Talk-to-Heal: Desenvolvimento e avaliação de viabilidade de um programa de treino teórico para otimizar a comunicação médico-paciente

BackgroundPhysician-patient communication (PPC) is widely recognized as a core competence in medical practice and has been associated with multiple benefits for patients, physicians, and the healthcare system. Despite extensive research on the link between good-quality PPC and patients’ adjustment outcomes, less attention has been paid to its associations with physicians’ own psychological adjustment. Moreover, research on the mechanisms underlying those associations has also been warranted. As a potential pathway to increase physicians’ psychological adjustment, PPC skills may be developed through interventions such as PPC training programs. However, current comprehensive communication training initiatives, especially at the level of continuing medical education (CME), present some limitations, such as poor theoretical grounding, focus on isolated skills, or failure to address critical content for managing the emotional demands related to PPC (e.g., physicians’ emotion regulation). Therefore, the main objectives of this research project were: (1) to explore the associations between PPC and adjustment outcomes, in both patients and physicians; (2) to develop a novel PPC training program for practicing physicians, informed by mutually informative theoretical frameworks; and (3) to assess the feasibility of this training program with practicing physicians.MethodsThe project followed a sequential multi-stage approach and included four main empirical studies. First, a systematic review with a meta-analysis of correlations (n = 33) was conducted to examine the associations between PPC and adjustment outcomes for both patients and physicians, from an initial pool of 11.488 articles. Second, a parallel mediation model was empirically tested in a sample of 221 physicians, using a cross-sectional design to explore the direct associations between PPC, physicians’ psychological adjustment (i.e., burnout and flourishing) and the quality of therapeutic relationships, along with the indirect associations through physicians’ barriers to compassion and expressive suppression. The third study was aimed at describing the development process and the validation through expert judgement (n = 21) of a novel PPC training program (“RE.COMMUNICATION”). Lastly, a mixed-method study was conducted to assess the feasibility of the “RE.COMMUNICATION” training program with 52 practicing physicians, including a preliminary longitudinal analysis of intervention effects. ResultsEmpirical Study I revealed a positive but modest association between PPC and patients’ adjustment outcomes, highlighting a significant gap in research focusing on physician-related outcomes. Empirical Study II identified significant associations between PPC, physicians’ psychological adjustment, and therapeutic relationships, with indirect associations with barriers to compassion and expressive suppression. Additionally, the model revealed structural invariance regardless of physicians’ years of professional experience. Empirical Study III presented “RE.COMMUNICATION”, a novel PPC training program, delivered in a single 8-h synchronous online session, and structured in three theory-grounded core modules. In addition, expert judgement revealed overall agreement between experts regarding the relevance and quality of the general and specific components of the intervention. Finally, Empirical Study IV demonstrated the acceptability and suitability of the “RE.COMMUNICATION” program, with promising preliminary intervention effects in improving participants' perceived communication competence and emotion regulation. Critical reflection from the research team and feedback from the participants also informed refinements in recruitment procedures, delivery format and human resources, paving the way for future pilot randomized controlled trials.ConclusionsThe findings of this research project make several original contributions to the field of research on PPC, medical education and health policy. By exploring the relevance of PPC for physicians' psychological adjustment, it reinforces its understanding as a process that benefits not only patients, but also physicians themselves and, consequently, the health system in general. The development and feasibility testing of the “RE.COMMUNICATION” program represent a significant step toward addressing longstanding gaps in CME initiatives, particularly by integrating emotion regulation strategies into communication training. Despite its limitations, this work lays important groundwork for future longitudinal research and efficacy studies. Ultimately, enhancing physicians’ PPC skills may be a promising avenue to support physicians’ work-related well-being, improve therapeutic relationships, and contribute to more sustainable and human-centered healthcare systems.