Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea

Research suggests that a warm and empathic “patient-centered” patient-clinician relationship produces better clinical outcomes when compared with a more neutral “disease-centered” relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. The present randomized controlled trial assigned patients (n=73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P=0.008 and P=0.037 respectively). CARE scores were higher for the augmented versus limited group (P=0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. Patients demonstrated greater improvement following acupuncture conducted with a more neutral, “disease-centered” style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. Clinicians should consider cultural differences when applying acupuncture therapy.