Relationship of patient shame to working alliance and satisfaction: a preliminary investigation

Date27 June 2019
Pages251-263
DOIhttps://doi.org/10.1108/JMHTEP-10-2017-0059
Published date27 June 2019
AuthorDaniel J. Carabellese,Michael J. Proeve,Rachel M. Roberts
Subject MatterHealth & social care
Relationship of patient shame to
working alliance and satisfaction:
a preliminary investigation
Daniel J. Carabellese, Michael J. Proeve and Rachel M. Roberts
Abstract
Purpose –The purpose of this paper is to explore the relationship of two distinct variants of dispositional
shame (internal and external shame) with collaborative, purpose-driven aspects of the patient–provider
relationship (working alliance) and patient satisfaction. The aim of this research was to conduct a preliminary
investigation into the relevance of dispositional shame in a general healthcare population.
Design/methodology/approach –In total, 127 community members (mean age 25.9 years) who reported
that they had regularly seen a GP over the past year were recruited at an Australian university. Participants
were asked to reflect on their relationship with their GP, and completed instruments assessing various
domains of shame, as well as working alliance and patient satisfaction.
Findings –Non-parametric correlations were examined to determine the direction and strength of
relationships, as well as conducting mediation analyses where applicable. Small, negative correlations were
evident between external shame and working alliance. Both external and internal shame measures were also
negatively correlated with patient satisfaction. Finally, the relationship of external shame to patient satisfaction
was partially mediated by working alliance.
Practical implications –Both the reported quality of patient–provider working alliance, and level of patient
satisfaction are related to levels of dispositional shame in patients, and working alliance may act as a mediator
for this relationship.
Originality/value –The findings from this preliminary study suggest that internal and external shame are
important factors to consider in the provision of medical care to maximise the quality of patient experience
and working alliance.
Keywords Patient satisfaction, Mediation, Shame, External shame, Internal shame, Working alliance
Paper type Research paper
Introduction
Medicine in the twenty-first century is increasingly viewed not as a discipline in which physicians
practise on patients, but rather one in which physicians, patients and healthcare professionals
form a multi-disciplinary team arrayed in opposition against illness and health concerns (Kitson
et al., 2013). One of the consequences of this shift in perspective is that medical professionals
generally now recognise and have practice requirements (Caesar, 2016) regarding the
importance of patient participation in healthcare and the value of the physician–patient
relationship. This is arguably a pillar of effective healthcare, in terms of its ability to influence
adherence to healthcare instructions and medication regimens (Fuertes et al., 2007), as well as
patient willingness to disclose vital health information, seek help and remain in treatment (Harris
and Darby, 2009; Fuertes et al., 2015).
As patient-centred care increasingly becomes a driver of policy in various healthcare disciplines
(Kitson et al., 2013), research attention has turned to the physician–patient relationship. Although
the therapeuticrelationship has been recognisedthroughout history (Bordin, 1979),it is only more
recently that this relationship has been measured empirically using various research instruments,
some of which are used for official purposes in the recertification of medical credentials.
Received 25 October 2017
Revised 2 February 2019
Accepted 3 March 2019
Daniel J. Carabellese ,
Michael J. Proeve and
Rachel M. Roberts are all
based at the School of
Psychology, University of
Adelaide, South Austr alia.
DOI 10.1108/JMHTEP-10-2017-0059 VOL. 14 NO. 4 2019, pp. 251-263, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE251

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