Constand et al.

BMC Health Services Research 2014, 14:271

http://www.biomedcentral.com/1472-6963/14/271

RESEARCH ARTICLE Open Access

Scoping review of patient-centered care

approaches in healthcare
Marissa K Constand*, Joy C MacDermid, Vanina Dal Bello-Haas and Mary Law

Abstract
Background: The purpose of this scoping review was to describe how three tenants of patient-centered care provision:
communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the
literature.
Methods: A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and
EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and
“model” to identify relevant studies.
Results: Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of
which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a
prospective study. From these articles, 25 different patient-centered care frameworks/models were identified.
Conclusions: The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective
communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach
from the literature that best suits their patient’s needs, and be confident that it will satisfy the three core elements of
patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was
limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care,
communication.
Keywords: Patient-centered care, Model, Framework

Background manage” their patient’s needs. Furthermore, Cott [4] identi-

Patient-centered care in healthcare is defined as care fied that an improved understanding of patient needs
provision that is consistent with the values, needs, and de- stems from clinicians acknowledging patient perspectives
sires of patients and is achieved when clinicians involve pa- on recovery.
tients in healthcare discussions and decisions [1]. The In a multi-site study conducted in primary care physi-
Patient Centered Clinical Method identifies that patient- cian’s offices servicing members of both urban and rural
centeredness is achieved in part by understanding patients communities, Little et al. [5] surveyed patient preferences
experiences with illness and disease as well as understand- for patient-centered care and suggested that the three
ing patients holistically [2]. Patient-centered care is thought main objectives of patient-centered care provision should
to have many benefits and has been proposed as a means include effective communication, partnership, and health
of achieving better health outcomes, greater patient satis- promotion. Effective communication has been defined as
faction, and reduced health costs [2]. For example, Cooper the exploration of the patient’s disease and illness to de-
and colleagues [3] have identified that in a population of velop an understanding of the patient’s healthcare experi-
patients receiving physiotherapy for the treatment of ences [1,2]. Developing a partnership with patients occurs
chronic low back pain, the provision of patient-centered when clinicians and patients find common ground upon
care helped the physiotherapists to “better understand and which a healthcare plan can be developed mutually [1,2].
Finally, effective health promotion, defined in this study as
tailoring healthcare plans based on reflections on the pa-
* Correspondence: [email protected]
School of Rehabilitation Science, McMaster University, 1400 Main Street West, tient’s past health history and current health context, helps
L8S 1C7, Hamilton, Ontario, Canada

© 2014 Constand et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Constand et al. BMC Health Services Research 2014, 14:271 Page 2 of 9
http://www.biomedcentral.com/1472-6963/14/271

