Presentation
From Synonyms to Solutions: Translating Therapeutic Alliance for Medical Specialties and Human Factors
SessionPoster Session 1
DescriptionTherapeutic Alliance (TA), or the degree to which a patient and provider ‘work together’ (Flock et al., 2023), stems largely from the psychotherapy specialty (Horvath & Luborsky, 1993) and has been a frequent area of interest for researchers embedded in counseling, mental health, and other therapeutic settings. Besides these origins, however, TA has gained traction within oncology, with recent work revealing positive associations between TA and cancer patients’ satisfaction (Velasco-Durántez et al., 2023) in addition to their quality of life (Thomas et al., 2021). These impacts have also been shown to extend beyond patients themselves, with parents of pediatric oncology patients reporting greater healthcare satisfaction when TA between parents and oncologists was higher (Stanek et al., 2025).
Despite the growing acknowledgment of the role of TA within oncology, other medical specialties have been slow to investigate this construct (Fuertes et al., 2007), in contrast to the long-recognized importance of the patient-provider relationship (Kaplan et al., 1989). One potential reason for this may stem from the variety of terms used synonymously with TA within the psychotherapy and oncology specialties, such as working alliance, helping alliance, therapeutic relationship, and rapport (Opland & Torrico, 2024). A comparable variety of terms are used to describe the patient-provider relationship in other medical specialties. The entwined and involuted nature of these terms only further impedes efforts to investigate TA by researchers external to the healthcare domain. When considering human factors-based investigations into TA, disentangling this concept into its underlying constructs and translating these into equivalent human factors (HF) terms is fundamental to any investigation that aims to leverage the wealth of existing work. Failures to reach this understanding between domains (i.e., human factors, psycho-oncology, and other medical specialties) will have implications for both research efforts and practical outcomes within the healthcare system. By facilitating these investigations, a more cohesive understanding between disciplines will be reached, which, in turn, has the opportunity to strengthen collective efforts to address TA across the healthcare domain.
In an effort to overcome this language barrier between psycho-oncology and human factors, the following work leveraged the Flock et al. (2023) systematic review of TA in psycho-oncology to identify measures of TA used in the literature. Based on the systematic review, 24 quantitative, qualitative, and mixed-methods studies that employed a variety of different measures of TA were discussed, with 11 unique measures being synthesized by the authors. These 11 measures varied greatly with respect to their formality (e.g., novel self-constructed items, existing and validated scales, etc.) and approach (e.g., surveys, interviews, questionnaires, etc.). Based on these measures, the authors made efforts to access the studies identified in the Flock et al. (2023) systematic review, in addition to the seminal works that first outlined the measures themselves. During this process, one measure could not be accessed by the authors, with the remaining being evaluated to decompose the underlying constructs/items at the heart of TA and identify equivalent terms used to describe corresponding constructs from HF literature. Particular emphasis was given to teams’ literature, given the intractable nature of the patient-provider team around which TA is centered.
After this evaluation, nine measures were fully decomposed into their underlying constructs/items, and HF equivalent terms were identified. One measure was unable to be assessed as the combination of its interview format, and the breadth of potential respondent answers meant the measure itself did not inherently align with TA. Instead, it generally evaluated aspects of therapy that a patient found helpful. Ultimately, across the nine measures reviewed, 31 constructs/items were identified and translated into HF equivalent terms. After translation, the original 31 constructs/items corresponded to 14 unique HF equivalent terms. The equivalent terms varied in their utilization, with six terms being more highly utilized (i.e., identified 3+ times across different constructs/items). These included “Social Cohesion” (5), “Task-Related Skills” (4), “Trust” (3), “Psychological Safety” (3), “Teamwork Satisfaction” (3), and “Interpersonal Skills” (3). The remaining eight terms were less utilized (i.e., identified 2 or fewer times across different constructs/items) and included “Shared Mental Model” (2), “Task Cohesion” (2), “Taskwork Satisfaction” (2), “Self-Efficacy” (2), “Voice Solicitation” (1), “Communication Skills” (1), “Team Potency” (1), and “Collective Efficacy” (1).
While supplementary work is needed to more formally relate the constructs/items central to TA to those more commonly used within HF, the above work provides initial insights into how these fields of study can be leveraged to benefit each other. Furthermore, with an externalized understanding of TA outside of psycho-oncology, additional applications of previous research and advances can be considered through an HF lens. Subsequently, they may be imparted to medical specialties within the healthcare domain, which have been sluggish in their embrace of TA. In an effort to continue this process, research and practical recommendations are outlined regarding future investigations of TA and subsequent interventions that act on findings. Future research investigating TA in healthcare can be advanced by (1) leveraging a combination of measures from different disciplines, (2) employing existing validated measures when possible, and (3) making efforts to develop cross-disciplinary models of TA and related constructs. From a practical standpoint, interventions that seek to employ findings surrounding TA into healthcare settings should consider (1) leveraging HF practitioners familiar with teams’ literature, (2) drawing on medical professionals from a variety of specialties to facilitate more widely applicable and beneficial processes, and (3) consolidating toolkits of measures and other data sources relevant to TA and outcomes of interest.
