The physician-patient working alliance

Patient Educ Couns. 2007 Apr;66(1):29-36. doi: 10.1016/j.pec.2006.09.013. Epub 2006 Dec 22.


Objective: Cognitive and emotional dimensions of the physician-patient relationship (working alliance) were examined in relation to patients' beliefs about the usefulness of treatment (perceived utility), patients' beliefs about being able to adhere to treatment (adherence self-efficacy beliefs), patients' follow through on their treatment plan (adherence), and patients' satisfaction.

Methods: Participants were 51 men and 67 women who averaged 38.9 years of age (S.D.=12.28). Seventy-two were Euro-American, 23 African-American, 6 Asian-American, 11 Hispanic, and 6 "Other." They reported an average of 7.3 years (S.D.=7.48) since being diagnosed with a chronic medical illness and an average of 7.1 (S.D.=4.88) visits to their doctor within the last year. Patients' conditions included HIV+/AIDS, hypertension, diabetes, asthma, and cancer.

Results: Results show moderate to strong relationships between working alliance and perceived utility (r=0.63, P<0.001), self-efficacy (r=0.47, P<0.001), adherence (r=0.53, P<0.001), and satisfaction (r=0.83, P<0.001). Regression analyses showed that ratings of the working alliance (SB=0.25, P<0.005) and self-efficacy beliefs (SB=0.48, P<0.001) predicted patient adherence and that working alliance ratings (SB=0.83, P<0.001) also predicted patient satisfaction.

Conclusion: The working alliance can be measured in medical care and appears to be strongly associated with patients' adherence to and satisfaction with treatment.

Practice implications: The working alliance is important in medical treatment, as it is associated with patient adherence and satisfaction. Patients' self-efficacy ought to be assessed and promoted as it is also associated with treatment adherence.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Analysis of Variance
  • Attitude of Health Personnel
  • Attitude to Health*
  • Chronic Disease* / prevention & control
  • Chronic Disease* / psychology
  • Cognition
  • Cooperative Behavior*
  • Emotions
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Promotion
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Patient Satisfaction
  • Patient-Centered Care
  • Physician-Patient Relations*
  • Research Design
  • Self Efficacy
  • Social Support
  • Treatment Outcome