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

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: to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; to review the measurement and impact of communication skills training on these outcomes; and to make recommendations to improve communication skills training and the PPR. RESULTS: Evidence supports the fact that interventions targeting patientprovider 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.

The symptom burden of Irritable Bowel Syndrome in tertiary care during the COVID‐19 pandemic

“…Most of the integrated multidisciplinary care provided prior to the pandemic in tertiary IBS care has traditionally been provided face‐to‐face. There is increasing recognition within the field of DGBI of the importance of enhanced communication in optimizing patient‐provider interactions to achieve positive outcomes, 38 and it is therefore possible that COVID‐19 enforced changes to the ways in which patients access and experience healthcare could have contributed to the observed findings in the post‐pandemic group. The pandemic has however provided new opportunities for innovative delivery of care remotely via video‐consultations, 13 , 39 remote helplines 40 and by the use of group therapy 41 to widen access, and future studies should evaluate their long‐term efficacy after the pandemic.…”

A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction

“…57,98 There are challenges to fostering this relationship that are beyond the scope of this WTR but are nicely presented in a previous WTR. 99 Doctors need to see more patients in less time and handle more administrative duties, shifting the focus away from the patient. They receive less reimbursement from third-party payers, and turn to tests as a seemingly time-efficient way to make a diagnosis.…”

Direct healthcare costs of Rome IV or Rome III‐defined irritable bowel syndrome in the United Kingdom

“…66 Careful explanation of symptoms, active listening, being empathetic, educating patients, offering reassurance and managing expectations are key to reducing multiple healthcare episodes. 67,68 The high levels of spending on IBS highlight the need for the optimised management of the condition, including a multidisciplinary approach and improved access to evidence-based treatments, such as eluxadoline, ramosetron, plecanatide and tenapanor, which are yet to be licensed in the United Kingdom. Compared with seeing a gastroenterologist alone, multidisciplinary care may not only reduce treatment costs for IBS, 69,70 but also unplanned hospital attendances.…”