Original Research Papers
Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study

https://doi.org/10.1016/j.aimed.2017.02.006Get rights and content

Abstract

Objective

Patient-centred care (PCC) is increasingly recognised as a valuable paradigm of clinical care, particularly in the field of chronic disease. As the use of complementary medicine (CM) grows, so does the need to explore the clinical experience of CM patients. This study aims to provide an examination of patient perceptions of the degree to which CM practitioners employ a patient-centred approach during consultation.

Design

Cross-sectional survey preliminary study.

Methods

A patient-reported survey was administered to assess perceptions of practitioner empathy and support, patient empowerment, and PCC in a multi-profession CM student clinic offering acupuncture, homeopathy, naturopathy, nutrition and myotherapy. The survey was comprised of four existing measures: the Consultation and Relational Empathy (CARE) measure, Patient-Centred Care scale, Perceived Provider Support scale and Empowerment scale.

Results

Amongst 252 respondents, positive perceptions towards all five professions were consistently reported by participants for all four measures. A higher proportion of positive experiences of practitioner empathy and PCC were reported by participants consulting with a naturopath, nutritionist or homeopath compared to those consulting with a myotherapist or acupuncturist. Participants who visited the clinic for assistance with a chronic health condition reported more positive perceptions for items regarding communication from the Patient-Centred Care scale (p = 0.02) and self-efficacy from the CARE measure (p = 0.04).

Conclusion

CM clinical care appears to be characterised by a patient-centred, empathic and empowering approach. CM may present a valuable resource of PCC, particularly within the field of chronic disease management. Further research is required in order to explore this approach in the wider CM community.

Introduction

Psychosocial elements of clinical care play an important role in patient experiences and can impact on health outcomes [1]. Factors such as practitioner empathy [2]; patient-practitioner communication and partnership [3]; individualised, holistic approaches to consultation [4]; and patient experiences of empowerment [5] may promote more favourable clinical outcomes. An increasing understanding of the importance of these psychosocial factors has led to a contemporary movement within the health and medical community toward more person-focussed models of clinical care, such as patient-centred care (PCC) [6], [7], [8].

Paradigms of care found within complementary medicine (CM) philosophies, such as holism [9], [10], promote a whole-person approach analogous with the person-focussed ideals espoused by PCC [11]. Both holism and PCC seek to comprehensively address the patient's health and well-being beyond immediate physical concerns by exploring and acknowledging each patient's individual needs and facilitating sustainable health promotion that accounts for social and environmental factors [11], [12]. CM approaches to treatment can vary in the level of participation required by the patient; treatment can be either patient-enacted (remedies prescribed for self-administration, dietary/lifestyle advice) [13] or practitioner-enacted (acupuncture, manual therapies) [14]. However, in regards to the nature of clinical care provided, patients who seek to consult with CM practitioners do so because they expect to participate in a patient-centred, holistic process [15], [16], [17]. In light of the global prevalence and increasing use of CM [18], [19], [20], it is of interest to note that perceptions of clinical care contribute to reasons for CM use.

Clinical care expectations as drivers of use are particularly applicable to patients seeking care from CM practitioners for chronic health conditions [21], [22], [23]. This is interesting to note due to the high representation of individuals with chronic health conditions amongst CM users [20], [24], the increasing contribution of chronic health conditions to the global burden of disease [25], and emerging assertions that PCC is a particularly effective approach to managing chronic health conditions [26], [27], [28]. If CM practitioners are indeed providing a consultation characterised by PCC, it follows that CM may proffer an overlooked resource of PCC with value to contribute by way of addressing patients’ psychosocial needs, particularly those of patients with chronic health conditions.

While there is a substantial body of qualitative literature supporting the predication that the practice of CM clinical care is indeed aligned with the principles of PCC, there has been little attempt to verify this correlation through quantitative methods [29]. The present study aims to provide a preliminary examination of patient perceptions of the degree to which CM practitioners from a variety of professions employ a patient-centred approach during clinical consultation.

Section snippets

Study design

A cross-sectional survey design was used in order to capture data on prevailing patient experiences. As this study was the first to use quantitative measures to assess PCC and its components across a variety of CM professions in Australia, a preliminary study approach was employed.

Setting

In order to readily access a cross-section of the general population of CM users, the study recruited participants from the setting of the Endeavour College of Natural Health's Wellnation student clinics in Brisbane,

Results

In total, 252 participants were recruited across the five clinics (myotherapy n = 77; naturopathy n = 55; nutrition n = 52; acupuncture n = 44; homeopathy n = 21) during the five weeks of data collection. Excluding follow-up patients who had already participated, the average response rate was 81.5% of those patients who were invited to take part. While efforts were made to invite every patient who attended the clinic when recruitment was taking place in order to limit sampling bias, this was not possible

Discussion

This study is the first to provide a quantitative report of patient perceptions of patient-centred clinical care across a variety of CM professions. The findings of this study draw attention to three key insights regarding: the characteristic nature of the patient's experience of CM clinical care; variations in perceptions of clinical care between different CM professions; and the nuances within CM clinical care as perceived by patients seeking treatment for chronic health conditions.

Conclusion

Findings from this study offer novel insights into the nature of the CM consultation as it is experienced by CM patients and as it relates to psychosocial aspects of health-care provision. These insights carry implications for the potential role of CM within the wider field of health-care, particularly in regards to the growing issue of chronic disease management. While the findings discussed here offer a promising preliminary view of CM clinical care and its potential applications, moreover

Conflicts of interest

None.

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

The authors wish to thanks Liz Iaccarino, Clinic Manager of Brisbane's Wellnation clinics, for her ongoing support throughout the project. The authors also wish to thank Brisbane's Wellnation clinic staff, supervisors and student practitioners for their support and contributions during data collection.

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