Patients as Partners in Teaching Attuned Responsiveness

We need to hear our patients' voices. We need to tune in to what our patients are communicating to us and respond to align with their healthcare needs. This is attuned responsiveness.¹

When we are not attuned, our interventions may not be as tailored to patient needs and preferences as they could be. Potential negative consequences include premature dropouts, unnecessary prolongation of unhelpful treatment approaches and patients feeling unheard and excluded from their treatment course.

How can medical learners optimise attuned responsiveness? How to best teach this vital skill? To investigate, our team went straight to the source—the patient.

This quality improvement (QI) project studied patients' experience of attuned responsiveness in psychotherapy. The implementation team consisted of the author and five psychiatry residents in supervision with the author. To measure attuned responsiveness while maximising practicality, one item from each of three subscales was selected from the 20-item Patient's Experience of Attunement and Responsiveness (PEAR) scale.¹ With input from patients and project team members, item wording was adapted to optimise a spirit of curious, non-judgemental inquiry. Surveys were distributed after each psychotherapy session.

The project followed a QI Plan-Do-Study-Act (PDSA) cycle framework, which guided iterative testing and refinement of change ideas. Interventions involved actively inviting patients to share their experience of the encounter, initially toward the end of each session, then additionally throughout sessions as they unfolded. Weekly data was analysed using run charts; run chart rules were applied to identify signals of non-random variation.

220 patient surveys were collected over 262 psychotherapy sessions.

ACTIVE, IN-SESSION INVITATION OF THE PATIENT PERSPECTIVE IMPROVES PATIENTS' EXPERIENCE OF ATTUNED RESPONSIVENESS. Patient ratings increased with regard to feeling understood, being able to be themselves, and gaining self-understanding, in line with previous studies. Run charts showed signals of non-random variation, with shifts in the intended direction (increase in total score and on each of the three subitems).

SYSTEMATIC INQUIRY WITH A SPIRIT OF COLLABORATIVE DISCOVERY PROMOTES A CULTURE OF FEEDBACK. Resident physicians' level of comfort with assessing attunement improved. Actively inviting patient feedback about moments that had missed the mark led to discussion of nuances patients may have otherwise disregarded or not felt comfortable bringing up, which enriched the understanding of patient experiences and helped shape approaches that were highly customised to each patient's individual needs.

ACTIVE, IN-SESSION INVITATION OF THE PATIENT PERSPECTIVE BY RESIDENT PHYSICIANS EMERGED AS AN IMPACTFUL TOOL DURING SUPERVISION SESSIONS. Feedback originating directly from patients offered an invaluable source of ‘supervision’, adding a new dimension to the supervisory process.

In summary, project findings suggest that systematically engaging the patient perspective in the moment of an encounter offers a practical and impactful means to empower the patient voice, enrich the supervisory process, enhance trainee learning and ultimately improve patient care by creating a more consistently attuned psychotherapy experience for patients. While testing on a larger scale and transferability to clinical contexts beyond psychotherapy remain subjects for further inquiry, this approach holds promise for empowering our teaching by empowering the patient voice.

Michelle van den Engh: Conceptualization; writing—review and editing; data curation; formal analysis; investigation; writing—original draft; project administration; funding acquisition; visualization.

The author has no conflict of interest to declare.

In consultation with the Island Health QI Ethics team, it was determined that as a Quality Improvement (QI) activity used exclusively for assessment, management or improvement purposes, this project was exempt from formal institutional research ethics review according to Article 2.5 of the TCPS2 Canadian policy framework governing research ethics.