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

Lewin, Simon; Skea, Zoë; Entwistle, Vikki; Zwarenstein, Merrick; Dick, Judy

doi:10.1002/14651858.cd003267

Cited by 443 publications

(456 citation statements)

References 139 publications

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“…There is evidence that shared decision-making brings a range of physical and psychological benefits for patients [1][2][3]. Offering choice is one way in which clinicians can attempt to realise these benefits.…”

Section: Introductionmentioning

confidence: 99%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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Using Conversation Analysis (CA), we studied conversations between one UK-based epilepsy specialist and thirteen seizure patients in whom there was uncertainty about the diagnosis, and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g. to address patient resistance). Close linguistic and interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician-dominated.

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Section: Introductionmentioning

confidence: 99%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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“…Strong evidence suggests that intensive training interventions, especially with longitudinal reinforcement sessions, can improve clinicians' communication with patients, enable patients to express their concerns and improve patients' satisfaction with care. 3,4 Such training requires taking time away from practice and implementing systems to support interpersonal communication.…”

Section: To the Editormentioning

confidence: 99%

Groups’ Use of Patient Experience Data

Lown

Rosen

2011

J GEN INTERN MED

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We read with interest the findings of Friedberg et al. that although a majority of physician groups reported using patient experience reports to improve group-wide performance, few focused on improving physician-patient communication. 1 In a recent national poll of 500 physicians and 800 recently hospitalized patients conducted by the Schwartz Center for Compassionate Healthcare (Boston, MA), the majority of patients and physicians agreed that effective communication and emotional support can make a difference in whether a patient lives or dies. 1 Licensing and accrediting bodies require demonstration of competency in interpersonal and communication skills, and the Patient Protection and Affordable Care Act of 2010 proposes including survey results of patients' experiences of care (including provider communication) among the measures to calculate value-based incentive payments for hospital discharges. 2 It's unclear why so few quality improvement efforts have included education to improve clinician's patient-centered communication given the increased recognition of its importance. Participants in the study by Friedberg et al. reported sensitivity to low morale among primary care physicians and reluctance to engage physicians' skepticism about their patient experience reports. Changing physicians' communication behaviors is not an easy task. Strong evidence suggests that intensive training interventions, especially with longitudinal reinforcement sessions, can improve clinicians' communication with patients, enable patients to express their concerns and improve patients' satisfaction with care. 3,4 Such training requires taking time away from practice and implementing systems to support interpersonal communication.Schwartz Center Rounds, which are offered in more than 200 hospitals, outpatient centers and nursing homes, provide a monthly or bi-monthly forum for clinicians and other team members to discuss the psychosocial and emotional aspects of care and their impact on patients, families and themselves. Attendees report enhanced attention to these issues; better communication with patients, family members, and colleagues; and decreased stress and isolation. 5 Further research is warranted on interventions designed to improve the capacity of physicians and physician groups to communicate effectively and to provide the emotional support that both patients and physicians believe can make life or death differences.Compassionate care-defined as patient-centered communication and emotional support of patients-must be measured and valued on par with other clinical process and outcomes measures. Changes in provider reimbursement based in part on patients' experiences of care may provide the impetus for this culture change.

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“…Revisão das técnicas para melhorar os problemas de comunicação derivados do que se considera enfoque sobre a doença em relação ao enfoque sobre o paciente (Lewin et al 2003). 18 Conclusão: evidências limitadas e heterogêneas sobre este tipo de intervenção. Necessária pesquisa suplementar.…”

Section: Paradigma Da Medicina Baseada Em Evidências E O Fundamentaliunclassified

Proliferação das rupturas paradigmáticas: o caso da medicina baseada em evidências

Vasconcellos-Silva

Castiel

2005

Rev. Saúde Pública

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DescritoresMedicina baseada em evidências. Metanálise. Paradigma. Publicações periódicas. KeywordsEvidence-based medicine. Metaanalysis. Paradygm. Periodicals. ResumoO presente trabalho descreve o fenômeno da proliferação das rupturas paradigmáticas publicadas na literatura biomédica. É discutida a distorção que, com o passar das décadas, atribuiu um sentido oposto ao original proposto por Thomas Khun. Na sua grande maioria percebemos que essas pseudo-rupturas se relacionam meramente a detalhes técnicos ligados a contextos específicos. Destaca-se o caso da medicina baseada em evidências (MBE), anunciada como uma dessas rupturas, em cuja essência se reafirmam antigas concepções. Alguns equívocos conceituais são enfatizados como tentativas de aplicar os pressupostos da MBE a fenômenos ligados à subjetividade e à dinâmica social, além de outros objetos de estudo peculiares às ciências sociais. São citadas 12 metanálises inconclusivas, que originam paradoxos quando estudados por esta via. A crítica a alguns aspectos da MBE é sintetizada pelo de seu efeito de confundimento epistemológico. Há imprecisões conceituais do termo relacionadas ao efeito de "entrincheiramento", ao qual são induzidos outros modelos epistemológicos não alinhados, assim como a tendência à compreensão universal dos fenômenos pela perspectiva dos estudos duplo-cego randomizados. Abstract The present study describes the phenomenon of paradigmatic ruptures proliferation in the biomedical literature. The current distortion is discussed, which has conferred in the last decades an opposite meaning to the term originally proposed by Thomas Khun. In most part, it is realized that pseudo-ruptures refer to technical details associated to specific contexts. It is pointed out the case of evidence-based medicine (EBM), proclaimed as one of these paradigmatic ruptures, but which essentially corroborates old concepts. Some conceptual errors are stressed as well as attempts to apply EBM assumptions to phenomena associated to subjectivity and social dynamics and other particular study subjects of social sciences. Twelve inconclusive metaanalyses are described to exemplify the paradoxes emerging from this approach. The criticism to some EBM features is summarized through the effects of epistemological bafflement, producing conceptual inaccuracies of the term; the defensive effect to which other disciplines are induced for not being adequate to such rationality; and the tendency of universal understanding of phenomena through the perspective of randomized double-blind studies.

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

Cited by 443 publications

References 139 publications

Offering patients choices: A pilot study of interactions in the seizure clinic

Offering patients choices: A pilot study of interactions in the seizure clinic

Groups’ Use of Patient Experience Data

Proliferação das rupturas paradigmáticas: o caso da medicina baseada em evidências

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