ensure that healthcare plans are developed from an under- and “model” were selected to classify the approaches to
standing of previous healthcare experiences. This ap- patient-centered care provision because they provide stan-
proach reduces the risk of failed treatments and ensures dardized methods that can be easily followed and repro-
optimal use of resources [1,2]. While these three compo- duced. A similar search was conducted for systematic
nents of patient-centered care have been identified as the reviews that included communication as a title word to
elements that are most valued by patients receiving med- identify the most easily accessible systematic reviews ad-
ical attention [5], the extent to which different patient- dressing communication.
centered care frameworks and models embrace these three
components as core elements, and their application across Study selection
different disciplines has not been studied. Although re- Articles were eligible for inclusion in this review if they de-
habilitation is an area of practice where patient-centered scribed a patient-centered care framework or model being
care is seen as “the way forward” [6], even here a consist- applied to an adult population receiving healthcare. Only
ent conceptual framework or model of patient-centered articles published since 1990 and written in English were
care has yet to be accepted. Clarity on definitions, frame- eligible for inclusion in this review. Articles were excluded
works, and essential ingredients of patient-centered care is if they did not pertain to a patient-centered care frame-
a prerequisite for developing rigorous empirical evidence work or model, or if did not address a healthcare context.
evaluating patient-centred care and for insuring fidelity Titles and abstracts of articles were independently
when it is implemented. A scoping review approach pro- reviewed by two authors (MKC and JCM). If articles were
vides a methodology for determining the state of the evi- representative of the inclusion criteria, the articles went
dence on a topic that is especially useful where issues through two full-text independent reviews by two authors
require clarification before rigorous empirical studies are (MKC and JCM). If disagreements arose, a third party re-
conducted. Therefore, the purpose of this study is to use viewer would be consulted. A second search was con-
Arskey and O’Malley’s scoping review methodology to de- ducted using communication as a keyword, and limiting
termine the following with respect to patient-centered the retrieval to systematic reviews using Clinical Queries
care frameworks and models: in Medline, and the term systematic review in other data-
bases. Articles were included from the secondary review
1. What is the extent and nature of published of the literature if they were systematic reviews identifying
scientific literature on patient-centered care effective communication strategies in any healthcare dis-
frameworks and models including the research cipline. Studies were excluded if they did not identify com-
designs used, areas of clinical practice, and munication strategies between clinicians and patients or
conceptualization of patient-centered care? families.
2. To what extent do the frameworks and models
address the three core components of patient- Charting data
centered care: effective communication, partnership, If an article was eligible for inclusion in this study, data re-
and health promotion? lated to the patient-centered care framework or model pre-
sented in the article was extracted by the lead author and
A secondary purpose was to reflect on the depth of evi- reviewed by a second author (JCM). Data extracted from
dence surrounding a key component of patient-centered the reviewed patient-centered care frameworks and models
care, effective communication, by charting the published was entered into data extraction records and synthesized
systematic reviews on effective communication practices. in summary format. Data were systematically charted using
This review was conducted as a secondary review in order the data charting form developed in Microsoft Excel. Infor-
to identify evidence supporting patient-centered communi- mation on authorship, article type, population, and patient-
cation that may not be associated with a patient-centered centered care approach were recorded on this form. A sec-
framework or model since effective communication is the ond data charting form was developed to chart data on the
most definable and consistent component of patient- communication systematic reviews identified. Information
centered care. on clinical context, patient-centered care focus, number of
studies reviewed and key findings were recorded on
Methods this form.
Identifying relevant studies
Literature published in English between 1990 and 2012 Collating, summarising and reporting results
was collected from three databases: Medline, CINAHL, Information that was organized on the data charting
and EMBASE. A key term search strategy was employed forms was employed to collate and report the articles’
using the words “patient-centered care”, “client-centered approaches towards achieving effective communication,
care”, “framework” and “model”. The terms “framework” partnership, and health promotion.
Constand et al. BMC Health Services Research 2014, 14:271 Page 3 of 9
http://www.biomedcentral.com/1472-6963/14/271

Results Compassionate and empowering care provision

From an original hit total of 101 articles, 60 articles were Providing compassionate and empowering care was cited
excluded after reading the article title, and 22 articles were as a component of achieving effective communication in
excluded after they were read fully (Figure 1). Nineteen ar- 53% of articles reviewed. Such care is described as being
ticles were selected for inclusion in this review. Twelve of attentive and altruistic, and was emphasized by several
these articles were narrative review articles. The remaining review articles and by the sole randomized control trial
studies included four qualitative research papers, one ran- included in this review [14,16]. As well, these articles
domized control trial, and one prospective study. Of the 19 described compassionate and empowering care as contrib-
included articles, 25 unique patient-centered care frame- uting to the development of a strong clinician-patient
works or models were identified (Table 1). The secondary relationship based upon patient feelings of autonomy
review conducted on communication strategies yielded a and trust [14,16].
hit total of 69 systematic review articles, 25 of which met
inclusion criteria (Table 2).
Sensitivity to patient needs
Strategies on how to be sensitive to patient needs were
Analysis primarily discussed in the qualitative research articles
Content analysis of all patient-centered care frameworks included in this review. Such strategies included ac-
and models included in this review revealed that all frame- knowledging and adapting to unique patient identifiers
works and models included approaches to achieving the [19,24,25]. For example, clinicians are urged to observe
three essential components of patient-centered care: ef- and reflect on fluctuating levels of patient alertness, pa-
fective communication, partnership, and health promotion tient comfort levels in the presence or absence of family
(Table 3). members, and different communication barriers such as
hearing loss, in order to facilitate clinical interactions
[15,19,22]. Of the articles reviewed, 58% identified that
Communication careful observation of unique patient characteristics is
Three components of communication were commonly necessary to providing care that will lead to optimal pa-
discussed in the articles reviewed: a) sharing informa- tient receptiveness and positive health outcomes.
tion, b) compassionate and empowering care provision,
and c) sensitivity to patient needs.
Partnership
Two components of partnership development were com-
Sharing information monly discussed in the articles reviewed: a) relationship
Creation of an effective learning environment was cited as building and b) inter-professional collaboration.
a method for supporting patient-centered care in 89.5% of
articles reviewed. Many articles discussed effective com-
munication of healthcare information from the clinician Relationship building
to the patient, but also included approaches to effective Relationship building was discussed by all article types
patient information uptake by the clinician. Effective infor- included in this review. Of the articles reviewed, 74%
mation uptake was seen as being an essential step in tai- identified that building relationships with patients and
loring information to suit patient needs, vulnerabilities, families contributes to understanding what problems the
and capacities [11,12]. Active listening, asking open ended patient is most concerned with and how their illness or
questions, and developing functional goals were strategies injury has affected their life [15,18,23]. The involvement
cited by review articles to achieve effective information of patients and families in their care builds trust and en-
uptake [11,12,15]. courages mutual problem solving [17].

