Doctor-patient communication in the treatment of schizophrenia: Is it related to treatment outcome?

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Successfully engaging people with schizophrenia in mental health services is a key clinical challenge, highlighted by clinicians, service users and carers alike, because (a) they are the most vulnerable of those with mental illness and (b) they are the most likely to disengage from services. In practice, engagement with services involves engagement with clinicians. However, there is a dearth of research on what service users and clinicians do when they meet and how they communicate with each other. In previous research, we found that patients repeatedly attempted to talk about the meaning of what is happening to them but that psychiatrists avoided engaging with these concerns. In a multi-centre observational study, we will audio-visually record 104 routine outpatient consultations between people with schizophrenia and their psychiatrists. We will analyse them using an innovative method, conversation analysis, which analyses what people do rather than what they say they do. We will (1) use operationalised criteria to identify how meaning is constructed in actual treatment encounters (2) investigate the association between meaning and treatment outcome. Outcome will be assessed twice. First, after the consultation is recorded, the therapeutic relationship will be assessed. Second, after 6 months, treatment adherence, engagement with services, relapses and psychopathology will be assessed. Our hypothesis is that the greater the frequency of and effort invested in addressing problems of meaning in a consultation, the more likely the patient is to have a better treatment outcome.