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Patient-centered care: Is there a state of the art?

Date and Location

Session: 

P2.100

Date

Saturday 21 September 2013 - 10:30 - 12:00

Location

Presenting author and contact person

Presenting author

Margaret Holmes-R...

Contact person

Margaret Holmes-R...
Abstract text
Background: A 2012 Cochrane systematic review of patient-centered care (PCC) training by Dwamena et al, shows effectiveness in transferring skills to providers. The review found positive impact on provider skill measures (clarifying patients' concerns and beliefs; communicating about treatment options; levels of empathy; patients' perception of attention to concerns as well as diseases). Meta-analysis showed mixed effects on patient outcomes (satisfaction, health behavior and health status). Objectives: Secondary data analysis to 1) investigate intervention characteristics associated with success and 2) evaluate relative success of shared decision making (SDM) vs. communication skills interventions. Methods: Qualitative analysis of included studies classified interventions by training technique(s) and presence of SDM. Univariate analyses were used to evaluate relationship(s) to patient outcomes. Results: Of 42 trials, all used combinations of readings, presentations, demonstration, role play, standardized patients, small group discussion and/or personal feedback. SDM was present in 20/42. Theoretical models were heterogeneous; all focused on interviewing skills to support active listening. For providers, demonstration was the only training technique positively related to successful transfer of skills. Short training (dichotomized at 10 hrs) was as effective as long among all provider types. and to patient satisfaction (p< .05). Patient satisfaction was associated with inclusion of patient readings, but not inclusion of a decision aid or other problem-specific educational material (included in 17/42 trials). SDM-related skills training was not associated with success. Variable use of terminology for patient education materials (PEMs) limits conclusions. Conclusions: Our results support the published review conclusion that PCC training is successful across trials. No training technique appears critical to success. Brief training is effective and appropriate for health care settings. Further investigation is required to differentiate the impact of SDM vs communication models with and without PEMs.