The effect of the patient–physician relationship on health-related quality of life after cardiac rehabilitation

Abstract

Purpose The patient–physician relationship has effects on adherence and health outcomes in chronic diseases. This prospective study investigates the effect of the patient–physician relationship on patients’ health-related quality of life (HRQOL) in the context of cardiac rehabilitation. Methods Three hundred and thirty-eight German patients filled out questionnaires at the start and end of rehabilitation and at 6 months follow-up. Patient–physician relationship variables surveyed were patient involvement (perceived involvement in care scales), trust in the physician, patient satisfaction (PHYSAT) and physician’s communicative behaviour (KOVA). After adjusting for multiple confounders, hierarchical regression analyses were conducted to predict the influence of the patient–physician relationship on HRQOL after rehabilitation. We further examined clinical relevance using minimal clinically important differences (MCID). Results In the hierarchical regression analyses, 42.8–54.9% of the variance at the end of rehabilitation and 22.4–40.5% at follow-up were explained. The patient–physician variables patient satisfaction, physician’s emotionally supportive communication and effective and open communication accounted for 1.4–2.6% of the variance and proved statistically and clinically significant for HRQOL change. Further predictors for better HRQOL were higher income and less trait anger. Conclusion Aspects of the patient–physician relationship are significant predictors for patients’ HRQOL after rehabilitation. Rehabilitation physicians should emotionally support the patients and communicate in an effective and open manner to enhance HRQOL.

Implications for rehabilitation

• Aspects of the patient–physician relationship have effects on adherence and clinical outcomes in chronic diseases.

• In this cardiac sample, the patient–physician relationship had an influence on patients’ health-related quality of life (HRQOL) after inpatient rehabilitation.

• Rehabilitation physicians should emotionally support and encourage the patients and communicate with them in an effective and open manner to enhance patients’ HRQOL.

Keywords:

• Minimal important difference
• patient–physician communication
• patient satisfaction
• socioeconomic factors

Acknowledgements

The authors thank the cooperating rehabilitation centres for their support in data collection: Zentrum für ambulante Rehabilitation Stuttgart (Stuttgart), Herz-Kreislauf-Klinik (Bad Berleburg), Kirchberg-Klinik (Bad Lauterberg im Harz), Vinzenz-Klinik (Bad Ditzenbach), MEDICA Klinik für ambulante Rehabilitation (Leipzig) and Zentrum für ambulante kardiologische Rehabilitation (Berlin).

Disclosure statement

The authors report no conflict of interest in this work.

Funding information

The data used in the present study stem from the project “Patient-provider communication for chronically ill patients: gender- and age-specific preferences of patients”, funded in Germany by the Federal Ministry of Education and Research (Grant No. 01 GX 0740) as part of the funding priority for “Chronic Illnesses and Patient Orientation”. The article processing charge was funded by the German Research Foundation (DFG) and the Albert Ludwigs University Freiburg in the funding program Open Access Publishing.