Understanding the role of positive emotions in healthcare communication - a realist review.

Aim To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient-provider relationship. Design We conducted a realist review guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards. Methods We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and outcomes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration). Results Our findings suggest that in the contexts of person orientation and positive outlook, patient-provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome