Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: A qualitative interview study using vignettes

Emily Lyness, Lucy Yardley, Hazel Everitt, et al.

Research output: Contribution to journalArticle (Academic Journal)peer-review


Background: Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.

Aim: To explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.

Design: Vignette study with qualitative semi-structured interviews.

Setting: Purposefully sampled patients (n=33) aged 45+ with hip/knee OA from Wessex GP practices.

Method: Fifteen participants watched two filmed OA consultations with a GP, and eighteen participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.

Results: Patients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.

Conclusion: Patients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.
Original languageEnglish
JournalBJGP Open
Publication statusAccepted/In press - 10 Feb 2021

Structured keywords

  • Physical and Mental Health


  • physician patient communication
  • placebo effect
  • primary health care

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