Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial.
OBJECTIVE
To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.


METHODS
Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.


RESULTS
Positive affect-oriented communication reduced anxiety (p<0.001), negative mood (p=0.001), and increased satisfaction (p<0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p<0.001) and outcome expectancies (p<0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001).


CONCLUSIONS
Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best.


CONCLUSIONS
Continued medical training is needed to harness placebo-effects of medical communication into practice.
NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
Mara
M
van Osch
NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Faculty of Health Science, University College of Southeast Norway, PO Box 7053, NO-3007 Drammen, Norway. Electronic address: s.vandulmen@nivel.nl.
Sandra
S
van Dulmen
NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
Liesbeth
L
van Vliet
NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands.
Jozien
J
Bensing
D000328:Adult; D000339:Affect; D001007:Anxiety; D003142:Communication; D004645:Empathy; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000517:prevention & control*; D009426:Netherlands; D017060:Patient Satisfaction; D016544:Patient Simulation; D010817:Physician-Patient Relations; D015990:Placebo Effect; D035501:Uncertainty; D014743:Videotape Recording
Analogue patients; Empathy; Expectations; Physician–patient interaction; Placebo-effects; Video-vignettes