Figure 1 Scoping review process.

Constand et al. BMC Health Services Research 2014, 14:271 Page 4 of 9
http://www.biomedcentral.com/1472-6963/14/271

Table 1 Scoping review included articles

Author Article type Population Patient-centered care approach identified
Ballweg [7] Review article Neonatal Intensive Care Unit Developmentally Supportive,
Family-Centered Care Model
Berger [8] Review article Psychiatry The Tidal Model
Bickler [9] Review article Surgery Patient-Focused Care Model
Boltz [10] Review article Geriatrics Nurses Improving Care for Health System Elders
Booth & MacBride [11] Review article Generic Patient-Centered Clinical Method
Briggs [12] Review article Palliative Care/ National Consensus Project for Quality Palliative Care
Physical Therapy/
End of Life Care Hypothesis Oriented Algorithm for Clinicians
Framework for Rehabilitation of
Neurodegenerative Diseases Framework for
Assessment in Oncology Rehabilitation
Models of Practice in Palliative Care
Browne et al. [13] Review article Nursing Decentralization
Cox [14] Review article Psychiatry Biopsychosocial Model
deLusignan et al. [15] Review article Nursing Model for Patient-Centered Consultations
with Nurses in Primary Care
DiGoia et al. [16] Prospective study Orthopedics Patient and Family Centered Collaborative Care
Enguidanos et al. [17] Randomized control trial Geriatrics/Psychiatry Integrated Depression Care Management Model
Ford et al. [18] Review article Nursing RNAO Best Practice Guideline on Client Centered Care
Hantho et al. [19] Review article General Malterud’s Key Questions
Stuart’s BATHE Model
The Communication Model
Hatzichristou & Tsimtsiou [20] Review article Urology Patient Centered Model for the
Management of Sexual Dysfunction
Kelleher [21] Review article Intensive Care The Synergy Model
Kibicho & Owczarzak [22] Qualitative research Pharmacy Patient-Centered Pharmacy Services
McCormack [23] Qualitative research Geriatrics Authentic Consciousness
Rosvik et al. [24] Qualitative research Geriatrics VIPS Practice Model
van der Eijk et al. [25] Qualitative research Neurology Theoretical Model of Patient Centeredness
for Parkinson’s Disease

Inter-professional collaboration Effective case management

Engaging in inter-professional collaboration to decentralize Effective case management was identified by 79% of arti-
health care provision was cited as a method of achieving cles reviewed as being a necessary component of health
partnership among healthcare professionals in 79% of the promotion. Effective case management involves the evalu-
articles reviewed. These articles were primarily review arti- ation of past successes and failures of care in order to best
cles that described decentralization as a team-based ap- tailor future health initiatives and reduce risk of adverse
proach to care provision that contributed to efficient and health outcomes [26]. This process is facilitated by discus-
focused care provision [7-10,13,21]. sions with patients about previous healthcare experiences
in order to develop an understanding of how patients re-
Health promotion spond to certain types of care, such as care requiring
Achieving health promotion in a patient-centered context follow-up appointments or self-directed home exercises
requires reflection on how to best support optimal health [17,19,20].
and care provision through reflection on the patient’s his-
tory. The two components of health promotion that were Efficient use of resources
commonly discussed in the articles reviewed as being ef- Appropriate organization of resources around patients
fective ways to achieve patient-centered care were: a) ef- was cited by 47% of articles included in this review as a
fective case management and b) efficient use of resources. way to achieve health promotion. By using resources that
Constand et al. BMC Health Services Research 2014, 14:271 Page 5 of 9
http://www.biomedcentral.com/1472-6963/14/271

