Table 1

Objective research approaches to the study of the therapeutic relationship (see companion paper for subjective approaches)8

ApproachDisciplineGeneral format of research questionPreferred study designQuality defined in terms of
1. Patient satisfaction surveysHealth services researchWhat do patients describe as important in their healthcare experience?Interviews, focus groupsService transaction: What are the ‘customers’ in the consultation looking for; what proportion of them are receiving it; and do health outcomes improve if they get it?15–17 Some instruments include measures of patients’ perceptions of patient centredness or shared decision making.
Of themes identified as ‘important’, what is the contribution of each to satisfaction and/or health outcome?Survey development with main focus on closed-item questionnaires oriented to hypothesis testing
2. Rate-your-relationship surveysSocial and clinical psychologyWhat do patients describe as important in the relationship they have with their practitioner, and what do these constructs predict?As above – preliminary qualitative studies followed by survey developmentQuantifying the subjective experience: What level of trust, compassion and interpersonal warmth does the patient feel is present?18–21
3. Interaction analysisCognitive and social psychologyWhat proportion of talk falls into what category (eg, ‘care talk’, ‘cure talk’, ‘patient focused’, ‘doctor focused’)?Interaction analysis (coding of transcript into categories of talk and non-verbal exchange)Types of talk: What types of talk are occurring in the consultation and how much time is spent on each type?21 To what extent is talk patient centred and/or to what extent is decision making shared?23 24