title: Patient-centred communication is associated with positive therapeutic alliance: a systematic review.
abstract: OBJECTIVE
  During the patient-therapist encounter, which communication factors correlate with constructs of therapeutic alliance?
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Clinicians and patients in primary, secondary or tertiary care settings.
  
  
  METHODS
  Studies had to investigate the association between communication factors (interaction styles, verbal factors or non-verbal factors) and constructs of the therapeutic alliance (collaboration, affective bond, agreement, trust, or empathy), measured during encounters between health practitioners and patients.
  
  
  RESULTS
  Among the twelve studies that met the inclusion criteria, 67 communication factors were identified (36 interaction styles, 17 verbal factors and 14 non-verbal factors). The constructs of therapeutic alliance in the included studies were rapport, trust, communicative success and agreement. Interaction styles that showed positive large correlations with therapeutic alliance were those factors that help clinicians to engage more with patients by listening to what they have to say, asking questions and showing sensitivity to their emotional concerns. Studies of verbal and non-verbal factors were scarce and inconclusive.
  
  
  CONCLUSIONS
  The limited evidence suggests patient-centred interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance. Clinicians can use this evidence to adjust their interactions with patients to include communication strategies that strengthen the therapeutic alliance.
authors.affiliation: The George Institute for Global Health, University of Sydney, Australia. rafaelzambelli@gmail.com
authors.forename: Rafael Zambelli
authors.initials: RZ
authors.lastname: Pinto
authors.forename: Manuela L
authors.initials: ML
authors.lastname: Ferreira
authors.forename: Vinicius C
authors.initials: VC
authors.lastname: Oliveira
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Franco
authors.forename: Roger
authors.initials: R
authors.lastname: Adams
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Ferreira
mesh_terms: D003142:Communication; D006801:Humans; D009633:Nonverbal Communication; D009819:Office Visits / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations