Patient-doctor interaction in rehabilitation: the relationship between perceived interaction quality and long-term treatment results.

OBJECTIVES: A body of evidence suggests that good interaction is crucial for high-quality medical practice and has a considerable impact on treatment outcomes. Less is known about the role and significance of doctor-patient interaction in rehabilitation. The study aim was to capture perceived quality of doctor-patient interaction in rehabilitation by a rating instrument (P.A.INT-Questionnaire. P.A.INT is the abbreviation for Patient-Arzt-Interaktion (German)) and to examine the relationship between perceived quality of interaction and long-term treatment outcomes.
METHODS: Referring to the approach of Bensing [Bensing JM. Doctor patient communication and the quality of care. Utrecht: NIVEL; 1990] we defined "quality of interaction" in terms of three dimensions: (1) affective behaviour, i.e. empathy, positive regard and coherence [Rogers CR. Die nicht direktive Beratung München: Kindler Studienausgabe [Counselling and psychotherapy, 1942]. Boston; 1972]; (2) instrumental behaviour: providing and collecting information, structuring and reinforcement; (3) participation and involvement of patients. Two parallel versions of the questionnaire were developed for patients and physicians. Seven rehabilitation clinics in north western Germany participated in the multi-centre study. Sixty-one doctors and their four hundred and seventy patients evaluated both their shared dialogues upon admission, discharge and ward round. Furthermore, patients rated their health status on admission (t0), discharge (t1) and six months after discharge (t2) with the IRES-3 (Indicators of Rehabilitation Status Questionnaire, Version 3).
RESULTS: (1) Comparisons of patient and physician evaluations on admission revealed the following: affective quality of contact (empathy and coherence) was rated positively and without discrepancies by both patients and physicians. On the other hand, instrumental behaviour (information and structuring) was rated less positively by patients than by physicians. (2) Patients who rated the dialogue on admission more positively showed stronger treatment effects with respect to pain as well as to anxiety at discharge and six months after discharge. Analysis for single scales of the P.A.INT-Questionnaire revealed that this is due to affective and instrumental quality of the dialogues.
CONCLUSION: Our results suggest a correlation between perceived interaction quality, as defined by our questionnaire and treatment effects six months after discharge. Comparisons of patient and physician evaluations showed that physicians seem to be successful in building relationships on the affective level, but less successful on the instrumental level (i.e. information, structuring and reinforcement). They also perceive disturbances on the relational and organisational level more strongly than patients. PRACTICE IMPLICATIONS: Our data underline the importance of interaction quality for the success of rehabilitation and thus the importance of specific skills such as providing and collecting information, recognizing patients' concerns and goals as well as reinforcement of health related action. Regular training and supervision should be provided to support physicians and to enhance their competence in dealing with patients concerns.