Table 2 Systematic reviews on communication in healthcare

Systematic review Clinical context PCC # Studies Key findings
focus reviewed
Beck, Daughtridge & Sloane [29] Primary Care Yes 22 • Physician behavior linked with
positive patient outcomes, adherence,
and patient satisfaction
Chan et al. [30] Pre-operative Care Yes 11 • Sharing information, family involvement,
autonomy, and professionalism are key
• Knowledgeable clinicians with positive
attitudes enhance patient “journey”
Davis et al. [31] Oncology Yes 21 • Complementary and alternative medicine
use in patients with cancer must be discussed
using effective communication skills in order
to avoid patients failing to disclose use with clinician
Edwards et al. [32] Genetics Yes 28 • Clinician provision of support and sharing emotion proven
to be more beneficial to patients than sharing information
Edwards et al. [33] Primary Care Yes 96 • Including patients in risk estimates during discussion
between patients and clinicians regarding genetic
screening results is productive
Egan et al. [34] Alzheimer’s Disease Not Clear 13 • Employing memory aids and specific caregiver training
programs enhances verbal communication, specifically
information uptake with patients with Alzheimer’s Disease
Eggenberger, Heimerl & Bennett [35] Dementia Yes 12 • Enhancing communication skills of professionals working
with dementia patients results in improvements
of patient quality of life, positive interactions with peers,
and organization of care
Fawole et al. [36] Palliative Care Yes 20 • Improving palliative care communication with patients
includes improving healthcare utilization
and patient/family consultations
Finke, Light & Kitko [37] Nursing Not Clear 12 • Improving communication between nurses and
non-verbal patients is necessary to reduce patient frustration
Hancock et al. [38] Palliative Care Not Clear 51 • Patients’ perceptions of shared information are
inconsistent with healthcare professional’s
perceptions of the information provided
• Healthcare professionals “underestimate” patient
need for information and “overestimate”
patient understanding of illness
Harrington, Noble & Newman [39] Primary Care Yes 25 • Improvements in perceptions of autonomy impacts
information recall, adherence, attendance, and clinical
outcomes following intervention studies aimed to
augment patient participation in medical interactions
Henry et al. [40] Primary Care Yes 26 • Increased patient satisfaction was correlated
with positive/warm clinician
interactions with active listening
Janssen & Largo-Janssen [41] Gynecology Yes 9 • Patient-centered communication
styles increase patient satisfaction
Laidsaar-Powell et al. [42] Primary Care Yes 52 • Triadic communication (patient-clinician-family member)
involves: encouraging family involvement in care,
re-enforcing positive family contributions,
identifying roles of patients and family members
Oliveira et al. [43] Primary Care Yes 27 • Communication indicating valuing
patient autonomy is correlated
with high patient satisfaction
Parker et al. [44] Palliative Care Not Clear 123 • At end-of-life, patients want less information sharing
and caregivers want more information sharing
• Patients value empathic and honest clinicians
who encourage questions and facilitate discussions
Pinto et al. [45] Rehabilitation Yes 12 • The “therapeutic alliance” is enhanced by
emotional support provision and patient
participation during consultation
Constand et al. BMC Health Services Research 2014, 14:271 Page 6 of 9
http://www.biomedcentral.com/1472-6963/14/271

Table 2 Systematic reviews on communication in healthcare (Continued)

Rodin et al. [46] Oncology Yes 21 • Patients have varying communication needs
and may prefer professional-centric communication
over patient-centered communication, therefore clinicians
are encouraged to individualize their
communication styles to patient needs
Scheunemann et al. [47] Intensive Care Yes 2841 • Printed communication aids, structured communication
from the healthcare team, and ethics consultations
improve emotional outcomes for families in the ICU
Slort et al. [48] Palliative Care Yes 15 • Clinician availability and openness to facilitating
discussions about end-of-life care, including
reflection on poor outcomes, facilitates
patient-clinician communication
Tay, Hegney & Ang [49] Nursing Not Clear 8 • While patient and clinician characteristics are found
to influence communication, the role of the environment
in effective communication between these
two parties is not well documented
• Reception to patient cues and effective information
sharing builds relationships with patients and
maintains open communication
Thompson & McCabe [50] Psychiatry Not Clear 23 • A strong clinician-patient relationship
that involves effective communication
is correlated with adherence
• Clinicians wishing to promote patient-clinician
collaboration must attempt to find common
ground with patients and share
decision making roles
Uitterhoeve et al. [51] Oncology Not Clear 7 • No correlation was found between
effective communication training
and patient distress outcomes
Vasse et al. [52] Dementia Not Clear 19 • Improving communication with patients
with dementia can improve daily care
activities and intervention outcomes; however,
has little impact on neuropsychiatric symptoms
Wanyonyi & Themessl-Huber [53] Primary Care Yes 6 • Clinicians should allocate time to “discover
their patients’ psycho-social characteristics”
in order to achieve health promotion

