Health effects of the patient-provider relationship: An interpretive study of the lived experience of women with chronic disease.

摘要

Relationships between patients and health care providers are considered an integral component of health care. Considerable empirical research has examined elements of the relationship in order to predict which clinician behaviors enhance the relationship and thereby influence better health outcomes. However, holistic evaluation of the nature of the relationship, its meaning to women and what they believe is helpful has not been examined. This interpretive research investigated what the relationship meant to women and how they believed it affected their health. Twenty-five women, 35 to 55 years, with chronic disease participated in two group interviews. Eleven of these were also interviewed individually. Hermeneutic phenomenology structured the design of the study as well as the narrative and thematic analysis of the data.; All women in the study actively appraised and evaluated their relations with health care providers (HCP), highlighting its salience for their health. Women acknowledged a continuum of relations with HCPs from connected to disconnected yet provided bold narration about the distinct poles of relationships. Connected relationships were distinguished as partnered and personable. HCPs who partnered with the patient engaged with mutual trust, respect and honesty in managing the woman's health concerns. Relationships were personable when the providers disclosed themselves as real persons with everyday struggles. Abstract technical and scientific management of disease concerns was insufficient for the women to believe they were well cared for. Disconnection, in which the provider assumed a personally disengaged professional role, asserted unnecessary power and control in the relationship, or demonstrated clinical mismanagement left women feeling alone and fearful for their health.; Women with chronic disease experienced increased vulnerability because of the care their illness management demanded. Disruptions to the relationship increased their vulnerability because it disallowed continuity of care. In a health system which encouraged or required individual responsibility and collaboration in care, women with strong self advocacy skills reported better health care and more connected relationships. Women lacking these skills suffered doubly because they could not engage the practitioner nor advocate adequately for their own health care needs.; Findings indicate a need for practice focused on the patient's illness experience and the meaning it has in daily life. Providers need to abandon aspects of professional roles that present barriers to authentic involvement with patients. Policy changes are required to address health care structures that bar engaged practice and create mutual distance and alienation in patients and providers alike.