A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report.

Douglas A Drossman, Lin Chang, Jill K Deutsch, Alexander C Ford, Albena Halpert, Kurt Kroenke, Samuel Nurko, Johannah Ruddy, Julie Snyder, Ami Sperber

Journal: Gastroenterology 2022;161(5):1670-1688.e7

PMID: 34331912

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Abstract

BACKGROUND & AIMS

Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited.

METHODS

The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR.

RESULTS

Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR.

CONCLUSIONS

We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.

Address: Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina. Electronic address: [email protected].; Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia.; Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut.; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.; Gastroenterology,Harvard University Health Services, Boston, Massachusetts.; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.; Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts.; Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina.; Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts.; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

DOI: 10.1053/j.gastro.2021.07.037