best suit patient needs and values, clinicians can tailor patient autonomy were the main facilitators of a positive
treatment plans to best represent how patients are likely clinical interaction.
to respond to certain interventions [16].
Discussion
Secondary review analysis of communication strategies This scoping review provides an overview of how patient-
The secondary review of systematic review articles on centered care is conceptualized in the current literature and
communication strategies in healthcare revealed that the suggests that the three components of patient-centered care
majority of articles (68%) explicitly related communication valued by patients are predominantly featured in patient-
strategies to patient-centered care. Articles that did not centered care models and frameworks across different
explicitly state this relationship through the use of the settings, populations, and applications. These core compo-
terms “patient-centered” or “client-centered” care, implied nents were approaches to achieving effective communica-
this relationship by identifying how effective communica- tion, partnership and health promotion. While some of the
tion between patients and healthcare professionals impacts articles reviewed pertained to specific target populations,
patient satisfaction and health outcomes. The breadth of the frameworks and models that they described were based
disciplines from which this literature was found is consist- on similar components of patient-centered care provision.
ent with the diverse nature of the literature found on This suggests that the models can be broadly applied. These
patient-centered care frameworks and models. Exploration components were clearly defined by authors, which made
of key findings revealed that effective communication common approaches to communication, partnership, and
strategies surrounding information provision and uptake health promotion easily identifiable during the progression
by the healthcare professional, as well as respect for of this scoping review’s analysis.
Constand et al. BMC Health Services Research 2014, 14:271 Page 7 of 9
http://www.biomedcentral.com/1472-6963/14/271

Table 3 Data summary form

Communication Partnership Health promotion
Article Sharing Compassion/empathy/ Sensitivity Relationship Collaboration Case management Resource use
information empowerment to needs building
Ballweg [7] x x x
Berger [8] x
Bickler [9] x x x
Boltz [10] x x x x
Booth & MacBride [11] x x x x
Briggs [12] x x x x
Browne et al. [13] x x x x
Cox [14] x
deLusignan et al. [15] x x
DiGoia et al. [16] x
Enguidanos et al. [17] x x
Ford et al. [18]
Hantho et al. [19]
Hatzichristou & x x x
Tsimtsiou [20]
Kelleher [21]
Kibicho & Owczarzak [22]
McCormack [23] x x
Rosvik et al. [24] x
van der Eijk et al. [25] x x
Total 17/19 11/19 14/19 15/19 15/19 9/19
Incorporates category
Does not incorporate x
category

Epstein et al. [26] identify that while patient-centered The use of theoretical foundations is considered import-
care is acknowledged by clinicians as an ideal approach to ant in in complex health care issues, but theory has been
care provision, “what it is and how to measure it” [26] is operationalized more conceptually than empirically within
not clear to clinicians. They suggest that additional re- the literature on patient-centered care, as indicated by the
search is needed to strengthen the evidence supporting fact that only one randomized control trial was identified.
patient-centered care in healthcare [26]. This scoping re- This is consistent with findings of how theory has been ap-
view provides a foundation for future research by collating plied to knowledge translation within the field of rehabilita-
and summarizing the theoretical and empirical evidence tion. Colquhoun et al. [27] found theoretical frameworks
regarding effective approaches to achieving patient- were more commonly used in a generic way rather than as
centered care provision. There is clearly a need for greater a specific operational tool for defining interventions, pro-
emphasis on empirical testing of the health and system cesses, expected outcomes or evaluation strategies. Chart-
impacts of providing patient-centered care in different ing the nature of the evidence with respect to the use of
contexts since the literature reviewed primarily addressed patient-centered care frameworks and models suggests a
this topic theoretically, and only one randomized control greater need for empirical studies that test the value of
trial was identified. Despite this finding, the consensus providing patient-centered care versus alternatives in a re-
around inclusion of communication, partnership, and habilitation context. Explicit use of the theory would
health promotion, across frameworks identified through ideally be integrated throughout training processes, mate-
this scoping review provides preliminary support that rials that operationalize patient-centered care, evaluative
these key features of patient-centered care should be spe- instruments that assess its implementation, and all re-
cifically included and evaluated in future studies or in clin- search that seeks to understand how it affects the process
ician training. and outcomes of care.
Constand et al. BMC Health Services Research 2014, 14:271 Page 8 of 9
http://www.biomedcentral.com/1472-6963/14/271

