The physician-patient working alliance: Theory, research, and future possibilities.

OBJECTIVE: This article discusses the physician-patient working alliance and reviews the empirical research that has been generated on the working alliance to date.

METHODS: The paper presents a brief history of the study of the physician-patient relationship, and discusses constructs that have examined aspects of the relationship, such as empathy, trust, and shared decision-making. Lastly, a meta-analysis was conducted based on the seven empirical studies (a total N of 1023 patients) that have examined the physician-patient working alliance.

RESULTS: Results of the meta-analysis found medium to large effect sizes between the working alliance and various behavioral care indices. The working alliance is positively associated with patient adherence, satisfaction, and improved patient outcomes.

CONCLUSION: Overall, the physician-patient working alliance provides researchers and medical-care providers with a unified construct that combines cognitive and affective dimensions inherent in the relationship in medical care. Furthermore, the PPWAI provides an efficient and inexpensive way to assess the physician-patient relationship in medical treatment.

PRACTICE IMPLICATIONS: The present findings warrant the development of an intervention focused on working alliance training that could be offered to healthcare providers.