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Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey.

Zill JM, Scholl I, Härter M, Dirmaier J - PLoS ONE (2015)

Bottom Line: In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results.In round two, this dimension did not reach sufficient ratings to be included in the model.Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

ABSTRACT

Background: Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1) validate, and 2) prioritize these dimensions.

Method: A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1) give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria.

Results: 105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median ≥ 7 on both criteria (relevance and clarity). Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment.

Discussion: 11 out of the 15 dimensions have been validated through experts' ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

No MeSH data available.


Model of patient-centeredness [23].The dimensions in the upper square presenting the enablers of patient-centeredness. I In the lower square the principles are shown, which frame the activities of patient-centeredness. The dimensions rated as the top five out of the fifteen dimensions are labeled with the numbers of their ranking of importance. The four dimensions that were rated with a median < 7 on at least one of the criteria (relevance or clarity) are crossed out.
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pone.0141978.g001: Model of patient-centeredness [23].The dimensions in the upper square presenting the enablers of patient-centeredness. I In the lower square the principles are shown, which frame the activities of patient-centeredness. The dimensions rated as the top five out of the fifteen dimensions are labeled with the numbers of their ranking of importance. The four dimensions that were rated with a median < 7 on at least one of the criteria (relevance or clarity) are crossed out.

Mentions: Based on the results of the Delphi survey, we present a revision of the original model including the relevance and clarity rating of the experts in Fig 1. The original model was developed based on a systematic review [22], which was conducted prior to this Delphi study. In this model we aligned the 15 dimensions to three categories namely a) principles, b) enablers, and c) activities. This proposed differentiation showed the interrelation of the dimensions. We found the dimensions patient as a unique person, biopsychosocial perspective, essential characteristics of the clinician and clinician-patient relationship as the underlying principles of a patient-centered care. For the implementation of these principles the patient-centered activities, i.e. patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical and emotional support are needed. Patient-centered care can be further facilitated and implemented through certain enablers that we found in the dimensions continuity of care, clinician-patient communication, integration of medical and non-medical care, teamwork and team building and access to care.


Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey.

Zill JM, Scholl I, Härter M, Dirmaier J - PLoS ONE (2015)

Model of patient-centeredness [23].The dimensions in the upper square presenting the enablers of patient-centeredness. I In the lower square the principles are shown, which frame the activities of patient-centeredness. The dimensions rated as the top five out of the fifteen dimensions are labeled with the numbers of their ranking of importance. The four dimensions that were rated with a median < 7 on at least one of the criteria (relevance or clarity) are crossed out.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4635011&req=5

pone.0141978.g001: Model of patient-centeredness [23].The dimensions in the upper square presenting the enablers of patient-centeredness. I In the lower square the principles are shown, which frame the activities of patient-centeredness. The dimensions rated as the top five out of the fifteen dimensions are labeled with the numbers of their ranking of importance. The four dimensions that were rated with a median < 7 on at least one of the criteria (relevance or clarity) are crossed out.
Mentions: Based on the results of the Delphi survey, we present a revision of the original model including the relevance and clarity rating of the experts in Fig 1. The original model was developed based on a systematic review [22], which was conducted prior to this Delphi study. In this model we aligned the 15 dimensions to three categories namely a) principles, b) enablers, and c) activities. This proposed differentiation showed the interrelation of the dimensions. We found the dimensions patient as a unique person, biopsychosocial perspective, essential characteristics of the clinician and clinician-patient relationship as the underlying principles of a patient-centered care. For the implementation of these principles the patient-centered activities, i.e. patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical and emotional support are needed. Patient-centered care can be further facilitated and implemented through certain enablers that we found in the dimensions continuity of care, clinician-patient communication, integration of medical and non-medical care, teamwork and team building and access to care.

Bottom Line: In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results.In round two, this dimension did not reach sufficient ratings to be included in the model.Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

ABSTRACT

Background: Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1) validate, and 2) prioritize these dimensions.

Method: A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1) give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria.

Results: 105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median ≥ 7 on both criteria (relevance and clarity). Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment.

Discussion: 11 out of the 15 dimensions have been validated through experts' ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

No MeSH data available.