Abstract
BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews. Purposefully sampled patients (n = 33) aged >45 years with hip or knee OA from GP practices in Wessex (Hampshire, Dorest, Wiltshire, and Somerset).MethodFifteen participants watched two filmed OA consultations with a GP, and 18 participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.ResultsPatients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised, and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.ConclusionPatients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.
Highlights
Previous studies in trial and/or laboratory settings suggest that clinician communication with empathy and optimism is likely to improve patient satisfaction, and experience of pain via mechanisms underpinning contextual or ‘placebo’ effects
There is a paucity of evidence about how patients feel about this approach, and, how it might work in real-life primary care consultations
This study highlights that a fine balance is necessary to communicate realistic empathic optimism so that it is acceptable to patients
Summary
Contextual and placebo factors make clinically meaningful contributions across diverse conditions including OA.[8,9,10,11] This common and disabling condition affects one in five adults aged >45 years in the UK, with hip and knee being frequently affected joints.[12,13] National Institute for Health and Care Excellence (NICE) guidance[12] recommends non-p harmacological treatments such as exercise and weight loss first line, and these have a similar effect size to medications such as non-s teroidal anti- inflammatory drugs.[14] patients often seem reluctant to engage with or struggle to undertake these strategies,[15] the need for communication approaches within primary care consultations that can better engage patients with these treatments.[16,17] The benefits of empathic and optimistic communication are accepted in the literature,[4,18,19] with evidence to show clinician communication style influences patient engagement with, and expectations of, positive health outcomes, which in turn can lead to improved patient outcomes such as reduced pain.[19,20]. Expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach
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