settings. Aim To determine if the patient score on WAI-GP can delineate the three components (goals, tasks, and bond), and to test concurrent validity with the Consultation and Relational Empathy (CARE) measure and the Patient Perception of Patient-Centredness (PPPC) measure. Design & setting A cross-sectional study took place in 12 general practice waiting rooms in Australia. Method The research instruments included the 12-item WAI-GP (the patient version), the CARE and PPPC measures, plus a survey of demographics and reason for consultation. To perform a principal components factor analysis of the WAI-GP, this dataset was combined with an existing dataset. The Spearman rank correlation was used to determine concurrent validity between the WAI-GP and the CARE and PPPC measures. Results Participants (97–99%) reported a strong positive alliance after the consultation (average WAI-GP mean 4.27 ± 0.67 out of 5, n = 146). Factor analysis could not separate the three components (one factor, eigenvalue >1; Cronbach’s α = 0.957; n = 281). Concurrent validity was supported by moderate correlations with the other measures (PPPC ρ = –0.51, P<0.005, CARE ρ = 0.56, P<0.005). Conclusion Three components could not be identified, but the WAI-GP has a high internal consistency and concurrent validity with moderate correlations with the CARE and PPPC. A more diverse sample may better distinguish the three components leading to more specific feedback to clinicians on their consultation practices.
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Boeckxstaens P, Meskens A, Van der Poorten A, Verpoort AC, Sturgiss EA. Exploring the therapeutic alliance in Belgian family medicine and its association with doctor-patient characteristics: a cross-sectional survey study. BMJ Open 2020; 10:e033710. [PMID: 32029490 PMCID: PMC7045179 DOI: 10.1136/bmjopen-2019-033710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient-doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance. DESIGN Cross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient-doctor relationship. SETTING Belgian primary care. PARTICIPANTS Every third patient (both practice and house call visits) was invited to participate. 170 patient-doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24-63 years) and 170 patients (35.9% men, age range 18-92 years). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations). RESULTS The median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year. CONCLUSIONS Consultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | - Annelou Meskens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | | | | | - Elizabeth Ann Sturgiss
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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