Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey

<div><p>Background</p><p>Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1) validate, and 2) prioritize these dimensions.</p><p>Method</p><p>A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1) give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria.</p><p>Results</p><p>105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median ≥ 7 on both criteria (relevance and clarity). Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: <i>patient as a unique person</i>, <i>patient involvement in care</i>, <i>patient information</i>, <i>clinician-patient communication</i> and <i>patient empowerment</i>.</p><p>Discussion</p><p>11 out of the 15 dimensions have been validated through experts’ ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.</p></div

An Integrative Model of Patient-Centeredness – A Systematic Review and Concept Analysis

<div><p>Background</p><p>Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results.</p><p>Methods</p><p>Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness.</p><p>Results</p><p>4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59%) contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care.</p><p>Conclusions</p><p>The proposed integrative model of patient-centeredness allows different stakeholders to speak the same language. It provides a foundation for creating better measures and interventions. It can also be used to inform the development of clinical guidance documents and health policy directives, and through this support the shift towards patient-centered health care.</p></div

Model of patient-centeredness [23].

<p>The dimensions in the upper square presenting the <i>enablers</i> of patient-centeredness. I In the lower square the <i>principles</i> are shown, which frame the <i>activities</i> of patient-centeredness. The dimensions rated as the top five out of the fifteen dimensions are labeled with the numbers of their ranking of importance. The four dimensions that were rated with a median < 7 on at least one of the criteria (relevance or clarity) are crossed out.</p

Dimensions of patient-centeredness [23].

<p>Dimensions of patient-centeredness [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141978#pone.0141978.ref023" target="_blank">23</a>].</p

Results for the relevance and <i>clarity</i> (<i>italic type</i>) of the dimensions (N = 71) of round 2.

<p>* Distribution of ratings (%) of the tertiles 1 to 3, 4 to 6 and 7 to 9 along the 9-point-rating-scale.</p><p>Results for the relevance and <i>clarity</i> (<i>italic type</i>) of the dimensions (N = 71) of round 2.</p

Prisma flow chart of study selection.

<p>Prisma flow chart of study selection.</p

Coding example.

<p>Each unit in square brackets was coded:</p>a<p>patient as a unique person;</p>b<p>biopsychosocial perspective;</p>c<p>patient involvement in care;</p><p>Coding example.</p

Results for the relevance (R) and <i>clarity</i> (<i>C</i>) of the dimensions (N = 105) rating of round 1.

<p><b>*</b> Distribution of ratings (%) of the tertiles 1 to 3, 4 to 6 and 7 to 9 along the 9-point-rating-scale.</p><p>Results for the relevance (R) and <i>clarity</i> (<i>C</i>) of the dimensions (N = 105) rating of round 1.</p

Characteristics of included full texts (%).

<p>Characteristics of included full texts (%).</p

Integrative model of patient-centeredness.

<p>The inner circle represents the micro level, the middle circle the meso level and the outer circle the marcro level of care.</p