CFPK - english version

Centre for Patient Communication

The Centre for Patient Communication is tasked with inspiring and contributing to the cultural, developmental and research activities that promote communication amongst patients, caregivers and healthcare professionals, with the aim of increasing the health literacy and vitality of the individual patient.

Based on interdisciplinary research on patient communication, the centre will breathe life into this research in close dialogue with patients, caregivers and healthcare professionals. Applying systematic implementation research, the centre will work to ensure that successful projects are subsequently put to use in the clinic.

The research is based on the research programme 'Healing Patient Communication - Relationships in Motion'. This programme builds on the assumption that, through specific communication initiatives, we can support the natural healing processes, thus helping to increase the vitality of the individual.

The aim is to ensure that the individual patient has the best possible life and level of activity.


Cure and healing

Our research is inspired by approaches utilised in health research and health communication, which unite the original two aspects of patient care: cure and healing

  • Cure focuses on activities related to diagnosing and curing diseases and/or symptoms and achieving the best possible survival rates
  • Healing focuses on activities aimed at helping the patient return to their own healthy life - with the highest possible level of health and well-being (1)

Our assumptions and hypotheses are particularly inspired by the 'Whole Person Care Programme’ at McGill University in Montreal, which has worked for several years to unite the two approaches.

This approach to patient care focuses on understanding the balance between what the disease does to the body and what it does to the patient (2).

This means that a healthcare provider should be able to handle both approaches in order to provide holistic patient care.

Basic perspectives on health research


Our work is based on the hypothesis that if we combine the two approaches (cure and healing), we will be able to free up resources for patients, relatives and staff, which will promote healing.
In this context, healing can be understood as practices aimed at helping the sick person return to the highest possible level of well-being (1).

The effect of this approach on the tasks and roles of the health service is that health professionals are today expected to manage cure-related communication and - ever increasingly - to take responsibility for healing-related communication.

These methods cannot be standardised because they require skills that must be learned individually, with a focus on teaching healthcare providers to understand themselves, their feelings and their reactions so that they can apply them when caring for the patient (3). It is also important that they are aware of and acknowledge their own mortality and have a clear understanding of this concept(4). To prepare healthcare providers for this task, they need systematic training in skills such as active listening, self-reflection and awareness of their own non-verbal language, etc. (5-7).

“Physicians need to manage professional and personal stress to maintain their own health and well-being and to maximise their ability to provide quality health care to their patients” Derek Puddester (8)


Research results

Since 2007, we have initiated a number of research projects aimed at improving the communication skills of healthcare professionals (9, 10) and increasing the benefit to patients from the communication (11-13). For instance, we have developed a communications programme that includes training in communication skills for all employees at Lillebælt Hospital who have contact with patients (14). Around 3,500 staff have participated in the programme, which has increased staff self-efficacy and significantly improved their attitude towards involving patients (15).

Based on a randomised study of 4,349 patients, we have shown that patients given the chance to listen to recordings of their consultations again are more likely to feel satisfied with the level of information provided and the level of involvement in their treatment. They are more satisfied with the treatment and their relationship to the staff (16, 17). This study has led to further development of the technology and the launch of an implementation study involving patients from both Lillebælt Hospital and Odense University Hospital.

At the same time, we are working to identify patient needs (18, 19), develop coaching methods, (20, 21) and to develop and validate tools to monitor the impact (22, 23).


Dissemination and cooperation

Our research on communication has inspired colleagues, both in Denmark and abroad, to test and/or implement similar interventions, for example at hospitals in Region Zealand, a department at Rigshospitalet, University of Copenhagen, care centres in Sønderborg Municipality, Helse Bergen in Norway and Confluence Health Central Washington Hospital in the USA.

In addition, we are working on further development and dissemination of research in cooperation with our partners in Interreg Project Prometheus , as well as with other partners such as

the Research Unit for General Practice, University of Southern Denmark, the Centre for Innovative Medical Technology (CIMT), Odense University Hospital/University of Southern Denmark, Deakin University, Australia, and the International Association for Communication in Healthcare (EACH)

We also collaborate closely with the Danish Society of Communication in Healthcare . In addition, the Centre for Patient Communication continually highlights communication in its role as organiser of the biannual 'Art of Communication' conference at Hindsgavl Castle and at the annual Vejle Symposia


Research in healing

Medical research is still primarily based on the biomedical mindset. Therefore, knowledge about the physiological effects of interventions with a holistic approach to patient care is limited.

However, the effect of patient-centred communication is now rather convincing when the overall goal is well-being(24-26). Many recent studies have ascertained the physiological effects of communication interventions based on very specific endpoints, including a long-term reduction in blood sugar, improved immune response and shortened duration of the illness (21, 27-31). Similarly, other studies indicate that elements such as trust, respect, exploration of the patient's values and positive reports about treatment, as well as providing reassurance and encouragement can help activate placebo-like effects that may supplement and, in some cases, even replace medical treatment (32, 33). These are causal relationships that can be partly explained by better treatment compliance, combined with a greater sense of control and satisfaction on the part of the patient (34, 35).

