Behaviorally Defined Patient-Centered Communication—A Narrative Review of the Literature

Michigan State University, B312 Clinical Center, East Lansing, MI 48824, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2011; 26(2):185-91. DOI: 10.1007/s11606-010-1496-5
Source: PubMed


Touted by some as reflecting a better medical model and cited by the influential IOM report in 2000 as one of the six domains of quality care, patient-centered medicine has yet to fully establish its scientific attributes or to become mainstream. One proposed reason is failure to behaviorally define what the term 'patient-centered' actually means.
(1) To identify patient-centered articles among all reported randomized controlled trials (RCT); (2) to identify those with specific behaviorally defined interventions; (3) to identify commonalities among the behavioral definitions; and (4) to evaluate the relationship of the well-defined RCTs to patient outcomes.
Medline from April 2010 to 1975. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: RCTs having any specific, behaviorally defined patient-centered skill(s) in an intervention with some patient outcome involving real adult patients and providers in real clinical situations. APPRAISAL AND SYNTHESIS METHODS: Critical appraisal via narrative review.
The prevalence of any mention of patient-centeredness among 327,219 RCTs was 0.50% (1,475 studies), from which we identified only 13 studies (0.90%) where there were behaviorally-defined patient-centered skills in an intervention. Although there were too few studies to make clinical recommendations, we identified common features of the behavioral definitions used: all went well beyond identifying individual skills. Rather, skills were grouped, prioritized, and sequenced by virtually all, often describing a stepwise patient-centered approach to, variously, gather data, address emotions, or inform and motivate.
The inherent subjectivity of our method for identifying behaviorally-defined studies could under- or over-represent truly replicable such studies considerably. Also, studies were few and very heterogeneous with interventions of widely differing intensity and foci.
RCTs identified as patient-centered were rare, and <1% of these were behaviorally defined and, therefore, possibly replicable. There were many common behavioral definitions in the studies reported, and these can guide us in identifying agreed-upon patient-centered interventions, the immediate next-step in advancing the field.

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Available from: Richard Frankel, Mar 06, 2014
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    • "This leads to an ambiguity concerning relevant and adequate dimensions for the measurement of patient-centeredness.1,4,16 Consequently, outcomes regarding the effectiveness of patient-centeredness are related to its definitions used in respective studies,25 which limits the comparability of their results.26 However, consistent measurement instruments are indispensable2,8,26 for implementing the concept of patient-centeredness in routine clinical practice, which is demanded from a health policy level. Therefore, the following objectives will be addressed in this study: "
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    Patient Preference and Adherence 04/2013; 7:345-51. DOI:10.2147/PPA.S42759 · 1.68 Impact Factor
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    • "These criticisms have led some to eschew PCI practices, dismissing them as 'soft science' [3]. Our group developed an evidence-based, behaviorally defined PCI method that enabled us to study the PCI experimentally and, in this particular case, to better understand its neurobiological underpinnings [3] [4] [5] [6] [7] [8]. "
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    • "Patient-centered interviewing (PCI) has been extensively studied, with recent work specifically defining PCI behaviorally and providing evidence that it is effective in improving patient outcomes [1] [2] [3] [4] [5]. This paper describes the emergent linguistic effects that distinguish standard clinician-centered interviewing (CCI) from a well-established, evidence-based method that integrates PCI and CCI, summarized in Table 1. "
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