When patients have a sense of mutual understanding, caring, and trust with their physicians they form a therapeutic alliance that makes a difference in care at the end of their life.
When the therapeutic alliance was strong, patients were less likely to spend time in an intensive care unit in the last week of life. They also had better emotional acceptance of their terminal illness.
A team at Dana Farber Cancer Institute in Boston developed and validated 16 questions to measure the connection between patient and doctor — The Human Connection (THC) scale.
They found there were lower scores on the THC for:
- Patients with many symptoms of their cancer.
- Patients who had reduced function and ability to manage activities of daily life.
- Patients who had symptoms of mental illness.
The THC score didn’t make a difference in whether or not doctors and patients had end-of-life discussions, but it did change the likelihood that patients would spend time in the ICU. Higher scores predicts less ICU use.
Jennifer W. Mack, MD, MPH and her colleagues concluded,
The THC scale is a valid and reliable measure of therapeutic alliance between patients with advanced cancer and their physicians. In addition, there was no evidence to suggest that EOL discussions harm patients’ therapeutic alliance. A strong therapeutic alliance was associated with emotional acceptance of a terminal illness and with decreased ICU care at the EOL among patients with advanced cancer.
SOURCE: Mack et al., Measuring therapeutic alliance between oncologists and patients with advanced cancer, Cancer, Volume 115, Issue 14, July 15, 2009.