Patient-centredness: a conceptual framework and review of the empirical literature

Mead, Nicola; Bower, Peter

doi:10.1016/s0277-9536(00)00098-8

Cited by 2,387 publications

(2,205 citation statements)

References 69 publications

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“…Other researchers have also reported no association [45,46], whereas a systematic review of general practice consultations found that consultations wherein a psychosocial problem was identified were typically longer in duration [47]. In any case, these findings will reassure audiologists that a focus on psychosocial topics at the beginning of consultations will not necessarily prolong the length of initial assessment appointments.…”

Section: Discussionmentioning

confidence: 91%

Audiologist-patient communication profiles in hearing rehabilitation appointments

Meyer

Barr

Khan

et al. 2017

Patient Education and Counseling

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Highlights Audiology consultations remain clinician-centred.  Three-quarters of appointments began with a biopsychosocial interaction.  All appointments ended with a biomedical interaction dominated by hearing aid talk.  Audiologist-patient communication was not associated with decision to trial HAs. Audiologist-patient communication in hearing rehabilitation 2 AbstractObjective. To profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients' decisions to pursue hearing aids.Methods. Sixty-three initial hearing assessment appointments were filmed and audiologistpatient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted.Results. Two distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Shorter appointments were significantly more likely to be associated with a narrowly biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients' decisions to pursue hearing aids. Conclusion.Initial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction.Practice Implications. Findings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients.

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Section: Discussionmentioning

confidence: 91%

Audiologist-patient communication profiles in hearing rehabilitation appointments

Meyer

Barr

Khan

et al. 2017

Patient Education and Counseling

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“…The biopsychosocial model [6,7] is often emphasized as useful for the management of MUS. When using the three dimensions involved for a holistic assessment, the model is suggested to be a key to patient-centeredness [8,9]. One aspect of patientcenteredness [9] is the therapeutic alliance.…”

Section: Introductionmentioning

confidence: 99%

“…When using the three dimensions involved for a holistic assessment, the model is suggested to be a key to patient-centeredness [8,9]. One aspect of patientcenteredness [9] is the therapeutic alliance. According to many studies on management and perceptions of MUS, the doctor-patient relationship is often a source of frustration due to differing illness perceptions [3].…”

Section: Introductionmentioning

confidence: 99%

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Johansen

Risør

2017

Patient Education and Counseling

101

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Please cite this article as: Johansen May-Lill, Risor Mette Bech.What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies.Patient Education and Counseling http://dx.doi.org/10.1016/j.pec. 2016.11.015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Highlights:-For GPs, dominant disease models (biomedical or psychosocial) often do not fit with reality -Both patients and doctors struggle with and suffer from this incongruence -In the lack of congruent disease models, a validating doctorpatient relationship can be a lifeline 2 Abstract:Objective To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. MethodsWe used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. ResultsThe problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless. In the face of cognitive incongruence, GPs have strived to achieve relational congruence with their patients. This has led to parallel positive experiences of mutual trust and validation. With more experience, some GPs seem to overcome the incongruences, and later studies point towards a reframing of the MUS problem. ConclusionFor GPs, the challenge with MUS is most importantly at an epistemological level. Hence, a full reframing of the problem of MUS for GPs (and for patients) implies broad changes in basic medical knowledge and education. 3Practice Implications Short-term: Improve management of patients with MUS by transferring experience-based, reality-adjusted knowledge from senior GPs to juniors. Long-term: Work towards new models of disease that integrate knowledge from all relevant disciplines.199 words

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“…Because a more patient-centred physician would place less emphasis on the visibility and objectivity of patients' signs and symptoms and tend to perceive patients as more unique individuals 36 , and also, because female physicians, probably as a consequence of gender socialization processes 37,39 , are more often patient-centred 10,33,45,46,47 , we hypothesised that: (H1) the absence of EP or presence of distressed pain behaviors would show effects consistent with results of former studies 52 on both male and female physicians' treatment and referral decisions, but these effects would be stronger among male physicians; (H2) the effects of EP and distressed pain behaviors on pain treatment and referral decisions would be mediated by pain credibility judgments and/or psychological attributions, but again these effects would be stronger among male physicians. Finally, because evidence shows that a CLBP scenario may suppress the impact of patient sex on pain judgments 8 …”

Section: Introductionmentioning

confidence: 99%

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Bernardes

Costa

Carvalho

2013

The Journal of Pain

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The impact of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been underexplored, especially in a pain context. Also, few studies have analyzed whether physicians sex moderates the influence of patients' or clinical situations' characteristics on pain management practices or its mediating processes. Therefore, our goal was to explore whether physician sex moderates the: a) effects of patient's (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain (CLBP), and b) mediating role of pain credibility judgments and psychological attributions on these effects. 310 general practitioners (GPs; 72.6% women) participated in a betweensubjects design, 2 (patient's pain behaviors) x 2 (EP) x 2 (GP sex) x 2 (patient sex). GPs were presented with vignettes depicting a fe(male) CLBP patient, with(out) distress and with(out) EP (e.g., herniated disc). GPs judged the patient's pain and the probability of treatment prescriptions and referrals. Results showed that EP had a larger effect on male than on female physicians' referrals to psychology/psychiatry. Also, GP sex moderated the pain judgments that accounted for the effect of EP and pain behaviors on prescriptions. These findings suggest framing medical decision making as a process influenced by gender assumptions. This is a postprint version of a manuscript published in THE JOURNAL OF PAIN available at http://dx.doi. org/10.1016/j.jpain.2013.03.004 3 Perspective This paper shows that physician sex moderates the influence of clinical cues on pain management practices and the mediating role of pain judgments on these effects. It may potentially increase clinicians' awareness of the influence of gender assumptions on pain management practices and contribute to the development of more gender sensitive services.

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Patient-centredness: a conceptual framework and review of the empirical literature

Cited by 2,387 publications

References 69 publications

Audiologist-patient communication profiles in hearing rehabilitation appointments

Audiologist-patient communication profiles in hearing rehabilitation appointments

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

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