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

  • Review
  • Intervention




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.


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.








我們搜尋了Medline (1966年至1999年12月); Health Star (1975年至1999年12月); PsycLit (1987年至1999年12月); Cinahl (1982年至1999年12月); Embase (1985年至1999年12月) 等資料庫及相關的參考書目


針對健康照護提供者於臨床諮詢中,促進以病人為中心之照顧介入的隨機對照試驗 (randomised controlled trials;RCTs) ,控制臨床試驗 (controlled clinical trials) ,控制事前事後研究 (controlled before and after studies) ,及間斷時間序列研究 (interrupted time series studies) 中,以病人為中心的照顧定義為鼓勵 (a) 共同參與諮詢,介入的決定,病人健康問題的治療,和/或 (b) 諮詢的重點在於視病人為在其社經背景下有個人喜好的整體 (相對於諮詢重點在於身體部位或疾病) 。參與者為健康照顧者,包含正受訓中之健康照顧者。









此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。



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.