Measuring the quality of patient-provider relationships in serious illness: A scoping review

Background: People affected by serious illness face several threats to their well-being: physical symptoms, psychological distress, disrupted social relations, and spiritual/existential crises. Relationships with clinicians provide a form of structured support that promotes shared decision-making and adaptive stress coping. Measuring relationship quality may improve quality assessment and patient care outcomes. However, researchers and those promoting quality improvement lack clear guidance on measuring this. Aim: To identify and assess items from valid measures of patient-provider relationship quality in serious illness settings for guiding quality assessment. Design: Scoping review. Data sources: We identified peer-reviewed, English-language articles published from 1990 to 2023 in CINAHL, Embase, and PubMed. Eligible articles described the validation of measures assessing healthcare experiences of patient populations characterized by serious illness. We used Clarke et al.'s theory of relationship quality to assess relationship-focused items. Results: From 3868 screened articles, we identified 101 publications describing 47 valid measures used in serious illness settings. Measures assessed patients and other caregivers. We determined that 597 of 2238 items (26.7%) related to relationships. Most measures (n=46) included items related to engaging the patient as a whole person. Measures evaluated how providers promote information exchange (n=35), foster therapeutic alliance (n=35), recognize and respond to emotion (n=27), and include patients in care-related decisions (n=23). Few instruments (n=9) assessed patient self-management and navigation. Conclusions: Measures include items that assess patient-provider relationship quality in serious illness settings. Researchers may consider these for evaluating and improving relationship quality, a patient-centered care and research outcome.