Despite the growing acknowledgment of the role of TA within oncology, other medical specialties have been slow to investigate this construct (Fuertes et al., 2007), in contrast to the long-recognized importance of the patient-provider relationship (Kaplan et al., 1989). One potential reason for this may stem from the variety of terms used synonymously with TA within the psychotherapy and oncology specialties, such as working alliance, helping alliance, therapeutic relationship, and rapport (Opland & Torrico, 2024). A comparable variety of terms are used to describe the patient-provider relationship in other medical specialties. The entwined and involuted nature of these terms only further impedes efforts to investigate TA by researchers external to the healthcare domain. When considering human factors-based investigations into TA, disentangling this concept into its underlying constructs and translating these into equivalent human factors (HF) terms is fundamental to any investigation that aims to leverage the wealth of existing work. Failures to reach this understanding between domains (i.e., human factors, psycho-oncology, and other medical specialties) will have implications for both research efforts and practical outcomes within the healthcare system. By facilitating these investigations, a more cohesive understanding between disciplines will be reached, which, in turn, has the opportunity to strengthen collective efforts to address TA across the healthcare domain.
In an effort to overcome this language barrier between psycho-oncology and human factors, the following work leveraged the Flock et al. (2023) systematic review of TA in psycho-oncology to identify measures of TA used in the literature. Based on the systematic review, 24 quantitative, qualitative, and mixed-methods studies that employed a variety of different measures of TA were discussed, with 11 unique measures being synthesized by the authors. These 11 measures varied greatly with respect to their formality (e.g., novel self-constructed items, existing and validated scales, etc.) and approach (e.g., surveys, interviews, questionnaires, etc.). Based on these measures, the authors made efforts to access the studies identified in the Flock et al. (2023) systematic review, in addition to the seminal works that first outlined the measures themselves. During this process, one measure could not be accessed by the authors, with the remaining being evaluated to decompose the underlying constructs/items at the heart of TA and identify equivalent terms used to describe corresponding constructs from HF literature. Particular emphasis was given to teams’ literature, given the intractable nature of the patient-provider team around which TA is centered.
After this evaluation, nine measures were fully decomposed into their underlying constructs/items, and HF equivalent terms were identified. One measure was unable to be assessed as the combination of its interview format, and the breadth of potential respondent answers meant the measure itself did not inherently align with TA. Instead, it generally evaluated aspects of therapy that a patient found helpful. Ultimately, across the nine measures reviewed, 31 constructs/items were identified and translated into HF equivalent terms. After translation, the original 31 constructs/items corresponded to 14 unique HF equivalent terms. The equivalent terms varied in their utilization, with six terms being more highly utilized (i.e., identified 3+ times across different constructs/items). These included “Social Cohesion” (5), “Task-Related Skills” (4), “Trust” (3), “Psychological Safety” (3), “Teamwork Satisfaction” (3), and “Interpersonal Skills” (3). The remaining eight terms were less utilized (i.e., identified 2 or fewer times across different constructs/items) and included “Shared Mental Model” (2), “Task Cohesion” (2), “Taskwork Satisfaction” (2), “Self-Efficacy” (2), “Voice Solicitation” (1), “Communication Skills” (1), “Team Potency” (1), and “Collective Efficacy” (1).
While supplementary work is needed to more formally relate the constructs/items central to TA to those more commonly used within HF, the above work provides initial insights into how these fields of study can be leveraged to benefit each other. Furthermore, with an externalized understanding of TA outside of psycho-oncology, additional applications of previous research and advances can be considered through an HF lens. Subsequently, they may be imparted to medical specialties within the healthcare domain, which have been sluggish in their embrace of TA. In an effort to continue this process, research and practical recommendations are outlined regarding future investigations of TA and subsequent interventions that act on findings. Future research investigating TA in healthcare can be advanced by (1) leveraging a combination of measures from different disciplines, (2) employing existing validated measures when possible, and (3) making efforts to develop cross-disciplinary models of TA and related constructs. From a practical standpoint, interventions that seek to employ findings surrounding TA into healthcare settings should consider (1) leveraging HF practitioners familiar with teams’ literature, (2) drawing on medical professionals from a variety of specialties to facilitate more widely applicable and beneficial processes, and (3) consolidating toolkits of measures and other data sources relevant to TA and outcomes of interest.
Authors
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Patient Safety Research and Initiatives