Interventions that strengthen the patient-clinician relationship improve healthcare outcomes: An updated systematic review and meta-analysis.

Abstract

This review updates a prior meta-analysis which suggested that clinician-focused interventions that strengthen the patient-clinician relationship improve healthcare outcomes. It also extends the previous meta-analysis with additional moderator and sensitivity analyses. This pre-registered systematic review (PROSPERO CRD42024554571) followed PRISMA guidelines. We searched Medline and EMBASE for randomized controlled trials published from November 2012 to June 2024, which compared any clinician-focused intervention to strengthen patient-clinician relationships with controls. Eligible outcomes were objective or validated subjective measures of physical health, health related quality of life, or healthcare resource use. Two investigators completed data extraction, and risk of bias assessment using the RoB2 tool. Random effects meta-analyses were performed. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were reported. Potential moderators investigated were intervention type, review wave (original vs. update), and trial duration. Twenty-eight randomized controlled trials (original review = 13, newly added = 15) comprising 18,046 patients met inclusion criteria. Interventions to improve the patient-clinician relationship were superior to attention-matched controls across a variety of healthcare outcomes (SMD = 0.223, 95% CI: 0.071-0.376, p = 0.004). High heterogeneity was present (Q(27) = 526.43, p < .001; I² = 94.9%), including an important outlier, and GRADE assessment showed certainty of evidence was low. Moderator analyses showed no significant effects. Interventions that strengthen patient-clinician relationships have small but significant effects on healthcare outcomes. Although heterogeneity between included studies is a limitation, the effect cannot be ascribed to differences in consultation duration or frequency, and the effect is observed across multiple clinical settings and health conditions. Health care professionals should embrace existing interventions, including training and resources, that have been shown to strengthen patient-clinician relationships. Health systems should support large-scale implementation of such interventions, not only to improve satisfaction but to achieve better healthcare outcomes.