How does communication heal? Pathways linking clinician–patient communication to health outcomes
Introduction
One of the most interesting, but least understood findings in health communication is provided by studies that have established an association between clinician–patient communication and patient health outcomes [1], [2], [3], [4], [5], [6]. Yet, researchers seldom try to test hypotheses explaining how communication might impact patient health.
The purpose of this article is three-fold. First, we offer a brief critique of current approaches to the study of communication and health outcomes. Second, we identify specific pathways through which communication can lead to better health. Finally, we propose a research agenda to discover mechanisms that can explain and influence ways in which communication affects health. Relevant health outcomes include disease markers (e.g., blood pressure, tumor markers), survival, and quality of life (e.g., functioning and well-being in physical, psychological and social domains).
Section snippets
Clinician–patient communication and outcomes: the state of the science
Research linking communication to improved health outcomes typically falls into two categories. First, a number of RCTs have examined the effects of interventions designed to alter clinician and patient communication and decision-making in medical encounters [7], [8]. In a review of these studies, Griffin et al. [8] demonstrated that communication interventions generally promoted physician and/or patient communication behaviors thought to be desirable and effective (e.g., patients asking more
What improves physical health?
Physical health status includes pain and other symptoms, disease markers (e.g., hemoglobin A1C, blood pressure, weight, prostate-specific antigen), functional capacity (e.g., ability to walk) and subjective self-ratings of health. There are essentially four types of therapeutic regimens that lead to improved physical health—chemical (e.g., medication), mechanical (e.g., surgery), behavioral (e.g., smoking cessation, diet) and psychological (e.g., placebo effects, cognitive therapy). For
Communication pathways to improved health outcomes
To understand why communication may lead to better or worse health outcomes, researchers must identify the pathway through which communication influences health and well-being. As shown in Fig. 1, the pathways through which clinician–patient/family communication can influence health outcomes may be direct. For example, talk can be therapeutic in that a physician who validates the patient's perspective or expresses empathy may help a patient experience improved psychological well-being—fewer
Directions for future research
Future research on the relationship between communication and outcomes should strive to identify the particular pathways through which the events of the consultation can affect subsequent health and well-being. In fact, researchers might be advised to identify the outcome of interest first, then work backwards to ascertain the relevant proximal and intermediate outcomes which should be measured, and finally determine what aspects of clinician–patient communication should be analyzed to predict
Conclusion
In this article, we focus on the relationship between communication and health outcomes. We have tried to illustrate ways in which theory can inform communication practice and assist with the design of studies that examine the relationship between specific communication behaviors and proximal and intermediate outcomes that contribute to health outcomes that are meaningful to patients. We have proposed a simple, pragmatic model that can inform hypotheses to guide future research; specifically,
Conflict of interest
The authors have no conflict of interest in the authoring of this manuscript.
Acknowledgements
This work was in part supported by a contract to the senior and lead authors from the Outcomes Research Branch of the Applied Research Program in the Division of Cancer Control and Population Sciences, National Cancer Institute, NIH and in part by the Houston VA HSR&D Center of Excellence (HFP90-020).
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