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Specifying the effects of physician's communication on patients’ outcomes: a randomised controlled trial.

Osch, M. van, Dulmen, S. van, Vliet, L. van, Bensing, J.M. Specifying the effects of physician's communication on patients’ outcomes: a randomised controlled trial. Patient Education and Counseling: 2017, 100(8), 1482-1489
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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),
(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).

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

Practice implications
Continued medical training is needed to harness placebo-effects of medical communication into practice.