Broadening our Sight: Considering Patient-Provider Therapeutic Alliances to Improve Health Care

Abstract

Two decades of research on patient experiences and patient-centered care has assumed that positive outcomes result from therapeutic alliances between patients and their professional care providers, yet therapeutic alliance has rarely been defined or measured. As more research reveals problems with patient experiences and reduced well-being among professional care providers, a closer examination of patient-provider relationships is warranted. The purpose of this qualitative study was to identify the attributes of a therapeutic alliance in health care from the patient’s perspective, then to identify quantitative measures that capture the full construct. We conducted conceptual analysis studies: (1) survey of therapeutic alliance dimensions by academic content experts (n=24); (2) two patient focus groups (n= 9; n=13); (3) a systematic review of measures of therapeutic alliance and its essential dimensions across three databases using the PRISMA guidelines. Of 2449 articles initially identified, 52 articles were retained for review after applying inclusion and exclusion criteria. Constructs measured were mapped onto the therapeutic alliance dimensions derived from this study’s preceding qualitative work. Analysis found no measures that captured all of the therapeutic alliance dimensions. “Shared Mind” was the most frequently measured construct (n=27 unique measures). “Full Presence/Authenticity” was identified by patients and content experts as being key for strong alliances, yet there was little published research on this construct. Broadening our sight for better health care necessitates considering the core patient-provider relationship and how it impacts both patient and care provider outcomes.