School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
BMJ Open. 2022 May 2;12(5):e059400. doi: 10.1136/bmjopen-2021-059400.
We aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019?
A scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to identify all peer-reviewed literature published since 1990 that focused on the concept of centredness in any healthcare discipline or setting. Screening occurred in duplicate by a multidisciplinary, multinational team. The team met regularly to iteratively develop and refine a coding template that was used in analysis and discuss the interpretations of centredness reported in the literature.
A total of 23 006 title and abstracts, and 499 full-text articles were screened. A total of 159 articles were included in the review. Most articles were from the USA, and nursing was the disciplinary perspective most represented. We identified nine elements of centredness: Sharing power; Sharing responsibility; Therapeutic relationship/bond/alliance; Patient as a person; Biopsychosocial; Provider as a person; Co-ordinated care; Access; Continuity of care. There was little variation in the concept of centredness no matter the preceding word (eg, patient-/person-/client-), healthcare setting or disciplinary lens. Improving health outcomes was the most common justification for pursuing centredness as a concept, and respect was the predominant driving value of the research efforts. The patient perspective was rarely included in the papers (15% of papers).
Centredness is consistently conceptualised, regardless of the preceding word, disciplinary lens or nation of origin. Further research should focus on centring the patient perspective and prioritise research that considers more diverse cultural perspectives.
我们旨在确定医疗保健文献中以患者为中心的核心要素。我们的总体研究问题是：1990 年至 2019 年期间发表的健康文献中如何体现以患者为中心？
通过对五个数据库（Medline（Ovid）、PsycINFO、CINAHL、Embase（Ovid）和 Scopus）进行范围界定综述，以确定自 1990 年以来发表的所有关注任何医疗保健学科或环境中以患者为中心概念的同行评审文献。由一个多学科、多国团队进行重复筛选。该团队定期开会，迭代开发和完善用于分析的编码模板，并讨论文献中报告的以患者为中心的解释。
共筛选出 23006 篇标题和摘要，以及 499 篇全文文章。共有 159 篇文章被纳入综述。大多数文章来自美国，护理是代表性最强的学科视角。我们确定了以患者为中心的九个要素：共享权力；分担责任；治疗关系/纽带/联盟；患者作为人；生物心理社会；提供者作为人；协调护理；获得护理；护理连续性。无论前面的词是什么（例如，患者/人/客户-），医疗保健环境或学科视角如何，以患者为中心的概念都没有太大变化。将以患者为中心作为一个概念来提高健康结果是最常见的理由，而尊重是研究工作的主要驱动价值。患者视角很少在论文中体现（15%的论文）。
以患者为中心的概念始终是一致的，无论前面的词、学科视角或国家来源如何。进一步的研究应关注以患者为中心的视角，并优先考虑考虑更多不同文化视角的研究。