Having found a consensus that communication, partner- Conclusion

ship and health promotion are key aspects to providing While no unifying patient-centered care framework/model
patient-centered care, it is important to have rigorous defi- was found, a consensus among frameworks and models of
nitions and clear descriptions of what these processes different disciplines suggest that three components of
entail, as well as evidence about how to operationally patient-centered care have been consistently recognized as
optimize these elements in different contexts and with dif- critical to the process. Health promotion, communication
ferent patient populations. This study highlighted a rich and partnership have been considered across multiple
body of evidence to inform our understanding of commu- areas of clinical practice although rarely through empirical
nication. However, health promotion and partnership have studies. This consensus suggests a broadly applicable
a generic meaning that is quite broad, as they have been di- framework/model of patient-centered care is feasible and
vided as having specific characteristics within patient- together with appropriate operational definitions might
centered care. This may cause confusion for clinicians who advance future empirical studies addressing whether
believe that they are practicing these components of patient-centered care improves outcomes. Studies that at-
patient-centered care, as their approach may be consistent test to the implementation and empirical evaluation of the
with the generic meaning of patient-centered care, but in- outcomes of patient-centered care are needed and should
consistent with the specific steps and components required at minimum include and measure the three tenets of
to operationalize them in a patient-centered way. Thus, fi- patient-centered care: communication, partnership, and
delity in patient-centered processes may be lost when the health promotion.
concept is disseminated or scaled-up. Furthermore, the lack
Competing interests
of consistency between the meaning of health promotion The authors declare that they have no competing interests.
within patient-centered care and other aspects of healthcare
warrants further consideration. Authors’ contributions
This study was completed as part of the graduate thesis work of MKC who
It may be that a more inclusive but specific definition was the principal investigator in this study. MKC and JCM collaborated to
would improve this component of patient centered care. create a study design to answer the research questions posed. MKC
For example, health promotion has been defined by the conducted the scoping review and JCM acted as the second reviewer. VDBH
and ML assisted in the review and feedback process during the final
World Health Organization as “the process of enabling production of this manuscript and also acted as supervisory committee
people to increase control over their health and its de- members of MKC. JCM served as MKC’s graduate supervisor. All authors read
terminants, and thereby improve their health” [28]. and approved the final manuscript.
However, within the patient-centered care literature it Received: 22 April 2014 Accepted: 16 June 2014
has been defined as developing healthcare plans based Published: 19 June 2014
on reflection on patient histories for the purposes of
References
health enhancement, risk reduction, and early detection 1. Mead N, Bower P: Patient-centredness: a conceptual framework and
of illness [5]. There are areas of conceptual consensus review of the empirical literature. Soc Sci Med 2000, 51:1087–1110.
across these definitions that suggest they promote a 2. Stewart M, Belle Brown J, Weston WW, McWhinney IR, McWilliam CL,
Freeman TR: Patient-Centered Medicine Transforming the Clinical Method. 2nd
common approach [29-53]. However, the patient- edition. Abingdon: Radcliffe Medical Press; 2003.
centered care definition implicitly refers to the clinical 3. Cooper K, Smith BH, Hancock E: Patient-centredness in physiotherapy
interaction and goals; whereas, the World Health from the perspective of the chronic low back pain patient.
Physiotherapy 2008, 94:244–252.
Organization places greater emphasis on determinants of 4. Cott CA: Client-centred rehabilitation: client perspectives. Disabil Rehabil
health. Differences in conceptual framing of health pro- 2004, 16:1411–1422.
motion make it difficult to isolate studies that investigate 5. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S:
Preferences of patients for patient centred approach to consultation in
the effect of this component of patient-centered care on primary care: observational study. BMJ 2001, 322:468–472.
outcomes. Conversely, there are a substantial number of 6. Gzil F, Lefeve C, Cammelli M, Pachoud B, Ravaud JF, LePlege A: Why is
systematic reviews that name communication as a key rehabilitation not yet fully person-centered and should it be more
person-centered? Disabil Rehabil 2007, 29:1616–1624.
focus (in their title) suggesting that communication strat- 7. Ballweg DD: Implementing developmentally supportive family-centered
egies can be improved by accessing high quality, empirical care in the newborn intensive care unit as a quality improvement
evidence. This reflects the importance of communication initiative. J Perinat Neonat Nurs 2001, 15:58–73.
8. Berger JL: Incorporation of the Tidal Model into the interdisciplinary plan
in most aspects of healthcare, and that it is studied as an of care–a program quality improvement project. J Psychiatr Mental Health
important concept even where not framed within a Nurs 2006, 13:464–467.
patient-centered care framework. From these studies, we 9. Bickler B: Putting patient-focused care into practice. AORN J 1994, 60:242–245.
10. Boltz M: A system-level approach to improving the care of the older
were able to determine that the majority of articles pub- critical care patient. AACN Adv Crit Care 2011, 22:142–149.
lished on effective communication strategies in healthcare 11. Booth BJ, McBride T: Patient focus and the quality framework. Aust Fam
have a patient-centered focus and that improved outcomes Physician 2007, 36:20–22.
12. Briggs RW: Clinical decision making for physical therapists in
can be expected when health services are designed to im- patient-centered end of life care. Top Geriatr Rehabil 2011, 27:10–17.
plement such strategies. 13. Browne R, Miller E: Leading Your Leader. Nurse Manage 2003, 34:58–62.
Constand et al. BMC Health Services Research 2014, 14:271 Page 9 of 9
http://www.biomedcentral.com/1472-6963/14/271

