
Vikki A EntwistleUniversity of Aberdeen | ABDN · (1) Health Services Research Unit; (2) Philosophy
Vikki A Entwistle
MA, MSc, PhD
About
245
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Introduction
I'm broadly interested in values and ethics in health care, public health and funeral provision. My work is collaborative and interdisciplinary, typically combining qualitative research methods with more philosophical conceptual and normative analyses.
I currently have particular interests in efforts to improve health care and how different aspects of quality (including fairness and person-centredness) are interpreted in relation to each other. I'm also working increasingly on death care.
Skills and Expertise
Additional affiliations
April 2020 - present
July 2018 - March 2020
January 2013 - May 2018
Publications
Publications (245)
The capability approach (CA) is a framework for understanding, assessing, and promoting the quality of human lives and social justice. It focuses on capabilities – people's freedoms and opportunities to live in valuable ways. Although its proponents readily acknowledge that capabilities can depend on personal, social and environmental factors, litt...
Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose...
Background
Personalised Care and Support Planning (PCSP) replaces conventional annual reviews for people with long-term conditions. It is designed to help healthcare professionals (HCPs) and patients engage in conversations as equals and collaboratively plan actions oriented to each patient’s priorities, alongside biomedical concerns. Little is kno...
Efficiency is often overlooked as an ethical value and seen as ethically relevant chiefly when it conflicts with other values, such as equality. This article argues that efficiency is a rich and philosophically interesting concept deserving of independent normative examination. Drawing on a detailed healthcare case study, we argue that making asses...
In his 1987 paper “Truth or Consequences,” Dan Brock describes a deep conflict between the goals and virtues of philosophical scholarship and public policymaking: whereas the former is concerned with the search for truth, the latter must primarily be concerned with promoting good consequences. When philosophers are engaged in policymaking, he argue...
Ethics involves examining values and identifying what is good, right, and justified – and why. Diverse values and ethical issues run through healthcare improvement, but they are not always recognised or given the attention they need. While much effort goes into understanding whether intervention X effectively leads to change Y, questions such as 'i...
Background
Two polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals’ perspectives on CSP to inform future developments.
Methods
Qualitative research including 23 semi-structu...
Livestreaming and filming death rites and funeral ceremonies to enable remote engagement proliferated rapidly during the COVID-19 pandemic, and many expect these options to remain prevalent going forward. This paper draws on interviews with a diverse UK sample of 68 bereaved people, funeral directors, officiants and celebrants. It illustrates how,...
Especially when travel and gatherings were restricted during the pandemic, filming and livestreaming enabled more people to connect with funerals than could attend in person. Filming has also created another less well considered possibility: of revisiting a funeral via a recording. This Viewpoint outlines a range of experiences and opinions about t...
Many different words and phrases are used to describe healthcare that treats patients as people. Do terms such as 'person centred', 'patient centred', 'people centred' and 'personalised' mean broadly the same thing or do they refer to distinct concepts? Should we prefer one over the others? In this essay, we set out the value and limitations of som...
The ‘improvement’ of health care is now established and growing as a field of research and practice. This article, based on qualitative data from interviews with 21 senior leaders in this field, analyses the growth of improvement expertise as not simply an expansion but also a multiplication of ‘ways of knowing’. It illustrates how health‐care impr...
Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, ev...
Background
The widespread shift to remote healthcare consulting prompted by Covid-19 is stimulating much-needed research into remote consulting practices and outcomes. Recognising that the challenges and implications vary across consultation types, we are focusing on the use of telephone consulting for ‘Care and Support Planning’ (CSP) consultation...
England’s National Health Service continues to signal a commitment to person-centred practice. It recently established a Personalised Care Institute which published a national Curriculum for all healthcare practitioners.
The Curriculum describes an educational framework which aspires to unify approaches and universalise provision of Personalised Ca...
Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a ‘clear definition and method of measurement,’ and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge cautio...
Shared decision making has been on the policy agenda in the UK for at least twelve years, but it lacked a comprehensive approach to delivery. That has changed over the past five years, and we can now see significant progress across all aspects of a comprehensive approach, including leadership at policy, professional and patient levels; infrastructu...
Objective
To generate stakeholder informed evidence to support recommendations for trialists to implement the dissemination of results summaries to participants.
Design
A multiphase mixed-methods triangulation design involving Q-methodology, content analysis, focus groups and a coproduction workshop (the REporting Clinical trial results Appropriat...
Policy discourse favours the idea of “ageing in place” but many older people move home and into different kinds of residential settings. This article extends the understanding of how relocation can promote as well as diminish older people’s well-being. Using relational understandings of place and capabilities (people’s freedoms and opportunities to...
Background
Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social co...
In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ‘normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as somethin...
Background
There is an ethical imperative to offer the results of trials to those who participated. Existing research highlights that less than a third of trials do so, despite the desire of participants to receive the results of the trials they participated in. This scoping review aimed to identify, collate, and describe the available evidence rel...
