Fostering Quality Relationships with Patients and Their Families

This is a writing sample from Scripted writer Elreacy Dock

Developing rapport and building relationships with patients is an integral component of providing patient-centered care, often resulting in improved patient experience and outcomes. Through relationship building, providers establish a genuine connection with the patient to foster a partnership that supports the patient’s progress and goals. In an effective and engaged patient-partner relationship, it is easier for the provider to facilitate behavioral interventions, lifestyle changes, health education, and maintain accountability as the patient works toward achieving defined goals. Additionally, the provider has greater insight into the patient’s background, preferences, and specific concerns that may impact treatment.

To have a meaningful patient-provider relationship, both parties must be fully present and engaged in their interactions, working together in a collaborative effort to consciously achieve specific outcomes in the patient’s best interest. Focused engagement through patient-centered communication and active listening during conversations helps to establish the larger shared dialogue between patients and providers, and likewise, further encourages the patient to adhere to their treatment plan through consistent support. In this regard, patient engagement and relationship building can be crucial when considering the importance of empowering patients through health education and maintaining motivation as they take necessary steps toward improvement through exercise, diet, smoking cessation, preventative care, and other key health decisions.

 

Exploring for Yourself

The patient-provider relationship is truly impactful within every patient’s healthcare journey. Without consistent communication and effective engagement, it is challenging to provide patient-centered care and treatment that meets the patient’s expectations and aligns with their needs. Taking a closer look at the Common Factors Model can help further illustrate the importance of the patient-provider relationship and its influence on patient outcomes.

The Common Factors Model is a definitive framework that highlights the common factors attributed to impacting treatment effectiveness (Wampold, 2015; Laska et al., 2014). All referenced factors are shared across treatments and are not exclusive to a specific treatment, model, or intervention. Although every treatment will have its own level of effectiveness, common factors are believed to further contribute to the overall effectiveness beyond treatment. The common factors defined within the model include the therapeutic alliance, goal consensus and collaboration, positive regard and affirmation, empathy, mastery, genuineness/congruence, and mentalization.

In the context of the patient-provider relationship, the Common Factors Model reiterates the value of understanding the patient experience and using their feedback to guide treatment decisions and the structure of the care plan. Through the implications of this model, providers can focus on a patient-centered approach that tailors treatment and care to the needs of the patient. More notably, the therapeutic alliance is a prominent common factor that is frequently attributed to the potential success and likelihood of achieving a positive outcome in treatment (Ardito & Rabellino, 2011; Cameron et al., 2018;. Zaitsoff et al., 2015). Further, the concept of the therapeutic alliance redefines clinical understanding of the effectiveness, shifting the focus away from treatment and redirecting it to the collaborative experience shared between the patient and provider or client and therapist.

When therapy and treatment align with the patient’s preferences, goals, and expectations, further highlighted by the overall collaboration within the relationship, the likelihood of attaining a positive outcome increases by nearly 7 times the amount normally attributed to treatment (Duncan & Miller, 2008). It is the shared relationship that is responsible for producing the change, reflecting the importance and value of treatments and plans that are tailored and aligned to the patient, as well as their overall perception of the alliance itself.

 

Background Information

Having acknowledged the value of relationship building and leveraging the therapeutic alliance with patients, importance can also be attributed to relationships and engagement with the patient’s family and spouse. Patient education often extends into family education due to the personal investment relatives and spouses typically have in the best interest of the patient’s care. Even if they are not the primary caretaker for the patient, they tend to interact frequently as a source of social support and may have a great influence in keeping the patient accountable for their goals and care plan.  

Another important reason to establish rapport and maintain engagement with the patient’s family centers around the circumstances and concept of providing education that is pertinent to the outcome of the patient’s treatment. For example, patients that are discharged from the hospital after certain procedures are typically given instructions that must be followed explicitly to reduce the risk of infections or complications. Patients that are in severe pain or heavily medicated may not be able to remember most of the instructions, which means a relative or spouse is usually responsible for engaging with the provider and verbalizing understanding of the expectations.

