Developing a research framework to inform an evidence base for person-centered medicine: keeping the person at the centre

Abstract

Abstract:Person-centered medicine exists at the intersect of science and humanism and has the dual goals of relational and evidence-based practice. In the operationalization of humanistic medicine then, the development of a sympathetic and facilitative research framework is a priority. The personcentric research framework is proffered as one such model and will be described in this paper with a view to eliciting discussion about the essential qualities of a person-centered approach to evidence generation. This framework has been emergent from the clinical practice of the author, and builds upon other pioneering work in this field. It is operationalized as a practitionerinformed philosophy of the conceptualisation, practice and interpretation of research. Evidence-based practice is a prerequisite for all medical and allied health disciplines. The person-centered community has to date, spoken to this requirement in one of two ways [4]: (i) establishing the efficacy and equivalence of person-centered approaches by adopting comparable positivistic research methodologies [1,2]; and (ii) using non-traditional methodologies, largely qualitative, in a bid to move beyond the question of equivalence and toward an exploration of exactly what elements or qualities of the person-centered approach are effective in supporting positive patient outcomes [3]. Both approaches have made substantial contributions to the evidence-base -the former approach affords credibility beyond the person-centered community while the latter generally feels more aligned with the philosophy of person-centered practice. However, both approaches are somewhat slavish in their commitment to one particular type of research methodology, each with their own limitations. Ideally, choice of research methodology should follow from the identification of a question and a philosophically driven consideration of how best to answer that question. At this juncture it seems apposite to reflect on what research values might support or undermine an evidence-base for person-centered practice with a view to developing a philosophical or values-driven model for person-centered research. The current paper acknowledges the genesis of person-centered research as belonging with Rogers and aims to present a conceptual and pragmatic synthesis of the subsequent history of person-centered research to afford a sound base on which this conversation can progress. A historical perspectiveIn medical and allied health spheres, the development of an evidence-base currently relies heavily on the adoption of positivistic scientific methods from the physical sciences in an effort to remove human error variance from the equation. Removing human error variance however, poses a problem for practitioners in the human sciences as it inherently distances research from the daily realities of clinical practice [3]. There is often a disjuncture, for example, between treatment studies using methodologies such as randomised control trials (RCT's) (usually considered the gold standard research metho...

Therapeutic alliance in videoconferencing psychotherapy: A review

“…Through combining quantitative and qualitative data, the researchers were able to access ‘multiple sources of evidence [which] essentially provided multiple measures of the same phenomenon’ (p. 92) . Indeed, the range of settings and populations studied and the inclusion of mixed methods for data analysis may in fact enhance the authenticity of the conclusions that have been reached and their generalisability to real clinical settings . The objective of this literature review was to explore research that has formally investigated TA in the context of psychotherapy via videoconferencing and to identify preliminary factors in the literature to date that may be influential in either enhancing or inhibiting the development of rapport, with particular reference to the therapeutic bond and experience of presence.…”

Untitled

“…Reid's [4] person-centered framework was used to establish whether clinician-derived criteria for quality research practice had been met. This model dictates that priority be given to six principal considerations, as discussed below.…”

Child-Centric Intervention Research: The Devil is in the Detail

“…This framework suggests that fulfilling the dual demands of practice and research requires: (i) infusion of the axiomatic practice elements of ethics and accountability into the research process; (ii) setting research practice within a relational frame rather than methodologically diminishing consideration of human factors; (iii) prioritising a commitment to capturing the complexity of real-world change processes; (iv) encouraging idiothetic levels of analysis so as to understand both individual and group needs and effects; (v) prioritizing reflective practice and (vi) understanding that contextually valid human research is an emergent, often messy, unfolding process. These principles, described in more detail elsewhere [8], guided the conceptual and methodological operationalization of person-centered principles in the context of intervention in childhood.…”

“…We sought a framework to systematically guide our research practice that was developmentally responsive to participants' clinical needs. Reid's person-centric framework prioritises practitioner values and is comprised of 6 key principles to keep the person and in our case the child and family, at the centre of methodological decision-making [8]. This framework suggests that fulfilling the dual demands of practice and research requires: (i) infusion of the axiomatic practice elements of ethics and accountability into the research process; (ii) setting research practice within a relational frame rather than methodologically diminishing consideration of human factors; (iii) prioritising a commitment to capturing the complexity of real-world change processes; (iv) encouraging idiothetic levels of analysis so as to understand both individual and group needs and effects; (v) prioritizing reflective practice and (vi) understanding that contextually valid human research is an emergent, often messy, unfolding process.…”