The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies

doi:10.1016/j.pec.2010.06.017

Patient Education and Counseling

Volume 80, Issue 3, September 2010, Pages 300-306

https://doi.org/10.1016/j.pec.2010.06.017 Get rights and content

Abstract

Objective

Patients’ affect and expectancies can set off placebo effects and thus impact patients’ health. We assessed the relative effects of physicians’ affect-oriented communication style and raising expectations on patients’ affective state and outcome expectancies.

Method

Thirty healthy women presented severe menstrual pain in a scripted consultation with a general practitioner (GP). In a 2 × 2 randomized controlled trial, the GP communicated in a warm, empathic or cold, formal way and raised positive or uncertain expectations. Effects on subjects’ state anxiety, affective state and outcome expectancies were assessed.

Results

Only warm, empathic communication combined with positive expectations led to a significant and relevant decrease in state anxiety. Subjects’ positive and negative affects were influenced by GPs affect-oriented communication style. Negative affect and outcome expectancies are influenced by GP suggestions about outcomes.

Conclusion

Manipulations in physicians’ affect-oriented and expectancy-related communication can have a large impact on patients’ affective state and outcome expectations. A combination of a warm, empathic communication style and raising positive expectations resulted in optimal subject outcomes.

Practice implications

Physicians should take into account that communicating in warm, empathic way combined with raising positive expectations seems to lead to the most favorable effects on patients’ state anxiety and outcome expectancies.

Section snippets

Background

Several review studies have demonstrated that clinical communication can influence patient health outcomes [1], [2], [3]. However, in most of these studies, communication is used as a container concept and usually the mechanisms through which communication might influence outcomes are not specified [3]. Therefore, instead of using communication as a ‘container concept’, we need to (1) define potential mechanisms which can explain the influence of specific communication behaviors on patient

Design

The study has an experimental design using videotaped medical consultations in which two communication elements (expectancies and affect) were manipulated in a 2 × 2 design (see Table 1). Thirty healthy subjects took part as analogue patients [23], [24], [28] in a role-played consultation with a GP. These analogue patients presented symptoms according to a simple script. The GP communicated in either a warm and empathic or a cold and formal manner and raised positive or negative expectancies

Background and general statistics

Analogue patients had a mean age of 25 years, their educational level was intermediate to high. Their actual mean experienced menstrual pain on a VAS scale was 35% (with 100% indicating most pain imaginable) for pain intensity and 38% for pain unpleasantness. They indicated that they found it easy to imagine they were taking part in a real consultation (mean 3.78 out of 5). This measure correlated with the VAS scores (both r = 0.5, p < 0.01) Subjects also thought the consultation closely resembled

Discussion and conclusion

Departing from hypotheses derived from theory on the placebo effect, this study made a focused attempt to disentangle the separate and combined effects of a physician's affect-oriented communication style and raising of treatment outcome expectations on analogue patients’ anxiety, affective state and outcome expectancies.

Conflict of interest statement

The authors have no conflict of interest.

Funding

This study was funded by the Spinoza Prize awarded to Professor Jozien Bensing, PhD by the Dutch Research Council (NWO).

Acknowledgements

We would like to thank the women who participated in this study. We also would like to thank the Patient Provider Interaction group (the Dutch chapter of EACH) for commenting on an earlier version of this paper and Lenja Witlox for video-coding.

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^☆: Second part of the plenary lecture at the International Conference on Communication in Healthcare (ICCH), October 2009, Miami.

View full text

The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies☆

Abstract

Objective

Method

Results

Conclusion

Practice implications

Section snippets

Background

Design

Background and general statistics

Discussion and conclusion

Conflict of interest statement

Funding

Acknowledgements

Patient Educ Couns

J Clin Epidemiol

Pain

Patient Educ Couns

Patient Educ Couns

Patient Educ Couns

Patient Educ Couns

Obstet Gynecol

Obstet Gynecol

J Psychosom Res

Influence of context effects on health outcomes: a systematic review

Lancet

The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review

Health Technol Assess

Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials

Ann Fam Med

Placebo analgesia: findings from brain imaging studies and emerging hypotheses

Rev Neurosci

The placebo effect: dissolving the expectancy versus conditioning debate

Psychol Bull

The placebo: is it much ado about nothing?

The effect of context in health care: a programming study

General practice consultations: is there any point in being positive?

Br Med J (Clin Res Ed)

A comprehensive review of the placebo effect: recent advances and current thought

Annu Rev Psychol

Types of stressors that increase susceptibility to the common cold in healthy adults

Health Psychol

Pain increases during sympathetic arousal in patients with complex regional pain syndrome

Neurology