What phase of the relationship establishment development and engagement model includes reflective listening, eliciting the patient's narrative, and exploring their perspective, particularly for adult or adolescent patients with complex medical histories or social situations?

Engagement Phase

The engagement phase of the relationship establishment, development, and engagement model includes reflective listening, eliciting the patient's narrative, and exploring their perspective. This initial phase focuses on connecting with the patient's story through active listening techniques that foster meaningful therapeutic relationships 1.

Core Components of the Engagement Phase

The engagement phase is characterized by five evidence-based practices that establish the foundation for the patient-provider relationship 1:

• Preparation with intent before seeing the patient sets the stage for meaningful connection 1
• Listening intently and entirely while sitting down demonstrates full attention and commitment to the patient's narrative 1
• Formulating an agreed agenda with the patient about what matters most ensures alignment of priorities 1
• Connecting with the patient's story through uninterrupted narrative elicitation is the cornerstone of this phase 1
• Exploring emotional cues by naming and validating the patient's feelings completes the engagement process 1

The Critical Role of Reflective Listening

Reflective listening involves summarizing what the patient said using their own words rather than paraphrasing, without digressing to other subjects 2. This technique:

• Reinforces patients' own expressions of problems, recognition of concerns, complaints, and values 2
• Reveals potential misunderstandings of patient's concerns early in the encounter 2
• Serves as a mandatory prerequisite for developing genuine empathy 2

Eliciting the Patient's Narrative

Expert clinicians allow patients to tell their complete story without interruption, which typically takes less than 2 minutes even in complex tertiary care cases 1. The narrative approach:

• Provides the most important entry into the medical record as "the history of the present illness" 1
• Connects cause and effect while addressing relational and psychological dimensions alongside physical illness 1
• Takes less time overall when patients can tell their story uninterrupted compared to being asked leading questions 1

Common Pitfall: Premature Interruption

Clinicians typically interrupt patients' initial statements within 22 seconds, which is counterproductive 1. This premature interruption:

• Prevents efficient information gathering that experienced clinicians achieve through complete narratives 1
• Leaves patients feeling hopeless and frustrated when their narrative is suppressed 1
• Increases the likelihood of last-minute questions, misunderstandings, and conflicts 1

Exploring the Patient's Perspective

The engagement phase requires exploring the meaning that patients give both to their health event and to their behaviors through a non-judgmental approach 1. This exploration:

• Helps tailor interventions according to patients' needs and resources 1
• Allows understanding of how to modify behaviors in ways compatible with reducing stress 1
• Provides a window into the patient's psychological traits and values through their narrative style 1

Expert Interviewer Characteristics

Skilled clinicians during the engagement phase remain curious and nonjudgmental, keep track of relevant information, identify metaphors and images, tolerate vagueness and uncertainty, recognize unspoken subtexts, and stay empathetic and attuned 1.

Clinical Outcomes of Effective Engagement

The engagement phase directly impacts patient outcomes beyond just satisfaction 1:

• Patients with diabetes mellitus have reduced hemoglobin A1c levels when their clinician demonstrates empathy through proper engagement 1
• Patients with common colds who were permitted to tell their illness narrative experienced illness duration shortened by almost 1 day 1
• Patients who describe the impact of illness on daily life during engagement are more likely to view the clinician as an empathic partner, which correlates with treatment adherence and care effectiveness 1

Neurobiological Basis

When listening to someone's narrative during engagement, brain patterns between patient and clinician begin to mirror each other 1. This neural coupling produces:

• Measurable increases in plasma cortisol (via increased attention) 1
• Elevated dopamine levels (via improved memory and pleasure) 1
• Increased oxytocin (via pro-social, empathic behavior) 1

Practical Implementation

Begin the engagement phase by allowing patients to tell their story in their own words before integrating any chart review information 3. This sequence:

• Prevents patients from feeling their narrative is being ignored 3
• Allows the clinician to establish the patient's perspective first 3
• Enables more focused questioning on areas needing clarification after the initial narrative 3