This paper analyses the ethics of routine measurement for healthcare improvement. Routine measurement is an increasingly central part of healthcare system design and is taken to be necessary for successful healthcare improvement efforts. It is widely recognised that the effectiveness of routine measurement in bringing about improvement is limited—i...
Objective
: To develop a core outcome set for the evaluation of interventions that aim to improve how people make decisions about whether to participate in RCTs (of healthcare interventions), the ELICIT Study.
Study Design
: International mixed-method study involving a systematic review of existing outcomes, semi-structured interviews, an online D...
Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of...
Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit (ICU) resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis wou...
Background:
Personalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes. However, this has not been confirmed in controlled studies. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) is a pragm...
Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled...
Therapeutic privilege (TP) is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapor...
Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that en...
'Quality' is a widely invoked concept in healthcare, which broadly captures how good or bad a healthcare service is. While quality has long been thought to be multidimensional, and thus constitutively plural, we suggest that quality is also plural in a further sense, namely that different conceptions of quality are appropriately invoked in differen...
In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We sho...
Estimates suggest that over 10% of the UK population are affected by food insecurity. International evidence indicates that food insecurity is a risk factor for many long‐term health conditions, and can adversely affect people's ability to manage existing conditions. Food insecurity is thus not only a serious social concern but also a healthcare is...
Objective
To elicit informed views from Australian women aged 70–74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen).
Design
Two community juries held in 2017.
Setting
Greater Sydney, a metropolis of 4.5 million people in New South Wales, Australia.
Particip...
There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of the...
Objective:
To identify and examine tensions and uncertainties in person-centred approaches to self-management support - approaches that take patients seriously as moral agents and orient support to enable them to live (and die) well on their own terms.
Methods:
Interviews with 26 UK clinicians about working with people with diabetes or Parkinson...
Objectives
(1) To characterise variation in general practitioners’ (GPs’) accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs’ reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary.
Study design an...
Patient or public involvement (PPI) in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research (generating knowledge), and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been cl...
Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyro...
Background:
Policy encourages health care providers to listen and respond to feedback from patients, expecting that it will enhance care experiences. Enhancement of patients' experiences may not yet be a reality, particularly in primary health care settings.
Objective:
To identify the issues that influence the use and impact of feedback in this...
Shared decision making (SDM) is firmly on the policy agenda in the UK and a recent legal ruling has confirmed its importance. Policymakers, ethicists, professional regulators and societies, patient organisations and now the courts are committed to ensuring that SDM becomes the norm throughout the NHS, but an unfavourable economic climate makes this...
Background
Continued smoking after cancer adversely affects quality of life and survival, but one fifth of cancer survivors still smoke. Despite its demands, cancer presents an opportunity for positive behaviour change. Smoking often occurs in social groups, therefore interventions which target families and individuals may be more successful. This...
This chapter discusses Part I of this book, which has provided an introduction to the history and development of HTA and to the various rationales for, and forms of, patient involvement within it. One of the points that recurred in the introductory chapters was the sense that patient involvement in HTA is ‘still contentious’ to some people (Sect. 5...
Objective
Family caregivers are regularly involved in cancer consultations and treatment decision-making (DM). Yet there is limited conceptual description of caregiver influence/involvement in DM. To address this, an empirically-grounded conceptual framework of triadic DM (TRIO Framework) and corresponding graphical aid (TRIO Triangle) were develop...
Table S1. Annotated bibliography.
Objective
To measure the value the patients place on different aspects of person-centred care.
Design
We systematically identified four attributes of person-centred care. We then measured their value to 923 people with either chronic pain or chronic lung disease over three discrete choice experiments (DCEs) about services to support self-managemen...
Background
Support for self-management (SSM) is a prominent strand of health policy internationally, particularly for primary care. It is often discussed and evaluated in terms of patients’ knowledge, skills and confidence, health-related behaviours, disease control or risk reduction, and service use and costs. However, these goals are limited, bot...
Objectives
To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.
Design
A grounded theory study.
Setting
Primary care practices in Australia and the UK.
Participants
69 GPs in Austra...
Definitions and interpretations of 'health literacy' have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across...
Background:
Prostate-specific antigen (PSA) testing for prostate cancer is controversial. There are unresolved tensions and disagreements amongst experts, and clinical guidelines conflict. This both reflects and generates significant uncertainty about the appropriateness of screening. Little is known about general practitioners' (GPs') perspective...
Background:
Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled.
Objective:
To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management.
Design:
Critical...
Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies (ART). Policies
regarding who can access ART and with what (if any) support from a collective purse are highly contested, raising questions
about what state responses are justified. Whilst much of this debate has focused on the status of inf...
Objective To identify what women report influences their preferred mode of birth after caesarean section.
Design Systematic review of qualitative literature using meta-ethnography.
Data sources Medline, EMBASE, ASSIA, CINAHL and PsycINFO (1996 until April 2013; updated September 2015). Hand-searched journals, reference lists and abstract authors.
