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Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals

Authors

  • Giulia Lamiani,

    1. Division of Critical Care Medicine, Institute for Professionalism and Ethical Practice, Children’s Hospital Boston, Boston, Massachusetts, USA
    2. Department of Medicine, Surgery and Dentistry, Institute of Medical Psychology, San Paolo Hospital, University of Milan, Milan, Italy
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  • Elaine C Meyer,

    1. Division of Critical Care Medicine, Institute for Professionalism and Ethical Practice, Children’s Hospital Boston, Boston, Massachusetts, USA
    2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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  • Elizabeth A Rider,

    1. Division of Critical Care Medicine, Institute for Professionalism and Ethical Practice, Children’s Hospital Boston, Boston, Massachusetts, USA
    2. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
    3. John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • David M Browning,

    1. Division of Critical Care Medicine, Institute for Professionalism and Ethical Practice, Children’s Hospital Boston, Boston, Massachusetts, USA
    2. Initiative for Pediatric Palliative Care, Education Development Center, Inc., Newton, Massachusetts, USA
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  • Elena Vegni,

    1. Department of Medicine, Surgery and Dentistry, Institute of Medical Psychology, San Paolo Hospital, University of Milan, Milan, Italy
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  • Emanuela Mauri,

    1. Department of Medicine, Surgery and Dentistry, Institute of Medical Psychology, San Paolo Hospital, University of Milan, Milan, Italy
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  • Egidio A Moja,

    1. Department of Medicine, Surgery and Dentistry, Institute of Medical Psychology, San Paolo Hospital, University of Milan, Milan, Italy
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  • Robert D Truog

    1. Division of Critical Care Medicine, Institute for Professionalism and Ethical Practice, Children’s Hospital Boston, Boston, Massachusetts, USA
    2. Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts, USA
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Giulia Lamiani, Institute of Medical Psychology, San Paolo Hospital, Via Di Rudiní 8, 20142 Milan, Italy.
Tel: 00 39 02 5032 3129; Fax: 00 39 02 5032 3015; E-mail: giulialamiani@libero.it

Abstract

Objective  To examine how patient-centredness is understood and enacted in an American (US) and an Italian group of health care professionals.

Methods  An action research methodology was used. Two interprofessional groups of US (n = 4) and Italian (n = 5) health care professionals independently wrote a patient-centred dialogue between a doctor and a patient based on the same scenario. The dialogues were then translated and exchanged. Both groups independently commented on the patient-centred aspects of the other’s dialogue by completing a written questionnaire. Their respective comments were then shared by international videoconference. The transcript of the videoconference was analysed via content analysis. The participants’ opinions about the study were then evaluated.

Results  Exploring the patient’s illness experience and handling the patient’s emotions were identified as core components of patient-centred care by both the US and Italian groups, but were expressed differently in their respective dialogues. Respecting the patient’s autonomy was recognised as a component of patient-centred care only by the US group. The Italian group demonstrated a more implicitly paternalistic approach. Participants highlighted the usefulness of one another’s feedback to uncover cultural assumptions of patient-centred care and increase self-awareness.

Conclusions  Results suggest that the concept and practice of patient-centred care is variable and may be influenced by culture. The study methodology improved participants’ self-awareness of cultural values, and has potential as a cost-effective, experiential educational approach.

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