The Physician–Patient Working Alliance in Hemodialysis Treatment

Abstract

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.

Social support and treatment adherence in patients with end‐stage renal disease: A systematic review

“…Studies revealing associations between these two variables pointed to the protective role of support received from family members, significant others, and health professionals of the dialysis staff on treatment adherence.…”

“…Treatment adherence was assessed using both direct (biomarkers) and indirect (pill counts, medical records and self-reported) measures. Four studies analyzed biological and biochemical markers, [20][21][22][23] seven studies applied PROM, 6,18,[24][25][26][27] one study used visual analogue scales, 19 two studies consulted medical records to assess information about dialysis sessions, 2,28 and one study used a medical device to assess medication intake. 28 Three studies collected information with direct and indirect measures, [29][30][31] while one study combined results from both measures into an overall score for treatment adherence.…”

“…One of these studies found that overall social support was negatively associated with less skipping of dialysis sessions, measured by consulting the patient's medical records. 29 When considering different sources of support, the other study reported that the alliance between the patient and the physician was a significant predictor of adherence, 24 measured by a self-reported instrument questioning the patient about the number of shortened or skipped sessions.…”

“…Power analysis were performed by five studies 6,20,24,28,32 and seven studies performed subsequent analysis to adjust for possible confounding factors 1,6,22,23,25,26,31 . Papers excluded did not describe sample characteristics, participation rate, assessment tools, power sample analysis, confounding factors, and statistical procedures.…”

“…The calculation of an overall social support score is also possible. The MSPSS was found to have good psychometric qualities across different studies Kara et al 25 Khalil et al 26 Kimmel et al 31 Varghese et al 2 Fuertes et al 24 PPWA Self-report measure that assesses the patient and the physician relationship regarding cognitive and emotional dimensions of empathy, goal setting, shared decision making, and trust. The PPWA was found to have good internal consistency Hitchcock et al 22 SSQ-6 Self-report measure used to assess the quantity and quality of an individual's perceived social support.…”