Context

The patient-caregiver relationship has become increasingly stressed over the past few decades as a result of the changing health care system.

Patients are more educated - with access to information technology, direct-to-consumer advertising of medical products, and “consumer directed” insurance products – and expect to work closely with caregivers and be involved in their medical care.

The U.S population has growing cultural and language diversity and a myriad of insurance coverage challenges.

Health care providers are faced with productivity expectations, time pressures, increased administrative burdens, and transparent performance measures.

Why Improving Communication Matters

In one study, at least half of the respondents reported that their regular physician did not ask for their opinions about treatment and care. Moreover, 30% of adults in poor health said that their doctor did not motivate them to adhere to treatment regimens. ¹

Effective patient-caregiver communication is associated with:^{2,3,4. 5}

• Stronger patient-caregiver relationships
• Enhanced patient satisfaction
• Superior decision making
• Increased compliance with recommended treatment^{6, 7, 8, 9}
• Improved health outcomes ¹⁰
• Reduced malpractice claims ⁸

Strong doctor-patient relationships based on trust and commitment are positively associated with patient adherence to treatment.¹⁶

• Cancer screening rates improve when healthcare providers spend more time with patients and adequately explain the importance of surveillance.¹⁷
• Mammography adherence in Latina women has been linked to satisfaction with the health-care relationship.¹⁸
• In a sample of low-income African-American patients, adherence to antihypertensive medications was higher among patients who rated their provider’s communication style as more collaborative.⁸

Communication between cancer patients and their care providers may impact cancer outcomes by influencing empowerment and hope. Physician communication has been reported to generate hope even when poor prognoses are disclosed. ²³

Patient-centered communication, an approach to care that helps patients feel understood at a psychosocial level and expands patient involvement in health decisions, is associated with a decrease in diagnostic test expenditures. When doctors listen to their patients, fewer tests are needed to come to the appropriate medical conclusions. ²⁵

Physicians who spend more time with patients, educate patients about what to expect, use humor, solicit patients’ opinions, and check understanding have fewer malpractice claims.⁵

Why Compassion and Empathy Matter

“When patients talk about the quality of health care, [they] mean something entirely different than experts do . . . compassion.” When caregivers demonstrate compassion and empathy, their patients feel a stronger connection to their providers and feel more engaged in the health care process. ²⁶

Empathy:

• Makes patients more forthcoming about their symptoms and concerns, yielding more accurate diagnoses and better care
• Helps patients regain autonomy and participate in their therapy
• Leads to therapeutic interactions that directly affect patient recovery.²⁷

Practitioners with warm, friendly, reassuring relationships with their patients were found to be more effective than practitioners who kept consultations formal and did not offer reassurance.^{7, 28}

Patients are less likely to file a malpractice claim if they feel their physician was caring and compassionate, even when there is a bad outcome.⁵

Interviews with oncology patients revealed that the degree to which they had felt ‘known’ by their health care provider, understood as a human distinct from the diseased organ, was a powerful force, often shaping their entire cancer care experience. ²⁹

Nurses demonstrating more empathy felt more committed to their jobs and were less likely to experience emotional burnout. ³⁰

Opportunities to reflect and process feelings triggered by their work refuels hospice clinicians and reduces the risk of staff burnout.³¹

Sharing stories about deceased patients with peers increased support, added meaning to the work, and was viewed as a positive approach to coping with grief by pediatric oncology nurses. ³²

Of caregivers who participate in Schwartz Center Rounds, 84% report feeling more compassion for patients and families and more energized about relationships with patients.³³

Schwartz Center Initiatives:  (click on links for detailed program information)

1. Compassionate Caregiver Award
2. Schwartz Center Rounds
3. CarePages Compassionate Connections

Why Spiritual Care Matters

Only 11% of respondents using prayer discussed it with their physicians.³⁴

Among adult hospital inpatients interviewed, 77% believed that a physician should consider their spiritual needs³⁵ and 72% of Americans say that they would welcome a conversation with their physician about faith. ³⁶

Patients with unmet spiritual needs report less satisfaction and poorer quality of care. ³⁷

Patients’ desire for physician involvement with their spiritual and religious concerns increased as the severity of illness increased. ³⁸

The extent to which terminal patients rely on religious coping correlates with advance care planning and desire for aggressive end-of-life treatment. ³⁹

Patients who viewed their disease as an indication that God was punishing or abandoning them were 30% more likely to die over the next two years.¹⁵

