The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review

Abstract

BackgroundNonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement.MethodsIn December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference.Results23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis.ConclusionsClinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

“…Disparities in minority groups' utilization and experiences of mental health services as well as patient-provider relationships are welldocumented (Alegria et al, 2008;DHHS, 2001;McGuire & Miranda, 2008). These inequalities have been attributed to provider's lack of empathy, cultural competence, provider's racial bias, as well as patients' distrust in the health care system (Constantine, 2007;Cooper et al, 2012;DHHS, 2001; L. Thompson & McCabe, 2012).…”

Antidepressant Adherence Across Diverse Populations and Health Care Settings

“…Another possible factor may be rapport between provider and patient, as other studies have shown that the quality of the provider-patient relationship, particularly surrounding communication and empathy, are positive predictors of medication adherence. [41][42][43] Psychiatrists often receive more training in patient engagement and motivational interviewing, and perhaps were able to develop better rapport with patients with depression.…”

Comparison of Student and Patient Perceptions for Medication Non-adherence

“…32,33 Pharmacists often assume that physicians explain the importance of the medications they prescribe, as well as assume that physicians routinely inquire about their patients' problems with therapies. This is often not the case.…”

“…These difficulties are lessened when the patient has a supportive, trusting relationship with their health care provider. 31 Thompson (2012) described how having an empathetic, respectful provider who is a good listener improves patients' adherence to therapy. Results from our study indicated that both patients and students were in agreement regarding the top three reasons for medication non-adherence -lending credence to student perceptions on these factors.…”