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Interventions to promote patient-centred clinical consultations may improve patient satisfaction
EVIDENCE -BASED HE ALTH PROMOTION
Interventions to promote patient-centred clinical consultations may improve patient satisfaction Abstracted from: Lewin S, Skea Z, EntwistleV, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.
BACKGROUND In patient-centred care, clinicians focus on the patient as an individual rather than as a ‘disease’. Although this way of thinking has been incorporated into training programmes, there is little consensus about its meaning. The e¡ects of a patientcentred approach remain unclear. OBJECTIVE To assess the e¡ect of interventions to promote a patient-centred approach in clinical consultations on provider^patient interactions, health behaviours, well-being and satisfaction. METHOD Systematic review. LITERATURE REVIEW MEDLINE, Health Star, PSYCHLIT, CINAHL and EMBASE were searched to December 1999. INCLUSION/EXCLUSION CRITERIA Eligible studies were randomised controlled trials, controlled clinical trials, controlled before-and-after studies and interrupted time series of any provider-directed intervention to promote patient-centred care in a clinical consultation. Patient-centred care was de¢ned as (i) shared control of the consultation and decisions, and (ii) considering the participant as a whole rather than focusing on the disease process. Studies that trained a provider to deliver an intervention regardless of the consultation purpose were excluded, as were those examining psychotherapy, counselling training or sensitivity training for speci¢c issues. Fifteen randomised controlled trials and two controlled clinical trials were
1462-9410/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebhc.2002.0522, available online at http://www.idealibrary.com.on
included, mostly based in the United Kingdom or North America. All studies involved training healthcare providers (mainly primary care physicians). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed methodological quality. OUTCOMES Consultation processes; participant satisfaction. MAIN RESULTS The intensity of interventions was not standardised and the range of participants wide. The focus on participants improved in 12 of the 14 studies that assessed consultation processes. Patients were more satis¢ed in 6 of 11 studies that assessed satisfaction. Few studies assessed healthcare behaviour or health status. AUTHORS’ CONCLUSIONS Although patientcentredness is widely promoted in clinical consultation, there is limited evidence of its e¡ects. Patient satisfaction may increase, but e¡ects on health remain unclear. NOTES The total number of healthcare providers and participants is not clearly speci¢ed. Seven studies included multifaceted interventions, making it di⁄cult to assess the e¡ect of di¡erent components. It is unclear whether interventions could be used by providers other than physicians.
Evidence-based Healthcare (2002) 6,127^128
127
Commentary The presumed benefits of ‘patient-centred’ approaches are widely espoused, especially in general practice. It seems intuitive that training healthcare providers to deal with the patient as an individual, rather than as a disease, and sharing decision-making would lead to better quality of care than a biomedical focus. As with many issues however, simple hypotheses are often deceptive. The findings of this comprehensive review are muddied by a lack of consensus over definition, measurement problems, the small number of studies and methodological shortcomings. The main strength of the review lies in identifying research priorities.
128
Evidence-based Healthcare (2002) 6,127^128
The broad finding is that patient-centred training impacts on provider behaviour, but the follow-on effects for patient satisfaction, health behaviour and health outcomes are unclear. The review does not make recommendations about strategies to affect satisfaction or behaviour (such as the type or intensity of training and associated costs). As the reviewers concede, the concept of patient-centredness is closely tied to many important philosophies of care, such as patient empowerment and holistic medicine. Evidence of effectiveness may therefore be a peripheral factor. Peter Bower Senior Research Fellow University of Manchester UK
& 2002 Elsevier Science Ltd. All rights reserved
Interventions to promote patient-centred clinical consultations may improve patient satisfaction Abstracted from: Lewin S, Skea Z, EntwistleV, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.
BACKGROUND In patient-centred care, clinicians focus on the patient as an individual rather than as a ‘disease’. Although this way of thinking has been incorporated into training programmes, there is little consensus about its meaning. The e¡ects of a patientcentred approach remain unclear. OBJECTIVE To assess the e¡ect of interventions to promote a patient-centred approach in clinical consultations on provider^patient interactions, health behaviours, well-being and satisfaction. METHOD Systematic review. LITERATURE REVIEW MEDLINE, Health Star, PSYCHLIT, CINAHL and EMBASE were searched to December 1999. INCLUSION/EXCLUSION CRITERIA Eligible studies were randomised controlled trials, controlled clinical trials, controlled before-and-after studies and interrupted time series of any provider-directed intervention to promote patient-centred care in a clinical consultation. Patient-centred care was de¢ned as (i) shared control of the consultation and decisions, and (ii) considering the participant as a whole rather than focusing on the disease process. Studies that trained a provider to deliver an intervention regardless of the consultation purpose were excluded, as were those examining psychotherapy, counselling training or sensitivity training for speci¢c issues. Fifteen randomised controlled trials and two controlled clinical trials were
1462-9410/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebhc.2002.0522, available online at http://www.idealibrary.com.on
included, mostly based in the United Kingdom or North America. All studies involved training healthcare providers (mainly primary care physicians). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed methodological quality. OUTCOMES Consultation processes; participant satisfaction. MAIN RESULTS The intensity of interventions was not standardised and the range of participants wide. The focus on participants improved in 12 of the 14 studies that assessed consultation processes. Patients were more satis¢ed in 6 of 11 studies that assessed satisfaction. Few studies assessed healthcare behaviour or health status. AUTHORS’ CONCLUSIONS Although patientcentredness is widely promoted in clinical consultation, there is limited evidence of its e¡ects. Patient satisfaction may increase, but e¡ects on health remain unclear. NOTES The total number of healthcare providers and participants is not clearly speci¢ed. Seven studies included multifaceted interventions, making it di⁄cult to assess the e¡ect of di¡erent components. It is unclear whether interventions could be used by providers other than physicians.
Evidence-based Healthcare (2002) 6,127^128
127
Commentary The presumed benefits of ‘patient-centred’ approaches are widely espoused, especially in general practice. It seems intuitive that training healthcare providers to deal with the patient as an individual, rather than as a disease, and sharing decision-making would lead to better quality of care than a biomedical focus. As with many issues however, simple hypotheses are often deceptive. The findings of this comprehensive review are muddied by a lack of consensus over definition, measurement problems, the small number of studies and methodological shortcomings. The main strength of the review lies in identifying research priorities.
128
Evidence-based Healthcare (2002) 6,127^128
The broad finding is that patient-centred training impacts on provider behaviour, but the follow-on effects for patient satisfaction, health behaviour and health outcomes are unclear. The review does not make recommendations about strategies to affect satisfaction or behaviour (such as the type or intensity of training and associated costs). As the reviewers concede, the concept of patient-centredness is closely tied to many important philosophies of care, such as patient empowerment and holistic medicine. Evidence of effectiveness may therefore be a peripheral factor. Peter Bower Senior Research Fellow University of Manchester UK
& 2002 Elsevier Science Ltd. All rights reserved