Pivoting to be Patient-Centered: A Study on Hidden Psychological Costs of Tele-Healthcare and the Patient-Provider Relationship

Abstract

Purpose: While the COVID-19 pandemic has necessitated a shift toward virtual medicine, there are some potentially important limitations with this modality of healthcare. One such concern, which has not yet been elucidated, is how telephone-based versus in-person visits differentially impact patients’ perceived autonomy and the resulting patient-provider relationship. Grounded in self-determination theory (SDT), this pilot study addresses this question by investigating the association between patients’ perceived autonomy support and relationship needs satisfaction (autonomy, competence, relatedness) in both types of visits with their family doctor and care team. Methods: Running from Sept. 2020 to Feb. 2021, data was collected via convenience sampling from n = 66 patients (34 in person, 32 virtual) nested within k = 6 family physicians. Patients completed an online survey containing two previously validated scales derived from SDT: The Healthcare Climate Questionnaire and the Basic Need Satisfaction in Relationships Scale. Each scale was adapted to reflect a virtual or in-person visit experience. A random effects model captured the relationship between the motivational variables in each group, adjusting for various sociodemographic effects. Results: Both groups’ perceived autonomy support positively related to their relationship needs satisfaction with their family doctor and care team. Compared to traditional in-person visits, patients perceived the virtual healthcare climate as significantly less autonomy-supportive. Conclusions: In line with SDT, findings from this study suggest that when patients sense a more autonomy-supportive healthcare climate, they will experience a more needs-satisfying relationship with their family doctor and healthcare team. These results have potentially significant implications for supporting patient motivation and facilitating optimal health and wellness outcomes, particularly within the virtual care environment.