The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective
To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes.
Design
Systematic review and meta-analysis.
Data Sources
Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews.
Eligibility Criteria for Selecting Studies
Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions.
Results
Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = −.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02).
Conclusions
This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.

研究目的

旨在明确医患关系（patient-clinician relationship）是否对客观医疗结局或经过验证的主观医疗结局产生有益影响。

研究设计

系统评价与元分析（meta-analysis）。

数据来源

电子数据库EMBASE、MEDLINE，以及既往综述的参考文献章节。

纳入研究的标准

纳入的研究为针对成年患者的随机对照试验（randomized controlled trials, RCT），其中医患关系得到系统性操纵，且医疗结局指标为客观测量指标（如血压）或经过验证的主观测量指标（如疼痛评分）。排除以下情况的研究：临床就诊为常规体格检查、心理健康或物质滥用门诊；结局指标为患者满意度、治疗依从性等中间结局；仅通过对患者进行干预来操纵医患关系；或不同实验组间临床就诊时长存在不均等的情况。

研究结果

共计13项随机对照试验符合纳入标准。各项独立研究的效应量范围为d=−0.23至0.66。采用随机效应模型计算得到的总效应量较小（d=0.11），但具有统计学显著性（p=0.02）。

研究结论

本项针对随机对照试验的系统评价与元分析结果表明，医患关系对医疗结局存在较小但具有统计学显著性的影响。鉴于符合纳入标准的随机对照试验数量相对较少，且其中多数研究并非专门为验证医患关系对医疗结局的影响而设计，我们呼吁未来针对这一重要主题开展更多相关研究。