The effects Of interventions for health care providers that promote patient centred approaches in clinical consultations: Results of a systematic review

Skea Z, Lewin S, Dick J, Entwistle V, Zwarenstein M

Background: Patient centred approaches to care are increasingly advocated by consumers and clinicians, and patient centred communication skills are being incorporated into the training of health care providers. However, relatively little empirical work has been undertaken to assess the effects of interventions to promote patient centredness within clinical consultations.

Objective: To assess the effects of interventions for health care providers that promote patient centred approaches in clinical consultations. Types of interventions: Any intervention directed at health care providers and intended to promote patient-centred care within clinical consultations. Patient-centred care was defined as a philosophy of care that encourages (a) shared control of the consultation, decisions about interventions or the management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole person, situated within a particular social context, who has individual preferences. We excluded studies that considered cultural sensitivity training only; studies that evaluated training in psychotherapy or counselling, unless they specifically indicated that the training aimed to encourage a more patient-centred approach to psychotherapy or counselling than is usually used; and studies where the only outcomes assessed were the knowledge, attitudes or intentions of health care providers.

Outcome measures: 1. Consultation processes, including the extent to which patient centred care was judged to be achieved in practice. 2. Other health care behaviours such as types of care plans agreed, adherence to care plans (medication, dietary advice etc) and attendance at follow-up consultations. 3. Health status and wellbeing. 4. Patient satisfaction with care.

Results: 12 RCTs and controlled before and after studies which meet the review's inclusion criteria have been identified to date from searches of Medline, Embase, PsycLIT, Health Star and Cinahl. Most are training interventions directed at physicians, but they vary considerably in terms of the communication skills and approaches that they cover, the training methods that they use and the clinical settings that they focus on. We report the findings of the review and discuss its implications for efforts to promote patient centred care within clinical consultations.