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The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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  • John M Kelley
  • Gordon Kraft-Todd
  • Lidia Schapira
  • Joe Kossowsky
  • Helen Riess

Abstract

Objective: To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes. Design: Systematic review and meta-analysis. Data Sources: Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews. Eligibility Criteria for Selecting Studies: Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions. Results: Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = −.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02). Conclusions: This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.

Suggested Citation

  • John M Kelley & Gordon Kraft-Todd & Lidia Schapira & Joe Kossowsky & Helen Riess, 2014. "The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-7, April.
    • Handle: RePEc:plo:pone00:0094207
    DOI: 10.1371/journal.pone.0094207
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    1. Ana Maria Rodriguez & Beth A Lown, 2019. "Measuring compassionate healthcare with the 12-item Schwartz Center Compassionate Care Scale," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-16, September.
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    3. Hardman, Doug & Geraghty, Adam W.A. & Lown, Mark & Bishop, Felicity L., 2020. "Subjunctive medicine: Enacting efficacy in general practice," Social Science & Medicine, Elsevier, vol. 245(C).
    4. Lazzaro-Salazar, Mariana & Pujol-Cols, Lucas J., 2022. "Instrumentos estandarizados para medir la relación médico-paciente: una revisión sistemática de la literatura internacional e iberoamericana," Nülan. Deposited Documents 3753, Universidad Nacional de Mar del Plata, Facultad de Ciencias Económicas y Sociales, Centro de Documentación.
    5. Michelle L Dossett & Lin Mu & Roger B Davis & Iris R Bell & Anthony J Lembo & Ted J Kaptchuk & Gloria Y Yeh, 2015. "Patient-Provider Interactions Affect Symptoms in Gastroesophageal Reflux Disease: A Pilot Randomized, Double-Blind, Placebo-Controlled Trial," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-13, September.
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    7. Óscar Rodríguez-Nogueira & Jaume Morera Balaguer & Abel Nogueira López & Juan Roldán Merino & José-Martín Botella-Rico & Sonia Del Río-Medina & Antonio R Moreno Poyato, 2020. "The psychometric properties of the person-centered therapeutic relationship in physiotherapy scale," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-16, November.
    8. Krunoslav Nikodem & Marko Ćurković & Ana Borovečki, 2022. "Trust in the Healthcare System and Physicians in Croatia: A Survey of the General Population," IJERPH, MDPI, vol. 19(2), pages 1-18, January.
    9. Laura Tam & Gail Garvey & Judith Meiklejohn & Jennifer Martin & Jon Adams & Euan Walpole & Michael Fay & Patricia Valery, 2018. "Exploring Positive Survivorship Experiences of Indigenous Australian Cancer Patients," IJERPH, MDPI, vol. 15(1), pages 1-12, January.
    10. Karen R. Sepucha & Steven J. Atlas & Yuchiao Chang & Andrew Freiberg & Henrik Malchau & Mahima Mangla & Harry Rubash & Leigh H. Simmons & Thomas Cha, 2018. "Informed, Patient-Centered Decisions Associated with Better Health Outcomes in Orthopedics: Prospective Cohort Study," Medical Decision Making, , vol. 38(8), pages 1018-1026, November.
    11. Kovacs, Roxanne J. & Lagarde, Mylene & Cairns, John, 2022. "Can patients improve the quality of care they receive? Experimental evidence from Senegal," World Development, Elsevier, vol. 150(C).
    12. Quan-Hoang Vuong & Tung-Manh Ho & Hong-Kong Nguyen & Thu-Trang Vuong, 2018. "Healthcare consumers’ sensitivity to costs: a reflection on behavioural economics from an emerging market," Palgrave Communications, Palgrave Macmillan, vol. 4(1), pages 1-10, December.
    13. Ying Lau & Kin Sun Chan, 2018. "Psychometric evaluation of the Chinese version of the fear of intimacy with helping professionals scale," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    14. Francesco Tramonti & Franco Giorgi & Annibale Fanali, 2021. "Systems thinking and the biopsychosocial approach: A multilevel framework for patient‐centred care," Systems Research and Behavioral Science, Wiley Blackwell, vol. 38(2), pages 215-230, March.

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