Date of Award

Spring 1997

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Taft, Thomas b.

Second Advisor

Fox, Robert

Third Advisor

Kipfmueller, Mark


The purpose of this research was to develop a theoretically-derived qualifiable model of the doctor-patient relationship and to explore its suitability for assessing process-outcome linkages in health care delivery as measured by health-related quality of life, morale, and medication adherence. Empirical research strongly supports the importance of interpersonal processes including medical behavior as a correlate of effective health care outcomes. However, research in this area has been hampered by a lack of a reliable methodology which can quantify this relationship. A measure used in psychotherapy process research derived from Bordin's micro-theory of change suggested a promising venue for exploration. This research reports the development of a new instrument, the Healthcare Treatment Alliance Scale, as a useful methodological tool. This study was conducted at a heart failure clinic at a medical school teaching hospital. The 48 participants ranged in age from 26 to 75 years with a mean age of 56.2 years. The sample was comprised of approximately 60% females and 40% males. Patients completed questionnaires measuring the doctor-patient relationship, medication adherence, quality of life, morale, and social support and stress. This was a descriptive, exploratory study; data were collected at one point in time. The research results demonstrated statistically significant correlations between the doctor-patient relationship and health-related quality of life and morale. In a regression analysis controlling for the effects of illness severity, age, and gender, the doctor-patient relationship emerged as a significant predictor of health-related quality of life. The research results did not substantiate the hypothesis that a positive relationship with the physician was associated with higher compliance. The highly skewed research population was most likely the greatest source of difficulty for testing this hypothesis. A possibly important and unanticipated finding was that stress demonstrated a significant inverse relationship to morale, health-related quality of life, mental health and well-being. Social support did not correlate with outcome measures. These research results suggest the healthcare Treatment Alliance Scale as a useful tool to measure the doctor-patient relationship. These results should be considered preliminary to future research and not as definitive conclusions.



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