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

  • Review
  • Intervention

Authors


Abstract

Background

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.

Objectives

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.

摘要

背景

於臨床諮詢中促進健康照護提供者以病人為中心照顧方式的介入

健康照護的溝通問題可能肇因於健康照護提供者專注於疾病及治療,而不是病人、其生活及健康問題。以病人為中心的照顧方法漸被消費者及臨床工作者所提倡,也被納入健康照護提供者的訓練中,而促進以病人為中心的的照顧介入成效則需評估。

目標

為評估健康照護者於臨床諮詢中,促進以病人為中心的照護方法之介入成效

搜尋策略

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

選擇標準

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。

資料收集與分析

兩位評論者獨立經由標準模式摘錄資料,並評估每一研究之品質。我們摘錄了除健康照護提供者的知識、態度及意圖外之所有結果。

主要結論

共17研究符合納入標準,而這些研究在介入方式、所關注的健康問題、比較及評估的結果呈現很大的異質性。所有納入的研究均以健康照護提供者的訓練作為介入的一個元素……有強烈的證據顯示,在臨床諮詢中促進健康照護提供者以病人為中心照顧方式的介入,可在諮詢過程中有意義的增加病人自主性,14篇研究中的12篇評估諮詢過程的研究亦顯示在一些評估結果上有改善;也有證據顯示,對健康照護提供者施予以病人為中心方法的訓練,在病人照護滿意度上有正向的影響。在11個評估病人滿意度的研究中,有六個研究發現,在介入方式上有統計上的差異,只有少數研究會評估健康照護行為及健康狀態結果。

作者結論

在臨床諮詢中促進健康照護提供者以病人為中心照護方式之介入,可有意義的增加病人對照護的自主性,可惜的是在對於健康照護行為及健康狀態的效果,或於其他非醫師之健康照護提供者的可行性之證據有限,尚需進一步之研究。

翻譯人

本摘要由成功大學附設醫院賴麗容翻譯。

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

總結

訓練健康照護提供者多些以病人為中心,可改善諮詢中的溝通,增加人們對於提供者態度的滿意度。健康照顧的問題可能會因健康照護提供者僅專注於解決疾病,而非專注於人或其健康問題。雖然『病人自主』難以定義及評估,但以病人為中心的方法逐漸納入於健康照護提供者的訓練中。介入主要在於像諮詢方式,培養同理心,辨識及處理情緒問題方面。這些試驗的回顧發現,對健康照護提供者施予以病人為中心照顧方式的訓練,可改善與病人的溝通,能夠澄清在諮詢中病人所重視的地方,及改善照顧的滿意度,但對於訓練是否改變健康照護的使用及結果則未知。

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.

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