Even in non-emergent health care scenarios, understanding how to effectively engage with the patient’s family is important. Through these interactions, education is provided that reflects adjustments that need to be made to dietary intake, which medications need to be taken and at what time, specific lifestyle changes that need to be supported, or symptoms and behaviors that need more immediate medical care. Since relatives and spouses are often the most consistent social support, their own relationship and alliance with the patient can further contribute to adherence to treatment plans or empower the patient to stay motivated even when treatments are not as effective as anticipated.

 

Facts to Consider

Without engagement, it is impossible to have open dialogue and consistent interaction within the patient-provider relationship. If the patient isn’t willing to engage and share details or information about their experience, it can be difficult for the provider to make informed decisions for treatment based on specific needs. Conversely, if the patient is openly sharing information and the provider isn’t actively engaging, it can seem as if the provider isn’t truly interested in a collaborative partnership or isn’t perceiving the patient’s concerns to be as serious and important as they should be. Some ways to foster engagement can include:

·      Active engaged listening

o   This method of listening focuses on what the patient is sharing, taking consideration of the emotions or thought processes behind the words. Sometimes it can also involve considering what the patient is not saying, especially when discussing sensitive topics. Through actively engaged listening, the provider fully acknowledges and validates what the patient is sharing, but also encourages the conversation to develop on a deeper level.

·      Asking the right questions

o   As the patient shares their experience and their thoughts or concerns, asking the right question can lead to additional information that may be helpful for ruling out other possibilities or learning more about the patient’s perceptions.

·      Using suggestions and discoveries

o   Taking an exploratory approach to finding a solution or an alternative action can welcome further interaction with the patient. This allows the patient to make their own suggestions, often leading to a personal insight or change. Instead of providing the patient with a direct order, suggestions can be made that will encourage further consideration and shared ideas.

 

Applying What You Know

When sharing health education with patients and their families, using an evidence-based approach such as the teach-back method can further promote patient engagement while likewise increasing the likelihood of treatment adherence and maintaining patient safety. In using the teach-back method, the provider should communicate everything clearly enough to the extent that the patient and their family fully understand what has been shared and can communicate the same information back to reflect comprehension.

The “teach-back” aspect of this method highlights that if the patient and their family have understood everything correctly, they will be able to teach the same information back to the provider.  To effectively use the teach-back method:

Use plain language to discuss the patient’s care

If there are misunderstandings, rephrase and explain until the patient understands 

Explain everything clearly and don’t rely on printed handouts for patient education

If extensive health education is being provided, summarize the information into smaller sections and check for understanding

Try to understand what makes it easier for the patient and their family to learn

Always ask the patient and their family to explain in their own words instead of yours

 

References

 

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2, 270.

 

Cameron, S. K., Rodgers, J., & Dagnan, D. (20180). The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: A meta-analytic review. Clinical Psychology & Psychotherapy, 25(3), 446-456.

 

Duncan, B., & Miller, S. D. (2008). ‘When I’m good, I’m very good, but when I’m bad I’m better’: A new mantra for psychotherapists. Psychotherapy in Australia, 15(1), 62.71.

 

Laska, K. M., Gurman, A. S., & Wampold, B.E. (2014). Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective. Psychotherapy, 51(4), 467.

 

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 14(3), 270-277. https://doi.org/10.1002/wps.20238

 

Zaitsoff, S., Pullmer, R., Cyr, M., Aime, H. (2015). The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review. Eating Disorders, 23(2), 99-114.

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Elreacy Dock
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Elreacy Dock is a thanatologist and doctoral candidate with over 5 years of experience in the behavioral health field and a decade of experience in copywriting. She is actively involved in working with a diverse range of professionals and organizations to improve health outcomes for patients affected by psychiatric disorders and chronic diseases. Although Elreacy is a subject matter expert on integrated care and death education, she also has ample experience in developing content focused on a wide range of topics including thought leadership, artificial intelligence, fashion, education, ent...
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