The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

Abstract

Context: Telemedicine has become one of the essential modes of healthcare delivery. Different aspects of the physician–patient relationship during tele and in-person consultation need to be studied. Aims: This study aimed to compare perceived empathy and therapeutic relationship between tele and in-person consultation and assess the patient’s satisfaction during teleconsultation for substance use disorder (SUD). Methodology: We consecutively recruited 100 adult patients with SUD, registered to the tele-addiction service between June and September 2020, and experienced both video and in-person consultations. We assessed therapeutic relationships, perceived empathy (for teleconsultation and in-person consultation), and patients’ satisfaction (with teleconsultation) with specific scales. We compared the scores of the therapeutic relationship and physician empathy scales for tele and in-person consultation. Results: The mean age of the patients was 35.5 (±10.4) years. Sixty percent had alcohol, followed by opioids (42%) and cannabis dependence (24%). Sixty percent of patients had comorbid tobacco dependence. Telehealth satisfaction (TSS) rating shows around 40% of patients had difficulty accessing the telehealth service and 7% felt their privacy was poorly respected. The mean total therapeutic relation (STAR) (t = −14.4; P <.001), positive collaboration (t = −12.8; P <.001), positive clinical input (t = −11.9; P <.001), and total Patient’s Perceptions of Physician Empathy (PPPE) score (t = −8.4; P < .001) were lower in the teleconsultation than in-person consultation group. TSS was positively correlated with positive collaboration, positive clinician input, and STAR total score. Conclusions: Our study suggests a stronger therapeutic relationship and higher physician empathy during in-person consultations. Poor accessibility and privacy concerns were critical challenges in telehealth service. TSS and therapeutic relationships positively influence each other.

Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications

“…Telehealth adoption may negatively affect clinical practice and therapeutic relationships [ 29 ]; this change in relationships also has the distinct advantage of humanizing interactions about mental health, and thereby removing some of the sterility of in-person outpatient appointments. As such, it is paramount to identify design features within a telehealth consult that promote engagement and therapeutic relationship building, particularly given recent research suggesting that therapeutic alliances are weaker when services are delivered online [ 30 , 31 ]. On top of this, a lack of familiarity with telehealth within New Zealand’s mental health services also points to the value of culture change to embed telehealth as a service delivery option.…”

Are we ready for Telepsychiatry? Benefits and challenges of digital psychotherapy

“…Consequently, the patient may conceal his or her symptoms for fear of criticism from others. The situations presented may decrease the quality of telepsychiatry services due to the lack of security, privacy and freedom of expression [67]. The above problem was presented in a 2022 meta-analysis by Al-Mahrouqi et al, based on the experiences of patients and therapists evaluating the use of video-based health care during the COVID-19 pandemic [39].…”

“…Establishing a solid relationship with a stranger requires trust in the therapist, which can be difficult with the image of the person on the screen [74]. In turn, doctors may find it difficult to show understanding and empathy through the screen [67]. They have expressed concerns about not being able to make comforting gestures to a sad patient [75].…”

“…W konsekwencji pacjent może zatajać swoje objawy w obawie przed krytyką innych. Przedstawione sytuacje mogą powodować spadek jakości usług telepsychiatrii ze względu na brak bezpieczeństwa, prywatności i swobody wypowiedzi [67]. Powyższy problem przedstawiono w metaanalizie z 2022 roku autorstwa Al-Mahrouqi i wsp., na podstawie doświadczeń pacjentów i terapeutów oceniających korzystanie z opieki zdrowotnej opartej na wideo podczas pandemii COVID-19 [39].…”

“…Nawiązanie silnej relacji z obcym lekarzem wymaga zaufania do terapeuty, a to może być trudne w przypadku wizerunku osoby na ekranie [74]. Z kolei lekarze mogą mieć trudności z okazaniem zrozumienia i empatii przez ekran [67]. Wyrażali oni obawy związane z brakiem możliwości wykonywania gestów pocieszenia smutnego pacjenta [75].…”