title: Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness.
abstract: Research evaluating self-management of chronic conditions points to the effectiveness of interventions' changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people's self-management activities fully, interpretation of self-management as compliance with medical instructions, and the organization of outpatients' clinics. Giving attention to these barriers might maximize the opportunities for patient self-management of chronic illness based on a therapeutic alliance with health care professionals.
authors.affiliation: National Primary Care Research and Development Centre, The University of Manchester, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nelson
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000523:psychology / Q000628:therapy*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012648:Self Care; D012944:Social Support