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Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled
Rose McCabe1, Paula John2, Jemima Dooley2
1Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK r.mccabe@exeter.ac.uk.
Background:
A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis.
Aims:
To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422).
Method:
In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship.
Results:
Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46-11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03-0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01-0.41, P = 0.043, a medium effect).
Conclusions:
Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.
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