INNOVATION FUND Innovation, Integration, & Implementation Emergency and Critical Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Emergency and Critical Care SHOWCASE 2016

Therapeutic Alliance

Emergency and Critical Care


Andre Amaral

416-480-6100 ext 83666

Sunnybrook Health Sciences Centre


Transformation: We expect processes of care related to communication and decision-making to improve.

Adaptability: We expect that many parts of our website will be used in other hospital settings, and the locally specific parts of the website will be easily adaptable at other institutions.

Outcomes: We expect that patient and family outcomes will improve.


Background: The ideal form of collaboration between healthcare providers, patients and families involves establishing individualized goals that respect patients’ values and beliefs. This collaboration is called “therapeutic alliance”, but building it is complex and requires that patients and families become partners in decision-making, and physicians hone their communication skills.

Methods: we conducted 19 semi-structured qualitative interviews with family members. The interviews were recorded and transcribed verbatim, and analyzed inductively and in iterative fashion following an interpretivist qualitative approach. Based on the analysis we created an educational curriculum for trainees and a website for families.

Results: The qualitative analysis shows that the sources of therapeutic alliance are: building relationship with nurses; physicians’ upfront communication; physicians’ building trust; clear messaging at decision-making; and discussion of goals of care. We identified the following barriers to therapeutic alliance: confusions about the staff and their roles; limits about physicians’ availability; cultural assumption about the busy doctor; physicians’ lack of compassion; the medical lingo; limited understanding of the decision-making role; how decisions are sometimes requested; not exploring family concerns; experience of power differences; and ambiguity about involvement of care. The trainees rate the ongoing curriculum, based on role-playing methodology, highly and our website gets mor than 1,000 hits/week. You can visit the website at 

Conclusion: Understanding the needs of family-members allowed us to create strategies to improve therapeutic alliance. We are currently measuring the effects of our strategies on therapeutic alliance with families.

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