Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: a qualitative interview study using vignettes

Emily Lyness; Jane Louise Vennik; Felicity L Bishop; Pranati Misurya; Jeremy Howick; Kirsten A Smith; Mohana Ratnapalan; Stephanie Hughes; Hajira Dambha-Miller; Jennifer Bostock; Leanne Morrison; Christian D Mallen; Lucy Yardley; Geraldine Leydon; Paul Little; Hazel Everitt

doi:10.3399/BJGPO.2021.0014

Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: a qualitative interview study using vignettes

BJGP Open. 2021 Jun 30;5(3):BJGPO.2021.0014. doi: 10.3399/BJGPO.2021.0014. Print 2021 Jun.

Authors

Emily Lyness¹, Jane Louise Vennik², Felicity L Bishop³, Pranati Misurya⁴, Jeremy Howick⁵, Kirsten A Smith², Mohana Ratnapalan⁶, Stephanie Hughes⁷, Hajira Dambha-Miller⁸, Jennifer Bostock⁹, Leanne Morrison¹⁰, Christian D Mallen¹¹, Lucy Yardley¹², Geraldine Leydon¹³, Paul Little¹⁴, Hazel Everitt¹⁴

Affiliations

¹ GP and Academic Clinical Fellow, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK emilylyness@doctors.org.uk.
² Research Fellow, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
³ Associate Professor in Health Psychology, School of Psychology, University of Southampton, Southampton, UK.
⁴ Research Assistant, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁵ Senior Researcher and Impact Fellow, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁶ GP and Academic Clinical Fellow, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁷ Senior Research Assistant, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁸ GP and Clinical Lecturer, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
⁹ Patient Public Involvement Contributor, Southampton, UK.
¹⁰ Lecturer in Health Psychology, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
¹¹ Professor of General Practice and Public Health, Keele University, Keele, UK.
¹² Professor in Health Psychology, University of Bristol, Bristol, UK.
¹³ Professor of Medical Sociology & Healthcare Interaction, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
¹⁴ Professor of Primary Care Research, Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.

Abstract

Background: Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients' views about this approach.

Aim: To explore patients' perspectives on clinician communication of empathy and optimism in primary care OA consultations.

Design & setting: Vignette study with qualitative semi-structured interviews. Purposefully sampled patients (n = 33) aged >45 years with hip or knee OA from GP practices in Wessex (Hampshire, Dorest, Wiltshire, and Somerset).

Method: Fifteen participants watched two filmed OA consultations with a GP, and 18 participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a 'neutral' approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.

Results: Patients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised, and embedded within an empathic consultation. Discussing patients' experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.

Conclusion: Patients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.

Keywords: physician–patient communication; physician–patient relations; placebo effect; primary health care.