Mitchell Polly, Cribb Alan, Entwistle Vikki
Centre for Public Policy Research, King's College London, London, SE19NH, UK.
Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
Wellcome Open Res. 2022 Jun 16;7:170. doi: 10.12688/wellcomeopenres.17970.1. eCollection 2022.
Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a 'clear definition and method of measurement,' and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis which is grounded in the body of literature concerning the theory and practice of person-centred care. We consider a range of influential definitional frameworks of person-centred care, highlighting their differences and showing that they do not correspond to a clearly circumscribed and consistent underlying concept. We argue that a degree of indeterminacy and vagueness should not be seen as a problem with the concept of person-centred care; these are features of a rich and contested concept which exists prior to and outside of practical and technical operational definitions and applications. We defend the value of operating with multiple accounts of person-centred care, arguing that what counts as being person-centred can vary across different care contexts, in relation to different patient groups, and as a reflection of different, defensible ethical perspectives. Although the idea of a single, agreed definition is attractive and may seem to be a practical or even necessary step towards meaningful and coordinated action, we argue that this is only the case in a qualified sense. Comprehensive attempts to narrow down the concept in this way should be resisted, as they risk undermining what it is that makes person-centredness a valuable concept in healthcare.
以患者为中心的护理是当代卫生政策、研究和实践的基石。然而，许多研究人员和从业者担心它缺乏“明确的定义和测量方法”，这给以患者为中心的护理的实施带来了问题，并限制了对其益处的理解。在本文中，我们敦促对这种担忧持谨慎态度，并抵制对明确、固定的定义和测量方法的呼吁。我们开展了一项基于有关以患者为中心的护理理论和实践的文献的哲学和概念分析。我们考虑了一系列有影响力的以患者为中心的护理定义框架，突出了它们的差异，并表明它们与一个明确界定且一致的潜在概念并不对应。我们认为，一定程度的不确定性和模糊性不应被视为以患者为中心的护理概念的问题；这些是一个丰富且有争议的概念的特征，它存在于实际和技术操作定义及应用之前和之外。我们捍卫采用多种以患者为中心的护理描述的价值，认为在不同的护理背景下、针对不同的患者群体以及作为不同的、合理的伦理观点的反映，被视为以患者为中心的内容可能会有所不同。尽管单一、商定的定义的想法很有吸引力，似乎是朝着有意义和协调行动迈出的实际甚至必要的一步，但我们认为只是在有限的意义上才是如此。应该抵制以这种方式全面缩小概念范围的尝试，因为它们有可能破坏使以患者为中心成为医疗保健中有价值概念的因素。