S...
Background
The process of obtaining informed consent for participation in randomised controlled trials (RCTs) was established as a mechanism to protect participants against undue harm from research and allow people to recognise any potential risks or benefits associated with the research. A number of interventions have been put forward to improve t...
Withdrawal of conditional regulatory approval or subsidization of new medicines when subsequent evidence does not confirm early trial results may not be well understood or accepted by the public.
We present a case study of the US Food and Drug Administration (FDA)’s decision to withdraw the indication of bevacizumab for the treatment of advanced br...
Objective
To test the feasibility and assess the uptake and acceptability of implementing a consumer questions programme, AskShareKnow, to encourage consumers to use the questions ‘1. What are my options; 2. What are the possible benefits and harms of those options; 3. How likely are each of those benefits and harms to happen to me?’ These three qu...
The process of obtaining informed consent for participation in randomised controlled trials (RCTs) was established as a mechanism to protect participants against undue harm from research and allow people to recognise any potential risks, or benefits, associated with the research. A number of interventions have been put forward to improve this proce...
Objectives:
'Nanny-state' accusations can function as powerful rhetorical weapons against interventions intended to promote public health. Public health advocates often lack effective rebuttals to these criticisms. Nanny-state accusations are largely accusations of paternalism. They conjure up emotive concern about undue governmental interference...
Personalised care planning for adults with chronic or long-term health conditions
Angela Coulter1,*,
Vikki A Entwistle2,
Abi Eccles3,
Sara Ryan4,
Sasha Shepperd5,
Rafael Perera6
Editorial Group: Cochrane Consumers and Communication Group
Published Online: 3 MAR 2015
Assessed as up-to-date: 1 JAN 2014
DOI: 10.1002/14651858.CD010523.pub2...
Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for...
Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for-and demands on-these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunit...
In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.
Aim
The aim of this work was to both critically evaluate and extend the current evidence base relating to o...
There has been growing interest internationally in how health services might more actively involve—and support the involvement of—patients in deciding about their treatments and in the delivery of their own care. Patient involvement can take diverse forms, and can be valued for a range of reasons. There has been a strong tendency for policies and s...
Healthcare policy leaders internationally recognise that people's experiences of healthcare delivery are important, and invest significant resources to monitor and improve them. However, the value of particular aspects of experiences of healthcare delivery – relative to each other and to other healthcare outcomes – is unclear.
This paper considers...
Background
Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or “outside” formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record.Methods
Exploratory qualitative interviews were condu...
Over the past decade, there has been growing international interest in shaping local organisational cultures in primary healthcare. However, the contextual relevance of extant culture assessment instruments to the primary care context has been questioned. The aim of this paper is to derive a new contextually appropriate understanding of the key dim...
To identify modifiable factors that influence patients' information-giving behaviour about their health during consultations with pharmacy staff.
A theory of planned behaviour questionnaire was posted to 3000 individuals randomly selected from the Scottish Electoral Register.
The 927 respondents confirmed a low rate of disclosure of information abo...
This report presents the findings of a comparative study of choice of provider in the UK.
It is well known that recruitment to trials can be difficult. A number of in-depth qualitative studies have been published that have examined patient experiences of recruitment and participation in trials. To understand the collective insights from these studies, we undertook a meta-ethnography (a formal synthesis method for constructing interpreta...
Midwives usually document women's health and maternal histories during booking appointments. This qualitative study of use of the Scottish Woman Held Maternity Record (SWHMR) found some midwifery teams were asking women to document their own histories before these appointments. Pregnant women and midwives from these teams thought this could save mi...
Communication with health care providers is important to help meet cancer patients' information and support needs. It can significantly affect the extent to which patients feel cared for, respected and involved, and it can influence a range of cancer care processes and outcomes. This paper presents findings from a study which explored urological ca...
/st>Trust is important for patients and may be used as an indicator and potential 'marker' for how patients evaluate the quality of health care. The review aimed to classify the current evidence base on trust in the patient-provider relationship in order to identify strengths and weaknesses and to point towards areas for future research.
/st>Nine e...
Randomized controlled trials are important for evaluating health care interventions, but recruitment can be difficult. Studies of potential participants' perspectives on trial participation are accumulating, but their collective contribution is not obvious. In 2007, we conducted a meta-ethnographic synthesis of people's reasons for accepting or dec...
Low literacy is a significant problem across the developed world. A considerable body of research has reported associations between low literacy and less appropriate access to healthcare services, lower likelihood of self-managing health conditions well, and poorer health outcomes. There is a need to explore the previously neglected perspectives of...
Health services internationally struggle to ensure health care is "person-centered" (or similar). In part, this is because there are many interpretations of "person-centered care" (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients' experiences of health care delivery. The...
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of personalised care planning for patients with long-term health conditions, as compared to forms of care in which active involvement of patients in treatment and management decisions (at least in goal setting and action planning) is not...