The advantages of nourishing the clinician-patient relationship, online and offline

Article by Daisy De Windt, BBus, BSc in BiomedSc, MHL; Associate Director, Medical Writing – Independent Medical Education

The doctor-patient relationship is one that has existed since time immemorial. Although the relationship has transformed over time and has expanded into the online space, healthcare professionals have a wonderful opportunity to work with their patients to improve global health outcomes.

• Effective communication aligns with the principle of person-centered care
• Improved communication leads to better treatment adherence
• Doctor-patient communications in online communities can enhance patient compliance

Since time immemorial, the doctor-patient relationship has held a special place in societies, being highly regarded and indeed subject to laws and regulations governing the responsibilities of the relationship^2,3. Although societal norms have shifted over time regarding the extent of involvement that patients have in decision-making within this relationship, the ability of the clinician to relate to their patients has always been of primary importance³.

Currently, person-centered care is at the heart of clinical practice. Although the term was coined decades ago, it is even more relevant now, given advances in precision medicine and targeted therapies, which by their nature require clinical practice to be focused on the patient³.

Person-centered care and effective communication go hand-in-hand: when patients are an equal partner in a clinician-patient relationship, this requires the clinician to provide information that is relevant to the patient, and in a clear, understandable format. A good demonstration of this paradigm is presented in the context of treatment adherence.

In the case of prostate cancer, research demonstrates that better information about side effects is associated with improved adherence to treatment⁴. Further, with antihypertensive medication, where suboptimal adherence contributes to poor blood pressure control, the relationship between patient and clinician is key to both monitoring adherence, and the choice of intervention most appropriate for the patient⁵. In hypertension, sub-optimal treatment adherence is a major contributor to inadequate blood pressure control, and hypertension is the leading cause of deaths from noncommunicable disease globally⁶. This demonstrates the importance of the clinician-patient relationship and the opportunities it affords to improve health outcomes around the world.

Fernandez-Lazaro and colleagues found that optimal levels of treatment adherence relating to chronic conditions in primary care were achieved thanks to strategies that included educating patients and consideration of their information needs⁷. In other research, pictograms combined with written/oral information were found to improve medication adherence in patients at high risk of non-adherence⁸.

According to research in schizophrenia, communication skills can have an impact on a patient’s recall as well as their understanding of diagnosis, prognosis and treatment options: when information about a person’s illness is not communicated appropriately, this can lead to confusion, further highlighting the importance of good communication skills within the clinician-patient relationship⁹.

Good communication between clinicians and patients is not restricted to the in-person clinic environment and can be fostered in online interactions. A systematic review and meta-analysis by Jeminiwa and colleagues found that eHealth interventions in asthma, particularly mobile health interventions, were effective at improving patient adherence to inhaled corticosteroids¹⁰. Similarly, a cross-sectional questionnaire study found that communications between physicians and patients in online health communities had a positive impact on patient compliance¹¹.

By fostering communication strategies, both online and offline, that are person-focused and consider the patient’s information needs, healthcare professionals have an opportunity to work in collaboration with patients to improve treatment adherence and health outcomes. When considering the global impact of treatment non-adherence, improvements in communication strategies within the doctor-patient relationship can have far-reaching benefits for population health.

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References

1. Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, et al. Can Patient–Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. Journal of General Internal Medicine. 2020;35(7):2107-2117.
2. RACGP - Duty of care or a matter of conduct – can a doctor refuse a person in need of urgent medical attention? Australian Family Physician. 2022.
3. Albini A. Evolution of the doctor-patient relationship: from ancient times to the personalised medicine era | Cancerworld Magazine. 2021.
4. Jung B, Stoll C, Feick G, Prott FJ, Zell J, Rudolph I, et al. Prostate cancer patients’ report on communication about endocrine therapy and its association with adherence. Journal of Cancer Research and Clinical Oncology. 2016;142(2):465-470.
5. Poultera NR, Borghib C, Gianfranco Paratic D, Atul Pathake F, Tolig D, Williamsh B, et al. Medication adherence in hypertension. Journal of Hypertension. 2022;37:1-9.
6. Burnier M, Egan BM. Adherence in Hypertension. Circulation Research. 2019;124(7):1124-1140.
7. Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Family Practice. 2019;20(1).
8. Sletvold H, Sagmo LAB, Torheim EA. Impact of pictograms on medication adherence: A systematic literature review. Patient Education and Counseling. 2020;103(6):1095-1103.
9. Farooq S, Johal RK, Ziff C, Naeem F. Different communication strategies for disclosing a diagnosis of schizophrenia and related disorders. Cochrane Database of Systematic Reviews. 2017(10).
10. Jeminiwa R, Hohmann L, Qian J, Garza K, Hansen R, Fox BI. Impact of eHealth on medication adherence among patients with asthma: A systematic review and meta-analysis. Respiratory Medicine. 2019;149:59-68.
11. Lu X, Zhang R. Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study. Journal of Medical Internet Research. 2019;21(5):e12891.