14. Cox JL: Empathy, identity and engagement in person-centred medicine: 38. Hancock K, Clayton JM, Parker SM, Walder S, Butow PN, Carrick S:
The sociocultural context. J Eval Clin Pract 2011, 17:350–353. Discrepant perceptions about end-of-life communication: a systematic
15. de Lusignan S, Wells S, Russell C: A model for patient-centred nurse review. J Pain Symptom Manage 2007, 34:190–200.
consulting in primary care. BJN 2003, 12:85–90. 39. Harrington J, Noble LM, Newman SP: Improving patients’ communication
16. DiGioia A, Greenhouse PK, Levison TJ: Patient and family-centered collaborative with doctors: a systematic review of intervention studies. Patient Educ
care: An orthopaedic model. Clin Orthop Rel Res 2007, 463:13–19. Couns 2004, 52:7–16.
17. Enguidanos SM, Davis C, Katz L: Shifting the paradigm in geriatric care 40. Henry SG, Fuhrel-Forbis A, Rogers MA, Eggly S: Association between nonverbal
management: Moving from the medical model to patient-centered care. communication during clinical interactions and outcomes: a systematic
Soc Work Health Care 2005, 41:1–16. review and meta-analysis. Patient Educ Couns 2012, 86:297–315.
18. Ford PE, Rolfe S, Kirkpatrck H: A journey to patient-centered care in 41. Janssen SM, Lagro-Janssen AL: Physician’s gender, communication style,
Ontario, Canada: Implementation of a best-practice guideline. CNS 2011, patient preferences and patient satisfaction in gynecology and
25:198–206. obstetrics: a systematic review. Patient Educ Couns 2012, 89:221–226.
19. Hantho A, Jensen L, Malterud K: Mutual understanding: A communication 42. Laidsaar-Powell RC, Butow PN, Bu S, Charles C, Gafni A, Lam WW: Physician-
model for general practice. Scand J Prim Health Care 2002, 20:244–251. patient-companion communication and decision-making: A systematic
20. Hatzichristou D, Tsimtsiou Z: Prevention and management of review of triadic medical consultations. Patient Educ Couns 2013, 91:3–13.
cardiovascular disease and erectile dysfunction: Toward a common 43. Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao
patient-centered, care model. Am J Cardiol 2005, 96:80M–84M. Filho RF: Communication that values patient autonomy is associated with
21. Kelleher S: Providing patient-centred care in an intensive care unit. satisfaction with care: a systematic review. J Physiother 2012, 58:215–229.
Nurs Stand 2006, 21:35–40. 44. Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S: A
22. Kibicho J, Owczarzak J: A patient-centered pharmacy services model of systematic review of prognostic/end-of-life communication with adults
HIV patient care in community pharmacy settings: A theoretical and in the advanced stages of a life-limiting illness: patient/caregiver
empirical framework. AIDS Patient Care ST 2012, 26:20–28. preferences for the content, style, and timing of information. J Pain
23. McCormack B: A conceptual framework for person-centred practice with Symptom Manage 2007, 34:81–93.
older people. Int J Nurs Pract 2003, 9:202–209. 45. Pinto RZ, Ferreira ML, Oliveira VC, Franco MR, Adams R, Maher CG: Patient-
24. Rosvik J, Kirkevold M, Engedal K, Brooker D, Kirkevold O: A model for using centred communication is associated with positive therapeutic alliance:
the VIPS framework for person-centred care for persons with dementia a systematic review. J Physiother 2012, 58:77–87.
in nursing homes: A qualitative evaluative study. Int J Older People Nurs 46. Rodin G, Mackay JA, Zimmermann C, Mayer C, Howell D, Katz M: Clinician-
2011, 6:227–236. patient communication: a systematic review. Supportive Care Cancer 2009,
25. van der Eijk M, Faber MJ, Al Shamma S, Munneke M, Bloem BR: Moving 17:627–644.
towards patient-centered healthcare for patients with Parkinson’s 47. Scheunemann LP, McDevitt M, Carson SS, Hanson LC: Randomized,
disease. Parkinsonism Relat Disord 2011, 17:360–364. controlled trials of interventions to improve communication in intensive
26. Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, care: a systematic review. Chest 2011, 139:543–554.
