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      What is meant by patient-centredness being value-based?

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          Abstract

          Objective

          To examine whether it is possible to further specify what is meant when we maintain that patient-centredness as a communication skill is a value-based clinical procedure.

          Design and main outcome measures

          Since a core element in patient-centredness is associated with patients feeling respected, a study regarding encounters where patients felt respected was analysed.

          Results

          Similarities were found between the core elements of patient-centredness in terms of inviting, listening, and summarizing, and patients feeling respected in terms of listening, having their questions answered, and believing in what they tell their GP.

          Conclusion

          Even though what is respected cannot be specified, the authors’ analysis indicates that feeling respected is frequently and strongly associated with encounters reflecting core aspects of patient-centredness. In this sense, patient-centredness might be considered value-based. Future research might shed light on what is actually respected: is it the patient's autonomy, integrity, dignity, or honour?

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          Most cited references 7

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          Physician communication and patient adherence to treatment: a meta-analysis.

          Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians' communication skills. Calculation and analysis of "r effect sizes" and moderators of the relationship between physician's communication and patient adherence, and the effects of communication training on adherence to treatment regimens for varying medical conditions. Thorough search of published literature (1949-August 2008) producing separate effects from 106 correlational studies and 21 experimental interventions. Determination of random effects model statistics and the detailed examination of study variability using moderator analyses. Physician communication is significantly positively correlated with patient adherence; there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well. Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training. Communication in medical care is highly correlated with better patient adherence, and training physicians to communicate better enhances their patients' adherence. Findings can contribute to medical education and to interventions to improve adherence, supporting arguments that communication is important and resources devoted to improving it are worth investing in. Communication is thus an important factor over which physicians have some control in helping their patients to adhere.
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            What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing.

            To identify the common, core elements of patient-centred care in the health policy, medical and nursing literature. Healthcare reform is being driven by the rhetoric around patient-centred care yet no common definition exists and few integrated reviews undertaken. Narrative review and synthesis. Key seminal texts and papers from patient organizations, policy documents, and medical and nursing studies which looked at patient-centred care in the acute care setting. Search sources included Medline, CINHAL, SCOPUS, and primary policy documents and texts covering the period from 1990-March 2010. A narrative review and synthesis was undertaken including empirical, descriptive, and discursive papers. Initially, generic search terms were used to capture relevant literature; the selection process was narrowed to seminal texts (Stage 1 of the review) and papers from three key areas (in Stage 2). In total, 60 papers were included in the review and synthesis. Seven were from health policy, 22 from medicine, and 31 from nursing literature. Few common definitions were found across the literature. Three core themes, however, were identified: patient participation and involvement, the relationship between the patient and the healthcare professional, and the context where care is delivered. Three core themes describing patient-centred care have emerged from the health policy, medical, and nursing literature. This may indicate a common conceptual source. Different professional groups tend to focus on or emphasize different elements within the themes. This may affect the success of implementing patient-centred care in practice. © 2012 Blackwell Publishing Ltd.
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              Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence.

              The provision of health care is inseparable from universal values such as caring, helping and compassion. Consideration for individual values, particularly those of the patient, has also been increasing. However, such consideration is difficult within the context of modern health care, where complex and conflicting values are often in play. This is particularly so when a patient's values seem to be at odds with evidence-based practice or widely shared ethical principles, or when a health professional's personal values may compromise the care provided. Values-based practice, a framework developed originally in the domain of mental health, maintains that values are pervasive and powerful parameters influencing decisions about health, clinical practice and research, and that their impact is often underestimated. Although it shares starting points with other approaches to values, it suggests that our current approaches lead us to ignore some important manifestations of values at both the general level, as relevant in legal, policy and research contexts, as well as at the individual level, as relevant in clinical practice. Drawing on ideas from philosophy, values-based practice significantly extends the range of phenomena that may be regarded as value-laden. It suggests that one of the reasons for overlooking values is that they are presumed to be shared when not apparently conflicting. Values-based practice is an approach to supporting clinical decision-making, which provides practical skills and tools for eliciting individual values and negotiating these with respect to best available evidence.
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                Author and article information

                Journal
                Scand J Prim Health Care
                Scand J Prim Health Care
                PRI
                Scandinavian Journal of Primary Health Care
                Informa Healthcare (Stockholm )
                0281-3432
                1502-7724
                December 2013
                December 2013
                : 31
                : 4
                : 188-189
                Affiliations
                1Centre for Family Medicine, Karolinska Institutet , Stockholm, Sweden
                2Centre for Healthcare Ethics, Karolinska Institutet , Stockholm, Sweden
                Author notes
                Correspondence: Niels Lynøe, Professor, Centre for Healthcare Ethics, Karolinska Institutet , Stockholm, Sweden. E-mail: niels.lynoe@ 123456ki.se
                Article
                848543
                10.3109/02813432.2013.848543
                3860293
                24164425
                © 2013 Informa Healthcare

                This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

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