Review
Patient-centered care in chronic disease management: A thematic analysis of the literature in family medicine

https://doi.org/10.1016/j.pec.2012.01.009Get rights and content

Abstract

Objective

The objective was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.

Methods

We developed search strategies for the Medline, Embase, and Cochrane databases, from 1980 to April 2009. All articles addressing patient-centered care in the context of chronic disease management in family medicine were included. A thematic analysis was performed using mixed codification, based on Stewart's model of patient-centered care.

Results

Thirty-two articles were included. Six major themes emerged: (1) starting from the patient's situation; (2) legitimizing the illness experience; (3) acknowledging the patient's expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system.

Conclusion

The context of chronic disease management brings forward new dimensions of patient-centered care such as legitimizing the illness experience, acknowledging patient expertise, offering hope and providing advocacy.

Practice implications

Chronic disease management calls for the adaptation of the family physician's role to patients’ fluctuating needs. Literature also suggests the involvement of the family physician in care transitions as a component of patient-centered care.

Introduction

Chronic diseases represent a major health burden worldwide [1]. Experience with chronic diseases implies that the patient, along with having to adopt improved health behaviors, is faced with having to make major adaptations to its repercussions and the daily management of the disease. As many people affected by chronic diseases frequently interact with a family physician [2], [3], [4], this professional is in a privileged position to play a significant role in their lives.

Patient-centered care is widely acknowledged as a core value in patient–physician interactions [1], [5]. Stewart et al. played a major role in the conceptualization of patient-centered care in family medicine. Their patient-centered care model, initially developed in the 1980s [6], [7], [8] and described later in 1995 in the first edition of their book [9], is now the most cited in family medicine [10], [11], [12], [13], [14]. This framework is taught in family medicine residency programs across Canada [15]. Much patient-centered care evidence in family medicine relies on Stewart et al.’s model [10], [16], [17] that proposes six dimensions: (1) exploring both the disease and the illness experience; (2) understanding the whole person; (3) finding common ground; (4) incorporating prevention and health promotion; (5) enhancing the patient–physician relationship and (6) being realistic.

Several recent studies have focused on patient-centered care in the specific context of patients affected by chronic diseases [18], [19], [20], [21], [22]. Some have suggested components of patient-centered care that go beyond Stewart et al.’s model, such as notions of hope [22] or engaging patient expertise [18]. Therefore, the aim of this research was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.

Section snippets

Search methods

We conducted an electronic literature search for English and French articles spanning the 1980 to April 2009 period in Medline (1980–), Embase (1980–), and Cochrane (1991–). An information specialist developed and ran the specific strategies for each database (Appendix A). The following MeSH terms and keywords were used: “patient-centered care” or its linguistic variants and, “family practice,” or “primary health care,” or “primary medical care,” or “primary care”. To broaden the scope of our

Included studies

Fig. 1 shows the number of references found at each stage of the selection process. The search strategies identified 1745 references, of which 1565 were kept after removing duplicates. The majority of these references were excluded by reading the abstract, as they clearly did not meet our inclusion criteria. One hundred five papers were read completely. References found through hand searching (n = 4) were also included, for a total of 109 potentially eligible references. Of these 109 articles, 77

Discussion

This thematic analysis of the literature is the first attempt to integrate theoretical and empirical literature on patient-centered care in chronic disease management in family medicine, building on Stewart et al.’s model. The four main dimensions of their model emerged from our analysis and were regrouped under broader themes and refined to account for chronic disease realities. For instance, considering the significant prevalence of multimorbidity in primary care practices [54], [55], [56],

Funding

This research received financial support from the Canadian Health Services Research Foundation (CHSRF) through the Research, Exchange and Impact for System Support (REISS) competition.

Conflict of interest

The authors declare that they have no competing interests.

Acknowledgement

The authors would like to thank Ms. Susie Bernier for her editorial assistance.

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