Duberstein PR: Measuring patient-centered communication in 48. Slort W, Schweitzer BP, Blankenstein AH, Abarshi EA, Riphagen II, Echteld MA:
patient-physician consultations: theoretical and practical issues. Soc Sci Perceived barriers and facilitators for general practitioner-patient
Med 2005, 61:1516–1528. communication in palliative care: a systematic review. Palliat Med 2011,
25:613–629.
27. Colquhoun HL, Letts LJ, Law MC, MacDermid JC, Missiuna CA: A scoping
49. Tay LH, Hegney D, Ang E: Factors affecting effective communication
review of the use of theory in studies of knowledge translation.
between registered nurses and adult cancer patients in an inpatient
CJOT 2010, 77:270–279.
setting: a systematic review. Int J Evid Based Healthc 2011, 9:151–164.
28. World Health Organization: [http://www.who.int/topics/health_promotion/en/.
50. Thompson L, McCabe R: The effect of clinician-patient alliance and
29. Beck RS, Daughtridge R, Sloane PD: Physician-patient communication in
communication on treatment adherence in mental health care:
the primary care office: a systematic review. J Am Board Fam Med 2002,
a systematic review. BMC Psychiatry 2012, 12:87.
15:25–38.
51. Uitterhoeve RJ, Bensing JM, Grol RP, Demulder PH, Van AT: The effect of
30. Chan Z, Kan C, Lee P, Chan I, Lam J: A systematic review of qualitative
communication skills training on patient outcomes in cancer care: a
studies: patients’ experiences of preoperative communication. J Clin Nurs
systematic review of the literature. Eur J Cancer Care 2010, 19:442–457.
2012, 21:812–824.
52. Vasse E, Vernooij-Dassen M, Spijker A, Rikkert MO, Koopmans R: A systematic
31. Davis EL, Oh B, Butow PN, Mullan BA, Clarke S: Cancer patient disclosure
review of communication strategies for people with dementia in residential
and patient-doctor communication of complementary and alternative
and nursing homes. Int Psychogeriatr 2010, 22:189–200.
medicine use: a systematic review. Oncologist 2012, 17:1475–1481.
53. Wanyonyi KL, Themessl-Huber M, Humphris G, Freeman R: A systematic review
32. Edwards A, Gray J, Clarke A, Dundon J, Elwyn G, Gaff C: Interventions to and meta-analysis of face-to-face communication of tailored health messages:
improve risk communication in clinical genetics: systematic review. implications for practice. Patient Educ Couns 2011, 85:348–355.
Patient Educ Couns 2008, 71:4–25.
33. Edwards A, Hood K, Matthews E, Russell D, Russell I, Barker J: The
doi:10.1186/1472-6963-14-271
effectiveness of one-to-one risk communication interventions in health
Cite this article as: Constand et al.: Scoping review of patient-centered
care: a systematic review. MDM 2000, 20:290–297. care approaches in healthcare. BMC Health Services Research 2014 14:271.
34. Egan M, Berube D, Racine G, Leonard C, Rochon E: Methods to Enhance
Verbal Communication between Individuals with Alzheimer’s Disease
and Their Formal and Informal Caregivers: A Systematic Review. Int J
Alzheimer’s Disease 2010, 2010:1–12. Submit your next manuscript to BioMed Central
35. Eggenberger E, Heimerl K, Bennett MI: Communication skills training in and take full advantage of:
dementia care: a systematic review of effectiveness, training content,
and didactic methods in different care settings. Int Psychogeriatr 2013,
• Convenient online submission
25:345–358.
36. Fawole OA, Dy SM, Wilson RF, Lau BD, Martinez KA, Apostol CC: A systematic • Thorough peer review
review of communication quality improvement interventions for patients • No space constraints or color figure charges
with advanced and serious illness. J Gen Intern Med 2013, 28:570–577.
• Immediate publication on acceptance
37. Finke EH, Light J, Kitko L: A systematic review of the effectiveness of
nurse communication with patients with complex communication needs • Inclusion in PubMed, CAS, Scopus and Google Scholar
with a focus on the use of augmentative and alternative • Research which is freely available for redistribution
communication. J Clin Nurs 2008, 17:2102–2115.
Submit your manuscript at
www.biomedcentral.com/submit