Sladdin I, Ball L, Bull C, Chaboyer W
Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.
J Hum Nutr Diet. 2017 Aug;30(4):453-470. doi: 10.1111/jhn.12444. Epub 2017 Jan 26.
Patient-centred care (PCC) is associated with significant improvements in patients' health outcomes and healthcare systems. There is an opportunity to better understand PCC in dietetics. Thus, the present integrative review aims to critically synthesise literature relating to PCC in dietetics.
A systematic literature search was conducted between February and March 2016. Studies were included if they (i) involved dietitians and/or patients who had participated in an individual dietetic consultation; (ii) related to one or more components of PCC; and (iii) were empirical full-text studies in English, involving adult participants, published between 1997 and 2016. Following title and abstract screening, full texts were retrieved and independently assessed for inclusion by two of the investigators. Two independent investigators conducted data extraction and quality assessment using the Mixed Methods Appraisal Tool. Study findings were analysed thematically using meta-synthesis. Twenty-seven studies met the inclusion criteria.
Six themes were discovered inductively: (i) establishing a positive dietitian-patient relationship; (ii) displaying humanistic behaviours; (iii) using effective communication skills; (iv) individualising and adapting care; (v) redistributing power to the patient; and (vi) lacking time for PCC practices. The first three themes were closely related. Studies used a broad range of methodological designs. Limitations of the studies included a lack of reflexivity and a lack of representativeness of the study population.
It is apparent that dietitians require good communication skills and humanistic qualities to build positive relationships with patients. Patients strongly desire individualised nutrition care and greater involvement in care. Ensuring dietitians are able to incorporate patient-centred practises during care requires further research.
以患者为中心的护理（PCC）与患者健康结局及医疗保健系统的显著改善相关。在营养学领域，存在更好地理解PCC的机会。因此，本整合性综述旨在批判性地综合与营养学中PCC相关的文献。
于2016年2月至3月进行了系统的文献检索。纳入的研究需满足以下条件：（i）涉及营养师和/或参与过个体营养咨询的患者；（ii）与PCC的一个或多个组成部分相关；（iii）为1997年至2016年间发表的、涉及成年参与者的英文实证性全文研究。在进行标题和摘要筛选后，检索全文并由两名研究者独立评估是否纳入。两名独立研究者使用混合方法评估工具进行数据提取和质量评估。研究结果采用元综合法进行主题分析。27项研究符合纳入标准。
归纳出六个主题：（i）建立积极的营养师 - 患者关系；（ii）展现人文行为；（iii）运用有效的沟通技巧；（iv）个性化和调整护理；（v）将权力重新分配给患者；（vi）缺乏进行PCC实践的时间。前三个主题密切相关。研究采用了广泛的方法设计。研究的局限性包括缺乏反思性以及研究人群缺乏代表性。
显然，营养师需要良好的沟通技巧和人文素养来与患者建立积极的关系。患者强烈渴望个性化的营养护理以及更多地参与护理。确保营养师能够在护理过程中融入以患者为中心的实践需要进一步研究。
