ReviewPatient-centered care in chronic disease management: A thematic analysis of the literature in family medicine
Introduction
Chronic diseases represent a major health burden worldwide [1]. Experience with chronic diseases implies that the patient, along with having to adopt improved health behaviors, is faced with having to make major adaptations to its repercussions and the daily management of the disease. As many people affected by chronic diseases frequently interact with a family physician [2], [3], [4], this professional is in a privileged position to play a significant role in their lives.
Patient-centered care is widely acknowledged as a core value in patient–physician interactions [1], [5]. Stewart et al. played a major role in the conceptualization of patient-centered care in family medicine. Their patient-centered care model, initially developed in the 1980s [6], [7], [8] and described later in 1995 in the first edition of their book [9], is now the most cited in family medicine [10], [11], [12], [13], [14]. This framework is taught in family medicine residency programs across Canada [15]. Much patient-centered care evidence in family medicine relies on Stewart et al.’s model [10], [16], [17] that proposes six dimensions: (1) exploring both the disease and the illness experience; (2) understanding the whole person; (3) finding common ground; (4) incorporating prevention and health promotion; (5) enhancing the patient–physician relationship and (6) being realistic.
Several recent studies have focused on patient-centered care in the specific context of patients affected by chronic diseases [18], [19], [20], [21], [22]. Some have suggested components of patient-centered care that go beyond Stewart et al.’s model, such as notions of hope [22] or engaging patient expertise [18]. Therefore, the aim of this research was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.
Section snippets
Search methods
We conducted an electronic literature search for English and French articles spanning the 1980 to April 2009 period in Medline (1980–), Embase (1980–), and Cochrane (1991–). An information specialist developed and ran the specific strategies for each database (Appendix A). The following MeSH terms and keywords were used: “patient-centered care” or its linguistic variants and, “family practice,” or “primary health care,” or “primary medical care,” or “primary care”. To broaden the scope of our
Included studies
Fig. 1 shows the number of references found at each stage of the selection process. The search strategies identified 1745 references, of which 1565 were kept after removing duplicates. The majority of these references were excluded by reading the abstract, as they clearly did not meet our inclusion criteria. One hundred five papers were read completely. References found through hand searching (n = 4) were also included, for a total of 109 potentially eligible references. Of these 109 articles, 77
Discussion
This thematic analysis of the literature is the first attempt to integrate theoretical and empirical literature on patient-centered care in chronic disease management in family medicine, building on Stewart et al.’s model. The four main dimensions of their model emerged from our analysis and were regrouped under broader themes and refined to account for chronic disease realities. For instance, considering the significant prevalence of multimorbidity in primary care practices [54], [55], [56],
Funding
This research received financial support from the Canadian Health Services Research Foundation (CHSRF) through the Research, Exchange and Impact for System Support (REISS) competition.
Conflict of interest
The authors declare that they have no competing interests.
Acknowledgement
The authors would like to thank Ms. Susie Bernier for her editorial assistance.
References (70)
- et al.
Patient-centredness: a conceptual framework and review of the empirical literature
Soc Sci Med
(2000) - et al.
Everyday use of patient-centred, motivational techniques in routine consultations between doctors and patients with diabetes
Patient Educ Couns
(2008) - et al.
Using the patient-centered method to achieve excellence in care for women with breast cancer
Patient Educ Couns
(1999) - et al.
Implementing practical interventions to support chronic illness self-management
Joint Comm J Qual Saf
(2003) - et al.
Improving the diabetes patient encounter by reflective tutoring for staff
Patient Educ Couns
(2004) - et al.
Patient-focused care: using the right tools
Chest
(2006) - et al.
Developing a training program in patient-centred consulting for evaluation in a randomised controlled trial: diabetes care from diagnosis in British primary care
Patient Educ Couns
(1996) - et al.
Breast cancer patients’ experiences of patient–doctor communication: a working relationship
Patient Educ Couns
(2000) - et al.
Patient-centredness in chronic illness: what is it and does it matter?
Patient Educ Couns
(2003) - et al.
Facilitating narrative medical discussions of type 1 diabetes with computer visualizations and photography
Patient Educ Couns
(2006)
Evaluation of a patient-centered approach in generalized musculoskeletal chronic pain/fibromyalgia patients in primary care
Patient Educ Couns
The innovative care for chronic condition (ICCC)
Comorbidity: implications for the importance of primary care in case management
Ann Family Med
Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implication for policy and practices
Healthcare Q
Former les personnels de santé du XXe siècle: le défi des maladies chroniques
Organizing care for patients with chronic illness
Milbank Q
The patient-centred clinical method III. Changes in residents’ performance over two months of training
Fam Pract
The patient-centred clinical method I. A model for the doctor–patient interactions in family medicine
Fam Pract
Patient-centred clinical method II. Definition and application
Fam Pract
Patient-centered medicine: transforming the clinical method
Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations
Brit Med J
Quality issues in the treatment of depression in general practice
Int J Health Care Qual Assur
Preferences of patients for patient-centred approach to consultation in primary care: observational study
Brit Med J
Quality, core values and the general practice consultation: issues of definition, measurement and delivery
Fam Pract
Defining competence for the purpose of certification by the College of Family Physicians of Canada
The impact of patient-centered care on outcomes
J Fam Pract
Patient-centred medicine: transforming the clinical method
Patient–provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study
BMC Health Serv Res
Optimizing migraine therapy: evidence-based and patient-centered care
Expert Rev Neurother
Prevention and management of cardiovascular disease and erectile dysfunction: toward a common patient-centered care model
Am J Cardiol
End-of-life care: guidelines for patient-centered communication
Am Fam Physician
Whatever happened to qualitative description?
Res Nurs Health
What's in a name? Qualitative description revisited
Res Nurs Health
Paradigmatic, controversies, contradictions, and emerging confluences
Using thematic analysis in psychology
Qual Res Psychol
Cited by (120)
Patient involvement in rheumatoid arthritis care to improve disease activity-based management in daily practice: A randomized controlled trial
2022, Patient Education and CounselingCitation Excerpt :In the care for people with chronic diseases, it is important that patients have the opportunity to be involved in and agree with the decisions made about their treatment. Shared decisions between patients and physicians allow treatment to be tailored to patients’ individual needs and preferences, and can improve patient care and patient outcomes [1–4]. In Rheumatoid Arthritis (RA) care, guidelines recommend that validated disease activity measures are used to monitor disease activity and adjust treatment accordingly.
Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care
2024, Journal of General Internal MedicineHigh-quality patient-centered palliative care: interprofessional team members’ perceptions of social workers’ roles and contribution
2024, Journal of Interprofessional Care