Relational Attributes Associated with Treatment Adherence: A Scoping Review

Treatment adherence improves health outcomes, reduces mortality, and saves healthcare costs. Since Hippocrates, patients' adherence has been a concern in health management and its factors found to be complex. Existing research has pointed to positive impacts of strong provider-patient relationships (PPRs) on health outcomes and adherence. This scoping review explores the specific relational attributes in existing literature within PPRs that directly affect adherence and draws out gaps for future research.

The databases CINAHL, Embase, and PubMed were searched for peer-reviewed articles published between 01.01.2015 and 07.01.2025 in English. Qualitative, quantitative, RCTs, and other empirical study designs were included. Included papers are those that report on any attribute(s) of the PPR that must be directly linked to treatment adherence.

Across 48 empirical studies included, we found 6 relational aspects of the PPR that were critical to adherence. Communication was cited to be the most important factor, particularly the content, communicative style, and frequency of information given to patients. Additional factors were also found, such as shared decision-making to empower patients in their own care, trust in the provider, provider's empathy towards the patient, the continuity of care in the duration of the relationship, as well as the lack of discrepancies between provider and patient perspectives towards treatment adherence. Nevertheless, most articles lacked definitions and standardized measurements of these attributes, which we believe is a major gap in the research on PPR and its associated implications for healthcare.

The PPR plays a complex but important role in adherence. More efforts should be made to clarify and standardize the attributes in PPRs in order to better understand how and by which mechanisms adherence may be promoted through the relational dimension of care. Our review also reflects upon these results with overall societal shifts such as digitalization, the movement from compliance to patient-centred adherence, as well as specialization of medicine away from relational care. Findings could translate practically to improve patient adherence by delineating clear and well-defined steps for providers towards the frequency and quality of engagement in clinical encounters towards patients.