Project Outline Master Thesis

Transcription

1 Project Outline Master Thesis How Therapeutic Alliance and Shared Decision Making relate to Patient Satisfaction with Physical Therapists Author: Larissa Suter Supervisor: Jan Kool , Kliniken Valens

2 Contents 1. Introduction/Background 2. Methodology 2.2 Sample 2.3 Measurement 2.4 Analysis 3. Ethic approval 4. Budget 5. Time schedule 6. References 7. Discussion/Questions 2

3 1. Introduction/Background 1.1 Patient Satisfaction Patient satisfaction is an important patient-centered outcome (Hush, 2011) ANQ is the bench mark in Switzerland to measure patient satisfaction patients satisfaction with PT is strongly related to the quality of the patient-therapist interactions (Hush, 2011; Goldstein, 2000; Beattie, 2002) includes: treating patient with respect Spending enough time with the patient Listening to patient s concerns Providing clear information 3

4 Patient s point of view is essential in achieving high quality care (Darzi, 2008) Aspects of care such as dignity and respect compassion and involvement in care decisions are important for a successful treatment (Darzi, 2008) Therapeutic Alliance (TA) includes this positive social connection between patient and therapist. 4

5 1.2 Therapeutic Alliance (TA) The three main components of TA are: (Bording, 1979) the patients and therapists agreement on goals the patients and therapists agreement on intervention the emotional bond between patient and therapist The WAI- SR (Working Alliance Inventory- Short Revised) measures these three key aspects of TA. In addition to the known research, aspects such as appraisal, trust and respect patient education shared decision making are also included in the questionnaire 5

6 Positive correlation between therapeutic alliance (TA) and: (Fuentes, 2013) treatment adherence improved pain reduced disability higher treatment satisfaction non- verbal communication such as eye contact, positively influence TA (Pinto, 2012) association between listening, asking questions, showing sensitivity to emotional concerns and TA (Pinto, 2012) 6

7 1.3 Shared Decision Making (SDM) SDM is recommended in health care as a model to improve patient involvement in the treatment decision making process (Dierckx, 2013) It assumes that the therapists and patients are equals (Dierckx, 2013) In PT setting the Dyadic OPTION is the only self-reported questionnaire measuring the involvement in the SDM- process (Devisch, 2015) 7

8 1.4 Research Question So far the relationship between TA and patient satisfaction with physical therapists has not been fully researched and the relationship between SDM and patient satisfaction has not been investigated How do therapeutic alliance and shared decision making relate to patient satisfaction with physical therapists in private practice and rehabilitation settings? 8

9 2. Methodology 2.1 Design The study design is a cross-sectional multicenter observation study. 2.2 Samples Recruitment A minimum of 70 patients need to be recruited 50% in Clinic Valens and 50% in three clinical practices in Zürich Potential study participants will be identified based on the inclusion criteria older than 18 years have the ability to fill out the questionnaires: German or English speaking, no serious cognitive limitations (one question of the questionnaires will be asked) have to be in the 3rd or more therapy session 9

10 Patient information and a consent form describing the study will be distributed Eligible patients will be registered in a list with ID number and telephone number Another list will be conducted with patients who do not agree to take part in the study, reason will be noted 2.3 Measurement Procedure Clinic Valens: fill out questionnaires in waiting room or personal room place the questionnaires in a shelf at the department therapies Clinical Practice: Time: fill out the 3 questionnaires in clinical practice (20 minutes) No time: send it back within 7 days Reminder by a telephone call 10

11 2.3.3 Assessments Patient Satisfaction Question relating to ANQ: (benchmark) A single-item question is adequate to show a sensitive result (Patel, 2011) Would you return for the same problem to the same physical therapist? Likertscale (yes, rather yes, rather no, no) 11

12 Therapeutic Alliance (TA) Working Alliance (Working Alliance Inventory short Revised WAI- SR) 12 items, meassures TA (Munder, 2010) Aspects as appraisal, trust, respect, patient education and SDM-process German adaption Good validty and reliability in psychometric properties (Munder, 2010) WAI-SR was allready used in a systematic review in order to measure TA in the PT setting (Doyle, 2013) 12

13 Shared decision making (SDM) Patients Involvement Dyadic OPTION (Observing) 12 item, which represent the process of SDM (Melbourne, 2010) Each item is rated from 0-4 and the maximum possible score is 48 Good inter-rater realibility, but not yet validated (Melbourne, 2010) No German version available Simple questions without a cultural background -> translate to German In PT setting the only self-reported qeustionnaire measuring the involment in the SDM- process (Devisch, 2015) 13

14 2.4 Analysis Sample size 70 participants will be included in this study. This number of participants is adequate to investigate the influence of 7 independent variable on patient satisfaction Data Analysis and Statistics Mixed models will be used to examine the influence of the independent variable on the dependent variable patient satisfaction. The data are analyzed with SPSS statistics program (Version 23). 14

15 6. References Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Physical therapy. 2002;82(6): Epub2002/05/31. PubMed PMID: Bording ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice. 1979(16): Darzi A. High quality care for all NHS Next Stage Review Final Report. Department of Health Devisch I, Dierckx K, Vandevelde D, De Vriendt P, Deveugele M. Patient s Perception of Autonomy Support and Shared Decision Making in Physical Therapy. Open Journal of Preventive Medicine. 2015(5): ): e297. doi: /journal.pmed Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. Physical therapy. 2013;93(10): Epub 2013/05/04. doi: /ptj PubMed PMID: Fuentes J, Armijo-Olivo S, Funabashi M, Miciak M, Dick B, Warren S, Rashiq S, Magee DJ, Gross DP. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Physical therapy. 2014;94(4): Epub 2013/12/07. doi: /ptj PubMed PMID: Goldstein MS, Elliott SD, Guccione AA. The development of an instrument to measure satisfaction with physical therapy. Physical therapy. 2000;80(9): Epub 2000/08/29. PubMed PMID:

16 Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Physical therapy. 2011;91(1): Epub 2010/11/13. doi: /ptj PubMed PMID: Melbourne E, Roberts S, Durand MA, Newcombe R, Legare F, Elwyn G. Dyadic OPTION: Measuring perceptions of shared decision-making in practice. Patient education and counseling. 2011;83(1):55-7. Epub 2010/06/12. doi: /j.pec PubMed PMID: Pinto RZ, Ferreira ML, Oliveira VC, Franco MR, Adams R, Maher CG, Ferreira PH. Patient centred communication is associated with positive therapeutic alliance: a systematic review. Journal of physiotherapy. 2012;58(2): Epub 2012/05/23. doi: /s (12) PubMed PMID: Wilmers F, Munder T, Leonhart R, Herzog T, Plassmann R, Barth J, Linster HW. Die deutschsprachige Version des Working Alliance Inventory short revised (WAI-SR) Ein schulenübergreifendes, ökonomisches und empirisch validiertes Instrument zur Erfassung der therapeutischen Allianz*. Klin Diagnostik u Evaluation. 2008(1):343 58,. 16

17 7. Discussion / Questions 17

18 Patient Satisfaction (single question) Würden Sie für das gleiche Problem nochmals zum gleichen Therapeuten zurückkehren? 18

19 WAI Working Alliance Inventory WHI-SR (short form) 19

20 Dyadic Observing Patient Involvement (OPTION) 20