The role of patient-provider relations and empowerment
Walsh, E., Bann, C., Greene, A., & Sirois, F. (2009). Symptom relief in CAM: The role of patient-provider relations and empowerment. In 2009 North American Research Conference on Complementary and Integrative Medicine http://www.cahcimabstracts.com/
Purpose: To evaluate the impact of newly developed measures of the therapeutic relationship (perceived support and patient-centered care) and empowerment on symptom relief for those receiving CAM treatments. Methods: We developed measures of symptom relief, patient-centered care, provider support, and empowerment based on analysis of CAM-user focus group data. We then conducted a pilot survey (n=217) to evaluate the psychometric properties of these scales and to test the relationship between these measures of patient-provider interaction and symptom relief using multivariate models. We modeled the impact of each patient-provider relation score separately and in combination on total symptom relief using linear regression and on the components of symptom relief (fewer symptoms, less severe symptoms, less frequent symptoms) using logistic regression. Results: The 3 measures of patient-provider interaction had strong psychometric properties (reported elsewhere). Controlling for demographics, presenting problem, and main CAM provider used in the past 12 months, each of the scales had a positive and significant relationship with total symptom relief. Patient-centered care was also a statistically significant predictor of having fewer and less frequent symptoms, and perceived provider support was a statistically significant predictor of having fewer and less severe symptoms. Empowerment had the greatest impact on the total symptom relief score and on each component of symptom relief and was the only scale that retained a significant impact on symptom relief when all 3 measures were included together in a single model. Conclusions: From a holistic perspective, CAM treatment effects can arise from sources related to the therapeutic relationship, as well as the philosophy of healing and specific techniques designed to reduce symptoms or treat underlying conditions. This exploratory analysis provides conceptual support for this perspective and a means to evaluate aspects of the therapeutic relationship and to measure its impact on outcomes of CAM treatment across conditions and therapies.