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以患者为中心与家长式作风:与权力共舞

Person-Centredness and Paternalism: The Dance With Power.

作者信息

Noel Clement, Hebron Clair

机构信息

School of Sport and Health Sciences, University of Brighton, Brighton, UK.

出版信息

Musculoskeletal Care. 2025 Mar;23(1):e70032. doi: 10.1002/msc.70032.

Abstract

OBJECTIVE

The World Health Organization advocates for person-centredness (PC) as essential for quality care, yet its definitions and interpretations vary widely among professionals. Most qualitative research on PC focuses on physiotherapists in countries such as the UK, Australia, and the US, where PC is explicitly emphasised. In contrast, the term PC is absent in French educational standards, and its promotion is lacking in the French healthcare system. This study explores French physiotherapists' conceptualisation of PC.

METHODS

This phenomenographic study followed an interpretivist paradigm. Seven physiotherapists practicing in France were purposively selected. Data were collected through remote semi-structured interviews, transcribed verbatim, and translated into English. The analysis followed the steps outlined by Larsson and Holmström (2007).

FINDINGS

Three categories were generated to illustrate the conceptualisation of PC by participants: Creating a relationship, Adapting the rehabilitation, and Giving the choice. Despite recognising the importance of these aspects, they also highlighted challenges related to paternalism and power dynamics, which often limited trusting relationships, effective adaptations and true shared decision-making.

CONCLUSION

While these physiotherapists expressed a commitment to person-centred practices, they encountered challenges in relinquishing power, highlighting the ongoing journey towards becoming person centred.

摘要

目的

世界卫生组织倡导以患者为中心(PC)是优质护理的关键要素,然而其定义和解释在专业人士中差异很大。大多数关于以患者为中心的定性研究聚焦于英国、澳大利亚和美国等明确强调以患者为中心的国家的物理治疗师。相比之下,法国的教育标准中没有“以患者为中心”这个术语,而且法国医疗体系中也缺乏对它的推广。本研究探讨法国物理治疗师对以患者为中心的概念理解。

方法

本现象学研究遵循解释主义范式。有目的地选取了七位在法国执业的物理治疗师。通过远程半结构化访谈收集数据,逐字转录并翻译成英文。分析过程遵循拉尔森和霍尔姆斯特伦(2007年)概述的步骤。

结果

生成了三个类别来说明参与者对以患者为中心的概念理解:建立关系、调整康复方案以及给予选择。尽管他们认识到这些方面的重要性,但也强调了与家长式作风和权力动态相关的挑战,这些挑战常常限制了信任关系、有效的调整以及真正的共同决策。

结论

虽然这些物理治疗师表示致力于以患者为中心的实践,但他们在放弃权力方面遇到了挑战,这突出了迈向以患者为中心的持续进程。

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Med Health Care Philos. 2023 Sep;26(3):367-384. doi: 10.1007/s11019-023-10150-2. Epub 2023 Apr 17.
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Patient-centeredness in Physiotherapy - A literature mapping review.患者为中心的物理治疗 - 文献制图回顾。
Physiother Theory Pract. 2022 Dec;38(12):1843-1856. doi: 10.1080/09593985.2021.1923095. Epub 2021 Jun 7.
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Conceptualisation of the therapeutic alliance in physiotherapy: is it adequate?物理治疗中治疗联盟的概念化:是否足够?
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