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Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

The physician-patient working alliance has been associated with improved patient satisfaction and adherence. However, up until now there has only been a patient form with which to assess the working alliance in medicine. The current study presents the provider form of the physician-patient working alliance, along with psychometric evidence and support. Participants were 106 psychiatrists (61 men and 45 women). They were selected from a database of providers in the Northeast of the U.S. and were asked to complete a mailed survey and to return it in stamped addressed envelope. We found evidence that the provider form is reliable and valid, and that the providers' ratings' of the working alliance were closely and significantly associated with their satisfaction with the treatment and with ratings of treatment outcome. The provider form of the physician-patient working alliance appears to be a reliable and valid measure of the working alliance. Providers' ratings of the working alliance can now be assessed and examined along with patients' ratings of the working alliance. Use of the measures may inform the relationship in medical treatment and advance the quality of care provided to patients.

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