Project overview
This research aimed to enable primary care practitioners to enhance the effectiveness of therapies for osteoarthritis pain through the development of a brief digital intervention: “Expectation Management for Patients with Osteoarthritis” (Empathico). We collaborated on this project with our PPI partner Jennifer Bostock and colleagues from Keele University (Christian Mallen) and University of Oxford (Jeremy Howick).
Background
Osteoarthritis pain is common, costly, and challenging to manage in busy primary care settings. While various drug-based and non-drug-based treatments are recommended, patients still experience pain, poor quality-of-life, and drug side effects. Regardless of which treatment patients receive, excellent practitioner-patient communication can significantly reduce patients’ pain while improving quality of life and satisfaction with care. Some research suggests patients experience less pain after consulting practitioners who show empathy and encourage optimism about treatment. Yet practitioners vary widely in how much they show empathy. Therefore, we developed an online training package to help practitioners (GPs, physiotherapists, and nurses) show more empathy and encourage patients to have positive yet realistic expectations.
Aims and Methods
Our research questions were:
- What strategies should we teach practitioners to use so that they will show more empathy and encourage patients to have realistic and positive expectations?
- What are patients’ and practitioners’ concerns and priorities, to address in our training?
- How can we make our training engaging and relevant for practitioners so that they use it?
To answer these questions, we:
- Reviewed existing trials to confirm what strategies enhance practitioner engagement.
- Reviewed existing qualitative studies to identify patients’ and practitioners’ priorities and concerns.
- Interviewed practitioners so we can make our training engaging and persuasive.
To design our training, we made a plan and used published evidence about how to help people change their behaviour. To produce our training package, we tested prototypes with patients and practitioners and made improvements.
Results
We successfully completed a series of qualitative studies in which we conducted 47 interviews with clinicians and 33 interviews with patients. We also completed 3 systematic literature reviews. This work helped us to develop Empathico and make sure it was engaging and relevant for primary care clinicians. This paper describes how we combined all this evidence, as well as theory on how to support clinicians to change their communication style, to develop Empathico.
After building and optimising Empathico, we conduced a small study (called a feasibility trial) to explore how best to test the effects of Empathico. The study ran from January to October 2020, with COVID-19 related modifications from March 2020. Nine general practices, 12 clinicians, and 437 patients took part. The results showed that with a few refinements it would be possible to conduct a large trial of Empathico in UK primary care. Full details.
Next Steps
The NIHR School of Primary Care Research has since funded a full trial of Empathico in UK primary care. For more on this, see the TIP2 Project page.
Researchers
The researchers employed on this project were: Jane Vennik, Mary Steele, Stephanie Hughes, and Kirsten Smith. Additional contributions were made by: Beth Stuart (lead statistician), Geraldine Leydon, Hajira Dambha-Miller, Riya Tiwari, Mohana Ratnapalan, Emily Lyness, Pranati Misurya and Clare Lockyer-Stevens.
