University Health Network and University of Toronto, Toronto, Ontario, Canada.
Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada.
PLoS One. 2019 Nov 8;14(11):e0224507. doi: 10.1371/journal.pone.0224507. eCollection 2019.
Patient-centred care (PCC) improves multiple patient and health system outcomes. However, many patients do not experience PCC, particularly women, who are faced with disparities in care and outcomes globally. The purpose of this study was to identify if and how guidelines address PCC for women (PCCW).
We searched MEDLINE, EMBASE, National Guideline Clearing House, and guideline developer websites for publicly-available, English-language guidelines on depression and cardiac rehabilitation, conditions with known gendered inequities. We used summary statistics to report guideline characteristics, clinical topic, mention of PCC according to McCormack's framework, and mention of women's health considerations. We appraised guideline quality with the AGREE II instrument.
A total of 27 guidelines (18 depression, 9 cardiac rehabilitation) were included. All 27 guidelines mentioned at least one PCC domain (median 3, range 1 to 6), most frequently exchanging information (20, 74.1%), making decisions (20, 74.1%), and enabling patient self-management (21, 77.8%). No guidelines fully addressed PCC: 9 (50.0%) of 18 depression guidelines and 3 (33.3%) of 9 cardiac rehabilitation guidelines addressed 4 or more PCC domains. Even when addressed, guidance was minimal and vague. Among 14 (51.9%) guidelines that mentioned women's health, most referred to social determinants of health; none offered guidance on how to support women impacted by these factors, engage women, or tailor care for women. These findings pertained even to women-specific guidelines. Reported use or type of guideline development process/system did not appear to be linked with PCCW content. Based on quality appraisal with AGREE II, guidelines were either not recommended or recommended with modifications. In particular, the stakeholder involvement AGREE II domain was least addressed, but guidelines that scored higher for stakeholder involvement also appeared to better address PCCW.
This research identified opportunities to generate guidelines that achieve PCCW. Strategies include employing a PCC framework, considering gender issues, engaging women on guideline-writing panels, and including patient-oriented tools in guidelines. Primary research is needed to establish what constitutes PCCW.
以患者为中心的护理（PCC）可改善患者和医疗体系的多项结果。然而，许多患者并未体验到 PCC，尤其是女性，她们在全球范围内面临着护理和结果方面的差异。本研究旨在确定指南是否以及如何针对女性（PCCW）解决以患者为中心的护理问题。
我们检索了 MEDLINE、EMBASE、国家指南清除中心和指南制定者的网站，以获取关于抑郁症和心脏康复的公开的、英文的指南，这两种病症都存在已知的性别不平等问题。我们使用汇总统计数据来报告指南的特征、临床主题、根据 McCormack 框架提及的以患者为中心的护理以及提及女性健康问题。我们使用 AGREE II 工具评估指南的质量。
共纳入 27 项指南（18 项抑郁症，9 项心脏康复）。所有 27 项指南均至少提及了一个以患者为中心的护理领域（中位数为 3，范围为 1 至 6），最常提及的是信息交换（20 项，74.1%）、决策制定（20 项，74.1%）和患者自我管理（21 项，77.8%）。没有指南完全涵盖以患者为中心的护理：18 项抑郁症指南中有 9 项（50.0%）和 9 项心脏康复指南中有 3 项（33.3%）涵盖了 4 个或更多以患者为中心的护理领域。即使有所涉及，指导也非常有限且模糊。在 14 项（51.9%）提及女性健康的指南中，大多数都提到了健康的社会决定因素；但没有提供如何支持受这些因素影响的女性、让女性参与进来或为女性量身定制护理的指导。这些发现甚至适用于专门针对女性的指南。报告的指南使用或类型的指南制定过程/系统似乎与 PCCW 内容无关。根据 AGREE II 的质量评估，这些指南要么不推荐，要么推荐但需修改。特别是，利益相关者参与的 AGREE II 领域最不受重视，但在该领域得分较高的指南似乎也更好地解决了 PCCW 问题。
本研究确定了制定实现以患者为中心的女性护理（PCCW）指南的机会。策略包括采用以患者为中心的护理框架、考虑性别问题、让女性参与到指南制定小组中以及在指南中纳入以患者为导向的工具。需要开展原发性研究来确定什么是 PCCW。
