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Interventions for providers to promote a patient-centred approach in clinical consultations

  • Review
  • Intervention

Authors


Abstract

Background

Communication problems in health care may arise as a result of healthcare providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. The effects of interventions that aim to promote patient-centred care need to be evaluated.

Objectives

To assess the effects of interventions for healthcare providers that aim to promote patient-centred approaches in clinical consultations.

Search methods

We searched: MEDLINE (1966 to December 1999); HEALTH STAR (1975 to December 1999); PsycLIT (1987 to December 1999); CINAHL (1982 to December 1999); EMBASE (1985 to December 1999) and the bibliographies of studies assessed for inclusion.

Selection criteria

Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions for healthcare providers that promote patient-centred care in clinical consultations. Patient-centred care was defined as a philosophy of care that encourages: (a) shared control of the consultation, decisions about interventions or management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole person who has individual preferences situated within social contexts (in contrast to a focus in the consultation on a body part or disease). The participants were healthcare providers, including those in training.

Data collection and analysis

Two review authors independently extracted data onto a standard form and assessed study quality for each study. We extracted all outcomes other than healthcare providers' knowledge, attitudes and intentions.

Main results

Seventeen studies met the inclusion criteria. These studies display considerable heterogeneity in terms of the interventions themselves, the health problems or health concerns on which the interventions focused, the comparisons made and the outcomes assessed. All included studies used training for healthcare providers as an element of the intervention. Ten studies evaluated training for providers only, while the remaining studies utilised multi-faceted interventions where training for providers was one of several components. The healthcare providers were mainly primary care physicians (general practitioners or family doctors) practising in community or hospital outpatient settings. In two studies, the providers also included nurses.

There is fairly strong evidence to suggest that some interventions to promote patient-centred care in clinical consultations may lead to significant increases in the patient centredness of consultation processes. Twelve of the fourteen studies that assessed consultation processes showed improvements in some of these outcomes. There is also some evidence that training healthcare providers in patient-centred approaches may impact positively on patient satisfaction with care. Of the eleven studies that assessed patient satisfaction, six demonstrated significant differences in favour of the intervention group on one or more measures. Few studies examined healthcare behaviour or health status outcomes.

Authors' conclusions

Interventions to promote patient-centred care within clinical consultations may significantly increase the patient centredness of care. However, there is limited and mixed evidence on the effects of such interventions on patient healthcare behaviours or health status; or on whether these interventions might be applicable to providers other than physicians. Further research is needed in these areas.

Plain language summary

Training healthcare providers to be more 'patient centred' in clinical consultations

Problems in health care may arise from healthcare providers focusing on managing diseases rather than on people and their health problems. Patient-centred approaches are increasingly incorporated into training for providers, although 'patient-centredness' is hard to define or measure. Interventions focus on issues like consultation style, developing empathy, and identifying and handling emotional problems. This review of trials found that training in patient-centredness for healthcare providers may improve communication with patients, enable clarification of patients' concerns in consultations and improve satisfaction with care. It is not clear whether this training makes a difference to healthcare use or outcomes.

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