Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives

Abstract

“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.

An exploratory QUALquan comparison of patient‐centeredness priorities in outpatient Care for Patients and Pharmacists

“…Directed content analysis of 439 excerpts (unit of analysis) produced 13 superordinate codes representing the meaning of patient-centeredness in pharmacist care consistent with the PPCP and the literature. 9,10 The applicability and comprehensiveness of the a priori coding scheme were sufficient to avoid adding new inductively generated codes. Both figures display parallel findings between the patient-only and pharmacist-only datasets for 7 of the top 10 superordinate concepts.…”

“…The most frequently coded superordinate concept in the Pharmacist‐only dataset was “Care Coordination and Integration” and is not well‐represented in the pharmacist patient‐centeredness literature 9,10 . Patients in the sample ranked this superordinate concept considerably lower than pharmacists.…”

“…The multi‐dimensional nature of patient‐centeredness has been studied extensively for over 50 years, particularly in the fields of medicine, nursing, and health policy. Pharmacist conceptualizations of patient‐centeredness come primarily from medicine, which is characterized by guiding principles for consideration by the clinician to understand the patient's perspective and facilitate desirable clinical outcomes (Table 1; see Data S1 for coding definitions and descriptions Additional information about concepts can be requested from Olson and colleagues) 9,10 . Less represented in pharmacist conceptualizations of patient‐centeredness are concepts reflecting a health care systems‐oriented approach that adjusts the care context to meet the unique needs of the patient.…”

“…The corresponding author proceeded to recruit these prospective participants as well as assess their eligibility for the study using the criteria described above. A purposive national sampling strategy was employed to include pharmacists in states that allowed modification of drug therapy by pharmacists, and that were representative of four distinct geographic regions (ie, East Coast, Midwest, T A B L E 1 Level of care for 40 seminal patient-centeredness concepts from three health profession fields and their relationships with the pharmacist literature [9][10][11][12][13][14] all patient care settings involving pharmacists. The criteria were also selected to recruit pharmacists and patients in contexts more likely to be involved in care that could be characterized as patient-centered.…”

“…Pharmacist conceptualizations of patient-centeredness come primarily from medicine, which is characterized by guiding principles for consideration by the clinician to understand the patient's perspective and facilitate desirable clinical outcomes (Table 1; see Data S1 for coding definitions and descriptions Additional information about concepts can be requested from Olson and colleagues). 9,10 Less represented in pharmacist conceptualizations of patient-centeredness are concepts reflecting a health care systems-oriented approach that adjusts the care context to meet the unique needs of the patient. This perspective expands the focus of care from the patient-provider encounter (ie, micro-level) to the level of health systems (ie, meso-level) and considers even more upstream factors like workforce dynamics, accreditation, and payment (ie, macro-level).…”