By connecting spiritually, caregivers are better able to relate to a patient’s deepest fears, accurately design treatment and help patients experience a more meaningful and hopeful existence or a more dignified and peaceful death. ⁴²

Why Enhancing Candor and Compassion in End-of-Life Care Matters

Most physicians are reluctant to initiate straightforward end-of-life discussions with their patients. ⁴³

Discussing end-of-life care can improve patients’ quality of life.37 Dying patients who participated in an intervention that promoted discussion of end-of-life issues showed improvements in functional status, anxiety, depression, and sense of preparation. ⁴⁴

End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals, contributing to improved quality of life for patients and better bereavement adjustments for family caregivers. ⁴⁵

Conversations about end-of-life care could lower national healthcare expenditures by tens of millions dollars each year for cancer care alone.³⁷

Physicians who viewed end-of-life care as an important responsibility reported increased job satisfaction. ⁴⁶

Health care institutions participating in Schwartz Center Rounds report earlier connections to palliative care services and significant improvements in end of life care for patients and families.¹⁴

Schwartz Center Initiatives:  (click on links for detailed program information)

1. Clinical Pastoral Education Fellowships for Health Care Professionals
2. Schwartz Center Rounds
3. Grants

W hy Cultural Competency Matters

Studies repeatedly show that patients desire health care that is culturally competent while providers receive little or no training in this area and present little diversity for patients to choose from. ⁴⁹

Fundamental differences among people arising from nationality, ethnicity, and culture affect:

• Perceptions about diseases and their causes
• Help-seeking behaviors
• Attitudes toward health care providers
• Expectations of health care encounters
• Provider, patient and family behaviors^{19, 50}

Ethnic differences between caregivers and patients pose barriers to partnership and effective communication. Physicians may incorporate biases into their interpretation of symptoms and medical decision making. Caregivers need to be educated as to how to communicate appropriately with all types of patients.⁵¹

Culturally competent health care involves awareness of and respect for cultural differences and results in improved communication, better health outcomes, and greater patient satisfaction.⁵²

Schwartz Center Initiatives:  (click on links for detailed program information)

Why Influencing Caregiver Training Matters

Caregivers often receive little training in the non-clinical aspects of patient care and are therefore reluctant to deal with patients on a more personal level. One survey indicated that while 83.8% of general practitioners felt communication skills were as important as technical skills to achieve positive patient outcomes, more than a third rated their communication training as inadequate.⁵³

Effective communication skills can be taught.⁵⁶

To strengthen the level of compassionate care, training must begin in graduate school, continue throughout residency/practical training, and be integrated into all levels of professional continuing education.⁵⁷ The health system must reward and reinforce compassionate care giving and provide positive role models from which others can learn.²⁴

A group faculty development approach that included exploration of values and supportive self-reflection had a “positive impact on participants' humanistic teaching.” ⁵⁸

Training doctors to manage their emotional responses openly may improve clinical judgment and reduce work stress.⁵⁹ Research suggests decreasing stress may enhance communication in the patient-provider relationship. ⁶⁰

Physicians who are stressed and dissatisfied are more likely to report making errors and/or providing suboptimal patient care.⁶¹

When medical errors occur, patients want caregivers to acknowledge the incident, take responsibility and apologize. Many providers are unprepared to deal with medical errors and lack the skill to apologize. ^{6, 62}

Schwartz Center Rounds participants report a significant reduction in stress and emotional difficulties. One survey revealed 88% of Rounds participants became more open to expressing thoughts about patient care with colleagues and 88% developed a greater sense of belonging to a caregiving team.¹⁴

Why Empowering Patients Matters

Care that is truly patient-centered embraces the patient as an integral partner who collaborates in making clinical decisions, giving the patient responsibility for self-care and monitoring along with the tools and support to carry out that responsibility.⁶⁴

When patients participate in shared-decision making with their caregivers, they are more likely to comply with recommended treatment.⁶⁵ Health outcomes improve, costs decrease and patient satisfaction increases.^{4, 66}

Patients with HIV who shared decision making with their providers were more likely to adhere to treatment guidelines.⁶⁷

Consumers will choose services that make them feel better and live longer, go to providers who teach them how to be better patients and select health plans that encourage healthy lifestyles.⁶⁸

Schwartz Center Initiatives:  (click on links for detailed program information)

1. The Patient Voice for Compassionate Care: Schwartz Center Dialogues
2. CarePages Compassionate Connections
   

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