It also seems that the importance of and capacity for attachment plays a significant role. Recent studies have shown that a capacity for attachment - or lack thereof - can significantly affect the way symptoms are experienced and the extent of the stress reaction that often accompanies an illness (36-38). At the same time, it is assumed that the physiological response activated while under stress, and the impact it has on our immune system when stress is prolonged, may predispose patients to disease, or exacerbate medical conditions (39). Stress is defined as the individual experience of uncertainty about what can be done to protect physical, mental or social well-being (39). Animal research studies confirm these findings, as they have been able to demonstrate that less solicitous care may lead to gene expression of stress and arteriosclerosis (40, 41).


The Centre for Patient Communication’s research programme

Our current research programme, 'Healing Patient Communication - Relationships in Motion', is based on this knowledge and previously achieved results. The overall goal of the programme is the cure/well-being of the patient, and its aim is to support sick people on their road to maximum well-being - be it physical, psychological or social. To meet this goal, we will:

  • Optimise healthcare providers’ skills in healing communication in order to strengthen their abilities to facilitate processes for optimisation of patients' well-being and healing.
  • Develop, evaluate and implement methods and technical solutions to support patient and family engagement in communication with the healthcare system and in their own healing process. 

This research plan consists of several independent projects, linked by an iterative research process based on Participatory Action Research (PAR) (42).


The link between individual focus areas and projects and the way in which they each contribute to the overall objective is illustrated below:


Within the four main focus areas (outlined on the left), there are five different research topics: patient experiences, mindful practice, data-guided health coaching, recordings of conversations and body and movement. The specific sub-projects related to these topics are also outlined. Sub-projects aim either to explore (E) or intervene (I) in relation to the overall objective.

There are examples of the endpoints related to the focus areas on the right-hand side of the figure.

The individual projects

Projects range from basic research, including hypothesis-generating studies and methodology development, to intervention and implementation studies.



The Centre for Patient Communication is a strategic research initiative based at Lillebælt Hospital.

The centre is organised under the Health Services Research Unit, and managed by the Head of Research, Professor Jette Ammentorp.

The Health Services Research Unit is an interdisciplinary unit at Lillebælt Hospital, affiliated with the Department of Regional Health Services Research, University of Southern Denmark.

An International Advisory Board - 'Healing Health Communication' - has been established for the research programme, and a User Panel has been set up for the Centre for Patient Communication.

“Perhaps the real goal of medicine should be to support patients in their healing journey, to help patients move towards life with a greater sense of connection and meaning, and a new relationship to wounding and suffering” Tom Hutchinson (43)




