Defining elements of patient-centered care for therapeutic relationships: a literature review of common themes

Rationale and aims: Patient-centered care is a recognized clinical method and ideal for patient - health professional relationships. Many definitions have influenced its evolution. For this research, our aim was: (1) to assess definitions and descriptions of patient-centered care to draw out elements of patient-centered care that are considered to be important markers of successful patient-centered care in the patient - health professional relationship and (2) to propose a set of elements that collectively reflect the diversity of ‘patient-centered’ definitions that describe the patient-professional relationship in this literature. A secondary aim was (3) to provide elements that could be used for development of a quality assessment tool.Methods: We conducted a critical interpretive review of patient-centered care and patient-centered communication literature, beginning with a critical synthesis that yielded 12 articles that introduced new theoretical and definitional work on patient-centered care and patient-centered communication. We used an inductive and iterative analysis process to identify and group common themes. We used operational language to describe these themes. Results: We identified 6 elements (each with 2 or more sub-elements) of the patient - health professional relationship that are considered important markers of successful patient-centered care (as found in this literature). The 6 elements are: (1) Engaging the Patient as a Whole Person, (2) Recognizing and Responding to Emotions, (3) Fostering a Therapeutic Alliance, (4) Promoting an Exchange of Information, (5) Sharing Decision-Making and (6) Enabling Continuity of Care, Self-Management and Patient Navigation. Conclusions: Comparable fundamental elements were common among most authors within this literature: we found that variation in theory was typically a matter of degree and language. This work contributes analyses towards greater theoretical consistency for conceptions of patient-centered care. It also provides avenues for future development of quality assurance benchmarks.

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