Patient-centredness: Is It Applicable Outside the West? Its Measurement and Effect on Outcomes

Abstract

Patient-centredness has been shown to be associated with improved patient outcomes in the West. The objectives of this study were: (i) to further test a specific method for measuring patient-centredness that had previously demonstrated validity and reliability, and (ii) to test the effectiveness of a patient-centred approach amongst poor, non-Western people in South Africa. Patient-centredness was measured in terms of the practitioner's facilitation of the patient's reasons for coming, including symptoms, thoughts, feelings, and expectations. The study involved nurse practitioners and medical doctors in three primary care settings with patients from eight language groups. The method for measuring patient-centredness was found to be valid, reliable (inter-rater correlations, rs = 0.95, 0.88, and 0.87), sensitive, and practical, being inexpensive, time efficient, suitable for consultations involving interpreters, and not requiring transcripts. The score for the first 2 minutes of the consultation correlated highly with the score for the entire consultation (rs = 0.92), which could make the method useful on a large scale. Patient-centredness itself, was also time effective, applicable to cross-cultural consultations involving interpreters, and was associated with patients feeling understood (P = 0.03), patient-practitioner agreement (P = 0.049), symptom resolution (P = 0.01), and concern resolution (P = 0.006). This study supports the effectiveness of patient-centred interviewing in a non-Western setting as well as this method of assessing it.

Health promoting effects of the physician-patient encounter

“…Furthermore, the patient's views can assist the physician in making a diagnosis (Peppiatt, 1992). Research shows that the extent of a physician's patient-centredness contributes to the improvement of somatic complaints in patients with headaches, rheumatism, gastric ulcer, diabetes and breast cancer (Bertakis et al, 1998;Greenfield et al, 1985;the Headache study, 1986;Henbest & Fehrsen, 1992;Henbest & Stewart, 1990;Kaplan et al, 1989;Lorig et al, 1993;Rost et al, 1991).…”

Non‐verbal behaviour in nurse–elderly patient communication

“…Following Henbest & Fehrsen (1992), who noted that scoring only a part of a consultation could be as reliable as scoring an entire consultation, preliminary observations with observation periods of 5 min, 10 min and the total length were carried out during 48 encounters. As 10-min observation periods proved to be very reliable compared with the observation of the total length (non-verbal communication between 0á61 and 0á92 and verbal communication between 0á80 and 0á93, Pearson's R), observation time was standardized and the ®rst 10 min were observed of each of the 181 nursing encounters.…”

Consultation in general practice: a standard operating procedure?

“…Arborelius and Bremberg [13] found that consultations, which both doctor and patient had a positive feeling about, took less time than consultations about which they had negative feelings. Concerning patient centeredness, Henbest and Fehrsen [14] found patient-centred consultations to be no longer than others. Observational studies revealed no difference in duration of the separate components of consultations, like history taking, examination, giving advice and social behaviour, in long versus short consultations [15].…”