  1. Cassell EJ. The nature of Healing:The modern practice of medicin. Oxford: Oxford University Press; 2012.
  2. Cassell EJ. Suffering, Whole person care, and the goals of medicine. In: Hutchinson T, editor. Whole person care: a new paradigm for the 21st century. New York, NY: Springer Science and Business Media, LLC; 2011. p. 9-22.
  3. Hutchinson T. Whole person care: a new paradigm for the 21st century. New York, NY: Springer Science and Business Media, LLC;; 2011.
  4. Gawande A. Being Mortal. Illness, medicin and what matteres in the end. London Profile Books LTD; 2014.
  5. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-93.
  6. Epstein RM. Mindful practice. JAMA. 1999;282(9):833-9.
  7. McNamara H, Boudreau JD. Whole person care: a new paradigm for the 21st century. . In: T. H, editor. New York, NY:: Springer Science and Business Media, LLC; 2011. p. 183-200.
  8. Puddester D. The Canadian Medical Association's Policy on Physician Health and Well-being. West J Med. 2001;174(1):5-7.
  9. Norgaard B, Ammentorp J, Kyvik KO, Kofoed PE. Communication skills training increases self-efficacy of health care professionals. J Contin Educ Health Prof. 2012;32:90-7.
  10. Ammentorp J, Sabroe S, Kofoed PE, Mainz J. The effect of training in communication skills on medical doctors' and nurses' self-efficacy. Patient Educ Couns. 2007;66(3):270-7.
  11. Norgaard B, Kofoed PE, Kyvik KO, Ammentorp J. Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care. Scand J Caring Sci. 2012;26:698-704.
  12. Ammentorp J, Laulund LW, Kofoed PE. I mpact of communication skills training on parents perceptions of care: intervention study. JAN. 2011;67(2):394-400.
  13. Ammentorp J, Kofoed PE. The long term effect of communication course for doctors and nurses. Comm Med. 2010(7):3-11.
  14. Ammentorp J, Kofoed PE. Research in communication skills training translated into practice in a large organization: a proactive use of the RE-AIM framework. Patient Educ Couns. 2011;82(3):482-7.
  15. Ammentorp J, Graugaard LT, Lau ME, Andersen TP, Waidtlow K, Kofoed PE. Mandatory communication training of all employees with patient contact. Patient Educ Couns. 2014;95(3):429-32.
  16. Wolderslund M, Kofoed PE, Holst R, Ammentorp J. Patients' use of digital audio recordings in four different outpatient clinics. Int J Qual Health Care. 2015;27(6):466-72.
  17. Wolderslund M, Kofoed PE, Holst R, Axboe M, Ammentorp J. Digital audio recordings improve the outcomes of patient consultations: A randomised cluster trial. Patient Educ Couns. 2017;100(2):242-9.
  18. Assing Hvidt E, Sondergaard J, Ammentorp J, Bjerrum L, Gilsa Hansen D, Olesen F, et al. The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark. Scand J Prim Health Care. 2016;34(4):385-93.
  19. Ammentorp J, Wolderslund M, Timmermann C, Larsen H, Steffensen CD, Nielsen A, et al. How Participatory Action Research changed our view on the challenges in Shared Decision Making training Patient Educ Couns. In review.
  20. Ammentorp J, Uhrenfeldt L, Ehrensv„rd M, Angel F, Carlsen EB, Kofoed PE. Can life coaching improve health outcomes? - a systematic review of intervention studies. BMCHealthServ Res. 2013;33:41-7.
  21. Ammentorp J, Thomsen J, Kofoed PE. Adolescents with poorly controlled Type 1 diabetes can benefit from coaching. A pilot study. J Clin Psychol Med Settings. 2013;20(3):343-50.
  22. Ammentorp J, Thomsen JL, Jarbøl DE, Holst R, Øvrehus AL, Kofoed PE. Comparison of the medical students' perceived self-efficacy and the evaluation of the observers and patients. BMC Med Educ. 2013  Apr 8;13:49.
  23. Axboe MK, Christensen KS, Kofoed PE, Ammentorp J. Development and validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication skills of health care professionals. BMC Med Educ. 2016;16(1):272.
  24. Roter D, Hall JA, Kern DE, Barker LR, Cole KA, Cole KA, et al. Improving physicians' interviewing skills and reducing patients' emotional distress. Arch Intern Med. 1995;155(17):1877-84.
  25. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The Impact of Patient-Centered Care on Outcomes. Fam Pract. 2000;49(9):796-804.
  26. Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician -patient interactions on the outcome of chronic disease. Med Care. 1989;27(3 suppl):110-27.
  27. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;13:76-84.
  28. Hojat M, Louis DZ, Markham FW, Wende R, Rabinowitz C, Connella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(359):64.
  29. Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87(9):1243-9.
  30. Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, archand L, et al. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns. 2011;85(3):390-7.
  31. Bonvicini KA, Perlin MJ, Bylund CL, Carroll G, Rouse RA, Goldstein MG. Impact of communication training on physician expression of empathy in patient encounters. Patient Educ Couns. 2009;75(1):3-10.
  32. Neumann M, Edelhauser F, Kreps GL, Scheffer C, Lutz G, Tauschel D, et al. Can patient-provider interaction increase the effectiveness of medical treatment or even substitute it?--an exploration on why and how to study the specific effect of the provider. Patient Educ Couns. 2010;80(3):307-14.
  33. Bystad M, Bystad C, Wynn R. How can placebo effects best be applied in clinical practice? A narrative review. Psychol Res Behav Manag. 2015;8:41-5.
  34. Street RL, Jr., Elwyn G, Epstein RM. Patient preferences and healthcare outcomes: an ecological perspective. Expert Rev Pharmacoecon Outcomes Res. 2012;12(2):167-80.
  35. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70(351):79.
  36. Ciechanowski PS, Katon WJ, Russo JE, Dwight-Johnson MM. Association of attachment style to lifetime medically unexplained symptoms in patients with hepatitis C. Psychosomatics. 2002;43(3):206-12.
  37. Ciechanowski PS, Walker EA, Katon WJ, Russo JE. Attachment theory: a model for health care utilization and somatization. Psychosom Med. 2002;64(4):660-7.
  38. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry. 2001;158(1):29-35.
  39. Peters A, McEwen BS, Friston K. Uncertainty and stress: Why it causes diseases and how it is mastered by the brain. Prog Neurobiol. 2017;156:164-88.
  40. Weaver IC. Epigenetic programming by maternal behavior and pharmacological intervention. Nature versus nurture: let's call the whole thing off. Epigenetics. 2007;2(1):22-8.
  41. Nerem RM, Levesque MJ, Cornhill JF. Social environment as a factor in diet-induced atherosclerosis. Science. 1980;208(4451):1475-6.
  42. Reason P, Bradbury H. The SAGE Handbook of Action Research. Participative Inquiry and Practice. 2nd ed. London: Sage Publications; 2008.
  43. Hutchinson T, Mount BM, Kearnery M. The healing journey. . In: Hutchinson T, editor. Whole person care: a new paradigm for the 21st century New York, NY: Springer Science and Business Media, LLC; 2011. p. 23-9.