Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results

Carla A. Green, Michael R. Polen, Shannon L. Janoff, David K. Castleton, Jennifer P. Wisdom, Nancy Vuckovic, Nancy A Perrin, Robert I. Paulson, Stuart L. Oken

Research output: Contribution to journalArticle

Abstract

Objective: Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Methods: Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Results: Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When "fit" with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters "like friendships," increasing willingness to seek help and continue care when treatments were not effective and supporting "normal" rather than "mentally ill" identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Conclusions: Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.

Original languageEnglish (US)
Pages (from-to)9-22
Number of pages14
JournalPsychiatric Rehabilitation Journal
Volume32
Issue number1
DOIs
StatePublished - Jun 2008
Externally publishedYes

Fingerprint

Continuity of Patient Care
Quality of Life
Psychotic Affective Disorders
Patient Participation
Mentally Ill Persons
Statistical Models
Mood Disorders
Patient Satisfaction
Bipolar Disorder
Psychotic Disorders
Observational Studies
Schizophrenia
Patient Care
Mental Health
Interviews

Keywords

  • Clinician-patient relationships
  • Continuity of care
  • Mental disorders
  • Mixed-methods
  • Quality of life
  • Recovery

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Rehabilitation
  • Health Professions(all)

Cite this

Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness : STARS study results. / Green, Carla A.; Polen, Michael R.; Janoff, Shannon L.; Castleton, David K.; Wisdom, Jennifer P.; Vuckovic, Nancy; Perrin, Nancy A; Paulson, Robert I.; Oken, Stuart L.

In: Psychiatric Rehabilitation Journal, Vol. 32, No. 1, 06.2008, p. 9-22.

Research output: Contribution to journalArticle

Green, Carla A. ; Polen, Michael R. ; Janoff, Shannon L. ; Castleton, David K. ; Wisdom, Jennifer P. ; Vuckovic, Nancy ; Perrin, Nancy A ; Paulson, Robert I. ; Oken, Stuart L. / Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness : STARS study results. In: Psychiatric Rehabilitation Journal. 2008 ; Vol. 32, No. 1. pp. 9-22.
@article{45ee7d30328d4a07afe0caae6128c739,
title = "Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results",
abstract = "Objective: Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Methods: Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Results: Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When {"}fit{"} with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters {"}like friendships,{"} increasing willingness to seek help and continue care when treatments were not effective and supporting {"}normal{"} rather than {"}mentally ill{"} identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Conclusions: Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.",
keywords = "Clinician-patient relationships, Continuity of care, Mental disorders, Mixed-methods, Quality of life, Recovery",
author = "Green, {Carla A.} and Polen, {Michael R.} and Janoff, {Shannon L.} and Castleton, {David K.} and Wisdom, {Jennifer P.} and Nancy Vuckovic and Perrin, {Nancy A} and Paulson, {Robert I.} and Oken, {Stuart L.}",
year = "2008",
month = "6",
doi = "10.2975/32.1.2008.9.22",
language = "English (US)",
volume = "32",
pages = "9--22",
journal = "Psychiatric Rehabilitation Journal",
issn = "1095-158X",
publisher = "Boston University",
number = "1",

}

TY - JOUR

T1 - Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness

T2 - STARS study results

AU - Green, Carla A.

AU - Polen, Michael R.

AU - Janoff, Shannon L.

AU - Castleton, David K.

AU - Wisdom, Jennifer P.

AU - Vuckovic, Nancy

AU - Perrin, Nancy A

AU - Paulson, Robert I.

AU - Oken, Stuart L.

PY - 2008/6

Y1 - 2008/6

N2 - Objective: Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Methods: Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Results: Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When "fit" with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters "like friendships," increasing willingness to seek help and continue care when treatments were not effective and supporting "normal" rather than "mentally ill" identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Conclusions: Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.

AB - Objective: Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Methods: Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Results: Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When "fit" with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters "like friendships," increasing willingness to seek help and continue care when treatments were not effective and supporting "normal" rather than "mentally ill" identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Conclusions: Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.

KW - Clinician-patient relationships

KW - Continuity of care

KW - Mental disorders

KW - Mixed-methods

KW - Quality of life

KW - Recovery

UR - http://www.scopus.com/inward/record.url?scp=48149093336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=48149093336&partnerID=8YFLogxK

U2 - 10.2975/32.1.2008.9.22

DO - 10.2975/32.1.2008.9.22

M3 - Article

C2 - 18614445

AN - SCOPUS:48149093336

VL - 32

SP - 9

EP - 22

JO - Psychiatric Rehabilitation Journal

JF - Psychiatric Rehabilitation Journal

SN - 1095-158X

IS - 1

ER -