Behaviorally defined patient-centered communication--a narrative review of the literature.
BACKGROUND
Touted by some as reflecting a better medical model and cited by the influential IOM report in 2000 as one of the six domains of quality care, patient-centered medicine has yet to fully establish its scientific attributes or to become mainstream. One proposed reason is failure to behaviorally define what the term 'patient-centered' actually means.


OBJECTIVE
(1) To identify patient-centered articles among all reported randomized controlled trials (RCT); (2) to identify those with specific behaviorally defined interventions; (3) to identify commonalities among the behavioral definitions; and (4) to evaluate the relationship of the well-defined RCTs to patient outcomes.


METHODS
Medline from April 2010 to 1975. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: RCTs having any specific, behaviorally defined patient-centered skill(s) in an intervention with some patient outcome involving real adult patients and providers in real clinical situations. APPRAISAL AND SYNTHESIS METHODS: Critical appraisal via narrative review.


RESULTS
The prevalence of any mention of patient-centeredness among 327,219 RCTs was 0.50% (1,475 studies), from which we identified only 13 studies (0.90%) where there were behaviorally-defined patient-centered skills in an intervention. Although there were too few studies to make clinical recommendations, we identified common features of the behavioral definitions used: all went well beyond identifying individual skills. Rather, skills were grouped, prioritized, and sequenced by virtually all, often describing a stepwise patient-centered approach to, variously, gather data, address emotions, or inform and motivate.


CONCLUSIONS
The inherent subjectivity of our method for identifying behaviorally-defined studies could under- or over-represent truly replicable such studies considerably. Also, studies were few and very heterogeneous with interventions of widely differing intensity and foci.


CONCLUSIONS
RCTs identified as patient-centered were rare, and <1% of these were behaviorally defined and, therefore, possibly replicable. There were many common behavioral definitions in the studies reported, and these can guide us in identifying agreed-upon patient-centered interventions, the immediate next-step in advancing the field.
Smith
Robert C
RC
Michigan State University, B312 Clinical Center, East Lansing, MI 48824, USA. Robert.smith@ht.msu.edu
Dwamena
Francesca C
FC
Grover
Madhusudan
M
Coffey
John
J
Frankel
Richard M
RM
D003142:Communication; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000523:psychology
Ann Intern Med. 1998 Jan 15;128(2):118-26
9441572
Soc Sci Med. 2002 Jul;55(2):283-99
12144142
Patient Educ Couns. 2002 Sep;48(1):51-61
12220750
Psychol Med. 1978 Nov;8(4):695-704
724878
Arch Intern Med. 1997 Nov 10;157(20):2334-41
9361574
Med Educ. 2002 Nov;36(11):1004-16
12406260
Arch Intern Med. 1999 Oct 11;159(18):2198-205
10527297
Patient Educ Couns. 2000 Jan;39(1):5-15
11013543
JAMA. 2003 Sep 3;290(9):1210-2
12953006
Am J Med. 2007 Oct;120(10):912-5
17904465
Med Teach. 1999;21(6):553-62
21281174
Patient Educ Couns. 2003 Nov;51(3):197-206
14630376
Med Care. 2001 Aug;39(8):813-23
11468500
Patient Educ Couns. 2000 Jan;39(1):27-36
11013545
Cochrane Database Syst Rev. 2001;(4):CD003267
11687181
Hematology Am Soc Hematol Educ Program. 2007;:493-7
18024670
Ann Intern Med. 1984 Nov;101(5):692-6
6486600
J Epidemiol Community Health. 1998 Jun;52(6):377-84
9764259
Med Care. 1985 May;23(5):521-38
4010349
Patient Educ Couns. 2003 May;50(1):27-32
12767581
Ann Fam Med. 2004 Nov-Dec;2(6):595-608
15576546
Soc Sci Med. 2005 Oct;61(7):1516-28
16005784
Am J Psychiatry. 1980 May;137(5):535-44
7369396
Med Care. 2007 Apr;45(4):340-9
17496718
J Fam Pract. 2000 Sep;49(9):796-804
11032203
Soc Sci Med. 2000 Oct;51(7):1087-110
11005395
Science. 1977 Apr 8;196(4286):129-36
847460
Perspect Biol Med. 1973 Autumn;17(1):71-92
4751534
Health Commun. 2006;20(2):123-9
16965249
J Gen Intern Med. 2008 Dec;23(12):2125-30
18830766
Adv Psychosom Med. 1990;20:65-88
2239506
J Gen Intern Med. 2006 Jul;21(7):671-7
16808764
CMAJ. 1995 May 1;152(9):1423-33
7728691
Arch Intern Med. 2008 Jul 14;168(13):1387-95
18625918
Med Educ. 1999 Sep;33(9):655-68
10476016